MIO Laborbefund
Version 1.0.0-update - ci-build

Resource Profile: KBV_PR_MIO_LAB_Observation_Laboratory_Study - Detailed Descriptions

Draft as of 2026-06-11

Definitions for the KBV-PR-MIO-LAB-Observation-Laboratory-Study resource profile.

Guidance on how to interpret the contents of this table can be foundhere

0. Observation
Definition

Dieses Profil bildet eine Laboruntersuchung ab.

Laboruntersuchungen können als Messung oder als Berechnung erfolgen.

Eine Laboruntersuchung als Messung beschreibt die quantitative oder qualitative Untersuchung eines spezifischen Laborparameters in einem definierten Probenmaterial; z. B. die Untersuchung des Hämoglobin-(Hb-)Werts als Konzentration im Blut. Der Bezug zur Probe, anhand derer die Messung vorgenommen wurde, muss erkennbar sein.

Berechnete Laborergebnisse können auf Messungen basieren, z.B. kann die berechnete GFR (glomeruläre Filtrationsrate) auf einem gemessenen Kreatinin-Wert im Serum basieren.


Measurements and simple assertions made about a patient, device or other subject.

ShortMeasurements and simple assertions
Comments

Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesVital Signs, Measurement, Results, Tests
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty())
obs-code-1: For Observation.code either a coding or a data absent reason must be provided. When stating a data absent reason, a text for Observation.code must be provided as well. (code.coding.empty() or code.extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').empty() and (code.extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists() implies code.text.exists()))
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty())
2. Observation.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Control0..1
TypeMeta
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Observation.meta.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..01
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
6. Observation.meta.versionId
Definition

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

ShortVersion specific identifier
Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

Control0..1
Typeid
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Observation.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

ShortWhen the resource version last changed
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Control0..1
Typeinstant
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Observation.meta.source
Definition

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.


A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

ShortIdentifies where the resource comes from
Comments

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

Control0..01
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Observation.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..01
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. Observation.language
Definition

The base language in which the resource is written.

ShortLanguage of the resource content
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Control0..01
BindingThe codes SHOULD be taken from CommonLanguageshttp://hl7.org/fhir/ValueSet/languages|4.0.1
(preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. Observation.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Control0..0*
TypeResource
Is Modifierfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
18. Observation.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Must Supporttrue
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Observation.extension. The slices areUnordered and ClosedOpen, and can be differentiated using the following discriminators:
  • value @ url
  • 20. Observation.extension:externalService
    Slice NameexternalService
    Definition

    Dieses Kennzeichen wird gesetzt, wenn die Laboruntersuchung von einem anderen Labor durchgeführt wird.

    ShortKennzeichen Fremdleistung
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(KBV_EX_MIO_LAB_External_Service) (Extension Type: boolean)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    22. Observation.extension:externalService.extension
    Definition

    An Extension


    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortExtensionAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..0*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 24. Observation.extension:externalService.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_External_Service
      26. Observation.extension:externalService.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control10..1
      Typeboolean, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Observation.extension:associationService
      Slice NameassociationService
      Definition

      Dieses Kennzeichen wird gesetzt, wenn die "Fremdleistung" von einem anderen Labor aus dem eigenen Verbund durchgeführt wird und diese Information aus administrativen Gründen zusätzlich benötigt wird.

      ShortKennzeichen Verbundleistung
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(KBV_EX_MIO_LAB_Association_Service) (Extension Type: boolean)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      30. Observation.extension:associationService.extension
      Definition

      An Extension


      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortExtensionAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..0*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 32. Observation.extension:associationService.url
        Definition

        Source of the definition for the extension code - a logical name or a URL.

        Shortidentifies the meaning of the extension
        Comments

        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Association_Service
        34. Observation.extension:associationService.value[x]
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortValue of extension
        Control10..1
        Typeboolean, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, Expression, Signature, unsignedInt, time
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Observation.extension:accreditedService
        Slice NameaccreditedService
        Definition

        Diese Angabe betrifft akkreditierte Labore. Basierend auf der Akkreditierung ist gefordert, dass nicht akkreditierte Leistungen gekennzeichnet werden, auch im Laborbefund.

        ShortKennzeichen Akkreditierte Laboruntersuchung
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(KBV_EX_MIO_LAB_Accredited_Service) (Extension Type: boolean)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        38. Observation.extension:accreditedService.extension
        Definition

        An Extension


        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortExtensionAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..0*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 40. Observation.extension:accreditedService.url
          Definition

          Source of the definition for the extension code - a logical name or a URL.

          Shortidentifies the meaning of the extension
          Comments

          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

          Control1..1
          Typeuri
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Accredited_Service
          42. Observation.extension:accreditedService.value[x]
          Definition

          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

          ShortValue of extension
          Control10..1
          Typeboolean, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, Expression, Signature, unsignedInt, time
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          44. Observation.extension:zlogValue
          Slice NamezlogValue
          Definition

          Der zlog-Wert ist ein Relativwert, der auf einer logarithmischen Skala angibt, um wie viele Standardabweichungen ein Messwert vom Mittelwert des Referenzkollektivs abweicht. Er kann ergänzend, orientierend zur Bewertung eines Messergebnisses herangezogen werden.

          Berechnung zlog-Wert zum Laborergebnis (x):

          zlog = (log(x) –(log(UG)+log(OG))/2)*3,92/(log(OG)–log(UG))

          (UG),(OG) sind die Unter- und Obergrenzen des Referenzintervalls

          Interpretation des zlog-Wertes:

          • Sein Referenzintervall liegt methodenunabhängig stets zwischen – 1,96 und + 1,96
          • Stark erniedrigte oder erhöhte Laborergebnisse führen zu zlog-Werten um – 5 bzw. + 5.
          ShortExtension
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(KBV_EX_MIO_LAB_zlog) (Extension Type: decimal)
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          46. Observation.extension:zlogValue.extension
          Definition

          An Extension


          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortExtensionAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..0*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 48. Observation.extension:zlogValue.url
            Definition

            Source of the definition for the extension code - a logical name or a URL.

            Shortidentifies the meaning of the extension
            Comments

            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_zlog
            50. Observation.extension:zlogValue.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control10..1
            Typedecimal, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. Observation.extension:alternativeResult
            Slice NamealternativeResult
            Definition

            Hier werden auf eine alternative Einheit umgerechnete Messergebnisse mitgeführt.

            Dies betrifft das quantitative Messergebnis, sowie die Richtgrenzenwerte und die zlog-Wert-Berechnung. Aus diesem Grund sind deren Strukturen hier (noch einmal) enthalten.

            ShortExtension
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(KBV_EX_MIO_LAB_Alternative_Result) (Complex Extension)
            Is Modifierfalse
            Must Supporttrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            54. Observation.extension:alternativeResult.extension
            Definition

            An Extension


            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortExtensionAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control10..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 56. Observation.extension:alternativeResult.extension:value
              Slice Namevalue
              Definition

              Hier wird ein Messergebnis mit Alternativeinheit angegeben.

              ShortMessergebnis quantitativ mit AlternativeinheitAdditional content defined by implementations
              Control10..1*
              TypeExtension
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              58. Observation.extension:alternativeResult.extension:value.extension
              Definition

              An Extension


              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortExtensionAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..0*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on Observation.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 60. Observation.extension:alternativeResult.extension:value.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                Fixed Valuevalue
                62. Observation.extension:alternativeResult.extension:value.value[x]
                Definition

                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                ShortValue of extension
                Control10..1
                TypeChoice of: Quantity, Range, Ratio, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Age, Reference, TriggerDefinition, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Observation.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                • type @ $this
                • 64. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity
                  Slice NamevalueQuantity
                  Definition

                  Hier wird der Ergebniswert als Quantität mit Alternativeinheit angegeben.


                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                  ShortErgebniswert mit AlternativeinheitValue of extension
                  Control0..1
                  TypeQuantity, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Pattern Value{
                    "system" : "http://unitsofmeasure.org"
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  66. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.value
                  Definition

                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                  ShortNumerical value (with implicit precision)
                  Comments

                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                  Control10..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Precision is handled implicitly in almost all cases of measurement.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  68. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.comparator
                  Definition

                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                  Short< | <= | >= | > - how to understand the value
                  Control0..1
                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Typecode
                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  70. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.unit
                  Definition

                  A human-readable form of the unit.

                  ShortUnit representation
                  Control10..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  72. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.system
                  Definition

                  The identification of the system that provides the coded form of the unit.

                  ShortSystem that defines coded unit form
                  Control10..1
                  This element is affected by the following invariants: qty-3
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to know the system that defines the coded form of the unit.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  74. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.code
                  Definition

                  A computer processable form of the unit in some unit representation system.

                  ShortCoded form of the unit
                  Comments

                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  76. Observation.extension:alternativeResult.extension:value.value[x]:valueRange
                  Slice NamevalueRange
                  Definition

                  Hier wird das Ergebnis als ein Wertebereich/Werteintervall mit Alternativeinheit angegeben.


                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                  ShortErgebnisbereich mit AlternativeinheitValue of extension
                  Control0..1
                  TypeRange, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  78. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low
                  Definition

                  The low limit. The boundary is inclusive.

                  ShortLow limit
                  Comments

                  If the low element is missing, the low boundary is not known.

                  Control0..1
                  TypeQuantity(SimpleQuantity)
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Pattern Value{
                    "system" : "http://unitsofmeasure.org"
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  80. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.value
                  Definition

                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                  ShortNumerical value (with implicit precision)
                  Comments

                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                  Control10..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Precision is handled implicitly in almost all cases of measurement.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  82. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.comparator
                  Definition

                  Not allowed to be used in this context


                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                  Short< | <= | >= | > - how to understand the value
                  Control0..01
                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Typecode
                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  84. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.unit
                  Definition

                  A human-readable form of the unit.

                  ShortUnit representation
                  Control10..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  86. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.system
                  Definition

                  The identification of the system that provides the coded form of the unit.

                  ShortSystem that defines coded unit form
                  Control10..1
                  This element is affected by the following invariants: qty-3
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to know the system that defines the coded form of the unit.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  88. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.code
                  Definition

                  A computer processable form of the unit in some unit representation system.

                  ShortCoded form of the unit
                  Comments

                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  90. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high
                  Definition

                  The high limit. The boundary is inclusive.

                  ShortHigh limit
                  Comments

                  If the high element is missing, the high boundary is not known.

                  Control0..1
                  TypeQuantity(SimpleQuantity)
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Pattern Value{
                    "system" : "http://unitsofmeasure.org"
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  92. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.value
                  Definition

                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                  ShortNumerical value (with implicit precision)
                  Comments

                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                  Control10..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Precision is handled implicitly in almost all cases of measurement.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  94. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.comparator
                  Definition

                  Not allowed to be used in this context


                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                  Short< | <= | >= | > - how to understand the value
                  Control0..01
                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Typecode
                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  96. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.unit
                  Definition

                  A human-readable form of the unit.

                  ShortUnit representation
                  Control10..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  98. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.system
                  Definition

                  The identification of the system that provides the coded form of the unit.

                  ShortSystem that defines coded unit form
                  Control10..1
                  This element is affected by the following invariants: qty-3
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to know the system that defines the coded form of the unit.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  100. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.code
                  Definition

                  A computer processable form of the unit in some unit representation system.

                  ShortCoded form of the unit
                  Comments

                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  102. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio
                  Slice NamevalueRatio
                  Definition

                  Hier wird der Ergebniswert als Ratio mit Alternativeinheiten angegeben.


                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                  ShortRatio mit AlternativeinheitValue of extension
                  Control0..1
                  TypeRatio, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  104. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator
                  Definition

                  The value of the numerator.

                  ShortNumerator value
                  Control10..1
                  TypeQuantity
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Pattern Value{
                    "system" : "http://unitsofmeasure.org"
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  106. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.value
                  Definition

                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                  ShortNumerical value (with implicit precision)
                  Comments

                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                  Control10..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Precision is handled implicitly in almost all cases of measurement.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  108. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.comparator
                  Definition

                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                  Short< | <= | >= | > - how to understand the value
                  Control0..1
                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Typecode
                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  110. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.unit
                  Definition

                  A human-readable form of the unit.

                  ShortUnit representation
                  Control10..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  112. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.system
                  Definition

                  The identification of the system that provides the coded form of the unit.

                  ShortSystem that defines coded unit form
                  Control10..1
                  This element is affected by the following invariants: qty-3
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to know the system that defines the coded form of the unit.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  114. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.code
                  Definition

                  A computer processable form of the unit in some unit representation system.

                  ShortCoded form of the unit
                  Comments

                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  116. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator
                  Definition

                  The value of the denominator.

                  ShortDenominator value
                  Control10..1
                  TypeQuantity
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Pattern Value{
                    "system" : "http://unitsofmeasure.org"
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  118. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.value
                  Definition

                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                  ShortNumerical value (with implicit precision)
                  Comments

                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                  Control10..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Precision is handled implicitly in almost all cases of measurement.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  120. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.comparator
                  Definition

                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                  Short< | <= | >= | > - how to understand the value
                  Control0..1
                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Typecode
                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  122. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.unit
                  Definition

                  A human-readable form of the unit.

                  ShortUnit representation
                  Control10..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  124. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.system
                  Definition

                  The identification of the system that provides the coded form of the unit.

                  ShortSystem that defines coded unit form
                  Control10..1
                  This element is affected by the following invariants: qty-3
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to know the system that defines the coded form of the unit.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  126. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.code
                  Definition

                  A computer processable form of the unit in some unit representation system.

                  ShortCoded form of the unit
                  Comments

                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  128. Observation.extension:alternativeResult.extension:referenceRange
                  Slice NamereferenceRange
                  Definition

                  Richtgrenzen für das quantitative Ergebnis mit Alternativeinheit.

                  ShortRichtgrenzen für AlternativeinheitAdditional content defined by implementations
                  Control0..1*
                  TypeExtension
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  130. Observation.extension:alternativeResult.extension:referenceRange.extension
                  Definition

                  An Extension


                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortExtensionAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..0*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on Observation.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 132. Observation.extension:alternativeResult.extension:referenceRange.url
                    Definition

                    Source of the definition for the extension code - a logical name or a URL.

                    Shortidentifies the meaning of the extension
                    Comments

                    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                    Control1..1
                    Typeuri
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    Fixed ValuereferenceRange
                    134. Observation.extension:alternativeResult.extension:referenceRange.value[x]
                    Definition

                    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                    ShortValue of extension
                    Control10..1
                    TypeRange, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    136. Observation.extension:alternativeResult.extension:referenceRange.value[x].low
                    Definition

                    The low limit. The boundary is inclusive.

                    ShortLow limit
                    Comments

                    If the low element is missing, the low boundary is not known.

                    Control0..1
                    TypeQuantity(SimpleQuantity)
                    Is Modifierfalse
                    Must Supporttrue
                    Summarytrue
                    Pattern Value{
                      "system" : "http://unitsofmeasure.org"
                    }
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    138. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.value
                    Definition

                    The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                    ShortNumerical value (with implicit precision)
                    Comments

                    The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                    Control10..1
                    Typedecimal
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Precision is handled implicitly in almost all cases of measurement.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    140. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.comparator
                    Definition

                    Not allowed to be used in this context


                    How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                    Short< | <= | >= | > - how to understand the value
                    Control0..01
                    BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                    (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                    How the Quantity should be understood and represented.

                    Typecode
                    Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                    Meaning if MissingIf there is no comparator, then there is no modification of the value
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    142. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.unit
                    Definition

                    A human-readable form of the unit.

                    ShortUnit representation
                    Control10..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    144. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.system
                    Definition

                    The identification of the system that provides the coded form of the unit.

                    ShortSystem that defines coded unit form
                    Control10..1
                    This element is affected by the following invariants: qty-3
                    Typeuri
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Need to know the system that defines the coded form of the unit.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    146. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.code
                    Definition

                    A computer processable form of the unit in some unit representation system.

                    ShortCoded form of the unit
                    Comments

                    The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                    Control10..1
                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    148. Observation.extension:alternativeResult.extension:referenceRange.value[x].high
                    Definition

                    The high limit. The boundary is inclusive.

                    ShortHigh limit
                    Comments

                    If the high element is missing, the high boundary is not known.

                    Control0..1
                    TypeQuantity(SimpleQuantity)
                    Is Modifierfalse
                    Must Supporttrue
                    Summarytrue
                    Pattern Value{
                      "system" : "http://unitsofmeasure.org"
                    }
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    150. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.value
                    Definition

                    The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                    ShortNumerical value (with implicit precision)
                    Comments

                    The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                    Control10..1
                    Typedecimal
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Precision is handled implicitly in almost all cases of measurement.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    152. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.comparator
                    Definition

                    Not allowed to be used in this context


                    How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                    Short< | <= | >= | > - how to understand the value
                    Control0..01
                    BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                    (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                    How the Quantity should be understood and represented.

                    Typecode
                    Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                    Meaning if MissingIf there is no comparator, then there is no modification of the value
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    154. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.unit
                    Definition

                    A human-readable form of the unit.

                    ShortUnit representation
                    Control10..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    156. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.system
                    Definition

                    The identification of the system that provides the coded form of the unit.

                    ShortSystem that defines coded unit form
                    Control10..1
                    This element is affected by the following invariants: qty-3
                    Typeuri
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Need to know the system that defines the coded form of the unit.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    158. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.code
                    Definition

                    A computer processable form of the unit in some unit representation system.

                    ShortCoded form of the unit
                    Comments

                    The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                    Control10..1
                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    160. Observation.extension:alternativeResult.extension:zlog
                    Slice Namezlog
                    Definition

                    Der zlog-Wert ist ein Relativwert, der auf einer logarithmischen Skala angibt, um wie viele Standardabweichungen ein Messwert vom Mittelwert des Referenzkollektivs abweicht. Er kann ergänzend, orientierend zur Bewertung eines Messergebnisses herangezogen werden.

                    Berechnung zlog-Wert zum Laborergebnis (x):

                    zlog = (log(x) –(log(UG)+log(OG))/2)*3,92/(log(OG)–log(UG))

                    (UG),(OG) sind die Unter- und Obergrenzen des Referenzintervalls

                    Interpretation des zlog-Wertes:

                    • Sein Referenzintervall liegt methodenunabhängig stets zwischen – 1,96 und + 1,96
                    • Stark erniedrigte oder erhöhte Laborergebnisse führen zu zlog-Werten um – 5 bzw. + 5.
                    ShortExtensionAdditional content defined by implementations
                    Control0..1*
                    TypeExtension
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    162. Observation.extension:alternativeResult.extension:zlog.extension
                    Definition

                    An Extension


                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortExtensionAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..0*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    SlicingThis element introduces a set of slices on Observation.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 164. Observation.extension:alternativeResult.extension:zlog.url
                      Definition

                      Source of the definition for the extension code - a logical name or a URL.

                      Shortidentifies the meaning of the extension
                      Comments

                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                      Control1..1
                      Typeuri
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      Fixed Valuezlog
                      166. Observation.extension:alternativeResult.extension:zlog.value[x]
                      Definition

                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                      ShortValue of extension
                      Control10..1
                      Typedecimal, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      168. Observation.extension:alternativeResult.url
                      Definition

                      Source of the definition for the extension code - a logical name or a URL.

                      Shortidentifies the meaning of the extension
                      Comments

                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                      Control1..1
                      Typeuri
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Alternative_Result
                      170. Observation.extension:alternativeResult.value[x]
                      Definition

                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                      ShortValue of extension
                      Control0..01
                      TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      172. Observation.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                      Summaryfalse
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      174. Observation.identifier
                      Definition

                      A unique identifier assigned to this observation.

                      ShortBusiness Identifier for observation
                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      Control0..2*
                      TypeIdentifier
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      Allows observations to be distinguished and referenced.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on Observation.identifier. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                      • value @ type
                      • 176. Observation.identifier:resultID
                        Slice NameresultID
                        Definition

                        Eindeutige ID zur Identifizierung der jeweiligen einzelnen Laboruntersuchung. Sie wird durch das auftragnehmende Laboratorium generiert.


                        A unique identifier assigned to this observation.

                        ShortBusiness Identifier for observation
                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        Control0..1*
                        TypeIdentifier
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Allows observations to be distinguished and referenced.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        178. Observation.identifier:resultID.use
                        Definition

                        The purpose of this identifier.

                        Shortusual | official | temp | secondary | old (If known)
                        Comments

                        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                        Control0..01
                        BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
                        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                        Identifies the purpose for this identifier, if known .

                        Typecode
                        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        180. Observation.identifier:resultID.type
                        Definition

                        A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                        ShortDescription of identifier
                        Comments

                        This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                        Control10..1
                        BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type|4.0.1
                        (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                        A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Allows users to make use of identifiers when the identifier system is not known.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                            "code" : "OBI",
                            "display" : "Observation Instance Identifier"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        182. Observation.identifier:resultID.type.coding
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                        Control10..1*
                        TypeCoding
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Allows for alternative encodings within a code system, and translations to other code systems.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        184. Observation.identifier:resultID.type.coding.system
                        Definition

                        The identification of the code system that defines the meaning of the symbol in the code.

                        ShortIdentity of the terminology system
                        Comments

                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                        Control10..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to be unambiguous about the source of the definition of the symbol.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        186. Observation.identifier:resultID.type.coding.version
                        Definition

                        The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                        ShortVersion of the system - if relevant
                        Comments

                        Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                        NoteThis is a business version Id, not a resource version Id (see discussion)
                        Control10..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        188. Observation.identifier:resultID.type.coding.code
                        Definition

                        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                        ShortSymbol in syntax defined by the system
                        Control10..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        190. Observation.identifier:resultID.type.coding.display
                        Definition

                        A representation of the meaning of the code in the system, following the rules of the system.

                        ShortRepresentation defined by the system
                        Control10..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        192. Observation.identifier:resultID.type.coding.userSelected
                        Definition

                        Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                        ShortIf this coding was chosen directly by the user
                        Comments

                        Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                        Control0..01
                        Typeboolean
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        194. Observation.identifier:resultID.type.text
                        Definition

                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                        ShortPlain text representation of the concept
                        Comments

                        Very often the text is the same as a displayName of one of the codings.

                        Control0..01
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        196. Observation.identifier:resultID.system
                        Definition

                        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                        ShortThe namespace for the identifier value
                        Comments

                        Identifier.system is always case sensitive.

                        Control0..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                        ExampleGeneral: http://www.acme.com/identifiers/patient
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        198. Observation.identifier:resultID.value
                        Definition

                        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                        ShortThe value that is unique
                        Comments

                        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        ExampleGeneral: 123456
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        200. Observation.identifier:resultID.period
                        Definition

                        Time period during which identifier is/was valid for use.

                        ShortTime period when id is/was valid for use
                        Control0..01
                        TypePeriod
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        202. Observation.identifier:resultID.assigner
                        Definition

                        Organization that issued/manages the identifier.

                        ShortOrganization that issued id (may be just text)
                        Comments

                        The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                        Control0..01
                        TypeReference(Organization)
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        204. Observation.identifier:GTIN
                        Slice NameGTIN
                        Definition

                        Mit der GTIN (kurz für Global Trade Item Number ) kann jeder Artikel, jedes Produkt oder jede Produktvariante weltweit überschneidungsfrei identifiziert werden. Sie fungiert als Zugriffsschlüssel auf in Datenbanken hinterlegte Produktinformationen. Die GTIN ist gleichzeitig die Basis für den Barcode (auch bekannt als Strichcode). Über den Barcode wird sie maschinenlesbar und kann per Scanner automatisch ausgelesen werden.

                        Verwendung im Kontext Laborbefund: für die Darstellung von Laboruntersuchungen kann die GTIN herangezogen werden, um die Vergleichbarkeit von Tests zu validieren.


                        A unique identifier assigned to this observation.

                        ShortBusiness Identifier for observation
                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        Control0..1*
                        TypeIdentifier
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Allows observations to be distinguished and referenced.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        206. Observation.identifier:GTIN.use
                        Definition

                        The purpose of this identifier.

                        Shortusual | official | temp | secondary | old (If known)
                        Comments

                        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                        Control0..01
                        BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
                        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                        Identifies the purpose for this identifier, if known .

                        Typecode
                        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        208. Observation.identifier:GTIN.type
                        Definition

                        A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                        ShortDescription of identifier
                        Comments

                        This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                        Control10..1
                        BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type|4.0.1
                        (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                        A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Allows users to make use of identifiers when the identifier system is not known.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                            "code" : "UDI",
                            "display" : "Universal Device Identifier"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        210. Observation.identifier:GTIN.type.coding
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                        Control10..1*
                        TypeCoding
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Allows for alternative encodings within a code system, and translations to other code systems.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        212. Observation.identifier:GTIN.type.coding.system
                        Definition

                        The identification of the code system that defines the meaning of the symbol in the code.

                        ShortIdentity of the terminology system
                        Comments

                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                        Control10..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to be unambiguous about the source of the definition of the symbol.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        214. Observation.identifier:GTIN.type.coding.version
                        Definition

                        The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                        ShortVersion of the system - if relevant
                        Comments

                        Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                        NoteThis is a business version Id, not a resource version Id (see discussion)
                        Control10..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        216. Observation.identifier:GTIN.type.coding.code
                        Definition

                        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                        ShortSymbol in syntax defined by the system
                        Control10..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        218. Observation.identifier:GTIN.type.coding.display
                        Definition

                        A representation of the meaning of the code in the system, following the rules of the system.

                        ShortRepresentation defined by the system
                        Control10..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        220. Observation.identifier:GTIN.type.coding.userSelected
                        Definition

                        Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                        ShortIf this coding was chosen directly by the user
                        Comments

                        Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                        Control0..01
                        Typeboolean
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        222. Observation.identifier:GTIN.type.text
                        Definition

                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                        ShortPlain text representation of the concept
                        Comments

                        Very often the text is the same as a displayName of one of the codings.

                        Control0..01
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        224. Observation.identifier:GTIN.system
                        Definition

                        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                        ShortThe namespace for the identifier value
                        Comments

                        Identifier.system is always case sensitive.

                        Control0..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                        ExampleGeneral: http://www.acme.com/identifiers/patient
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        226. Observation.identifier:GTIN.value
                        Definition

                        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                        ShortThe value that is unique
                        Comments

                        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        ExampleGeneral: 123456
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        228. Observation.identifier:GTIN.period
                        Definition

                        Time period during which identifier is/was valid for use.

                        ShortTime period when id is/was valid for use
                        Control0..01
                        TypePeriod
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        230. Observation.identifier:GTIN.assigner
                        Definition

                        Organization that issued/manages the identifier.

                        ShortOrganization that issued id (may be just text)
                        Comments

                        The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                        Control0..01
                        TypeReference(Organization)
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        232. Observation.basedOn
                        Definition

                        A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.

                        ShortFulfills plan, proposal or order
                        Control0..0*
                        TypeReference(CarePlan, DeviceRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

                        Alternate NamesFulfills
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        234. Observation.partOf
                        Definition

                        A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.

                        ShortPart of referenced event
                        Comments

                        To link an Observation to an Encounter use encounter. See the Notes below for guidance on referencing another Observation.

                        Control0..0*
                        TypeReference(MedicationAdministration, MedicationDispense, MedicationStatement, Procedure, Immunization, ImagingStudy)
                        Is Modifierfalse
                        Summarytrue
                        Alternate NamesContainer
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        236. Observation.status
                        Definition

                        Bearbeitungsstatus der einzelnen Laboruntersuchung. Die Status-Werte orientieren sich an HL7® FHIR® Version 4.0.1, jedoch wurde der Wert "unknown" aufgrund von Nichtverwendung herausgenommen.


                        The status of the result value.

                        Shortregistered | preliminary | final | amended +
                        Comments

                        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                        Control1..1
                        BindingThe codes SHALL be taken from ObservationStatushttp://hl7.org/fhir/ValueSet/observation-status|4.0.1
                        (required to http://hl7.org/fhir/ValueSet/observation-status|4.0.1)

                        Codes providing the status of an observation.

                        Typecode
                        Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to track the status of individual results. Some results are finalized before the whole report is finalized.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        238. Observation.category
                        Definition

                        Zur einzelnen Laboruntersuchung wird das "fachliche Gruppierungsmerkmal" REDUNDANT abgebildet, der Inhalt entspricht exakt dem fachlichen Gruppierungsmerkmal der zugehörigen Untersuchungsgruppe. Dies ermöglicht bei datenbankbasierten Abfragen von Einzeluntersuchungen (z.B. in der ePA) eine direkte Zuordnung zur fachlichen Gruppierung. Das fachliche Gruppierungsmerkmal der Untersuchungsgruppe ist grundsätzlich führend!


                        A code that classifies the general type of observation being made.

                        ShortFachliche Bezeichnung für die zugehörige Untersuchungsgruppe, Inhalt identisch zu Observation_Laboratory_Study_Group.categoryClassification of type of observation
                        Comments

                        In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                        Control10..3*
                        BindingThe codes SHOULD be taken from ObservationCategoryCodeshttp://hl7.org/fhir/ValueSet/observation-category|4.0.1
                        (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                        Codes for high level observation categories.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Used for filtering what observations are retrieved and displayed.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                        • value @ extension.value
                        • 240. Observation.category:laboratory
                          Slice Namelaboratory
                          Definition

                          A code that classifies the general type of observation being made.

                          ShortClassification of type of observation
                          Comments

                          In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                          Control10..1*
                          BindingThe codes SHOULD be taken from ObservationCategoryCodeshttp://hl7.org/fhir/ValueSet/observation-category|4.0.1
                          (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                          Codes for high level observation categories.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Used for filtering what observations are retrieved and displayed.

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
                              "code" : "laboratory"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          242. Observation.category:laboratory.extension
                          Definition

                          An Extension


                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortExtensionAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control10..*
                          TypeExtension
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and ClosedOpen, and can be differentiated using the following discriminators:
                          • value @ url
                          • 244. Observation.category:laboratory.extension:laboratory
                            Slice Namelaboratory
                            Definition

                            Diese Extension dient als Unterscheidungsmerkmal für den Diskriminator

                            ShortExtension
                            Control1..1
                            TypeExtension(KBV_EX_MIO_LAB_Diskriminator) (Extension Type: string)
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            246. Observation.category:laboratory.extension:laboratory.extension
                            Definition

                            An Extension


                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortExtensionAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..0*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on Observation.category.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 248. Observation.category:laboratory.extension:laboratory.url
                              Definition

                              Source of the definition for the extension code - a logical name or a URL.

                              Shortidentifies the meaning of the extension
                              Comments

                              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                              Control1..1
                              Typeuri
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Diskriminator
                              250. Observation.category:laboratory.extension:laboratory.value[x]
                              Definition

                              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                              ShortValue of extension
                              Control10..1
                              Typestring, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summaryfalse
                              Pattern Valuelaboratory
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              252. Observation.category:laboratory.coding
                              Definition

                              A reference to a code defined by a terminology system.

                              ShortCode defined by a terminology system
                              Comments

                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                              Control0..*
                              TypeCoding
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              Allows for alternative encodings within a code system, and translations to other code systems.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              254. Observation.category:laboratory.coding.system
                              Definition

                              The identification of the code system that defines the meaning of the symbol in the code.

                              ShortIdentity of the terminology system
                              Comments

                              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                              Control10..1
                              Typeuri
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              Need to be unambiguous about the source of the definition of the symbol.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              256. Observation.category:laboratory.coding.version
                              Definition

                              The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                              ShortVersion of the system - if relevant
                              Comments

                              Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                              NoteThis is a business version Id, not a resource version Id (see discussion)
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              258. Observation.category:laboratory.coding.code
                              Definition

                              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                              ShortSymbol in syntax defined by the system
                              Control10..1
                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              Need to refer to a particular code in the system.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              260. Observation.category:laboratory.coding.display
                              Definition

                              A representation of the meaning of the code in the system, following the rules of the system.

                              ShortRepresentation defined by the system
                              Control10..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              262. Observation.category:laboratory.coding.userSelected
                              Definition

                              Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                              ShortIf this coding was chosen directly by the user
                              Comments

                              Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                              Control0..01
                              Typeboolean
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              264. Observation.category:laboratory.text
                              Definition

                              A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                              ShortPlain text representation of the concept
                              Comments

                              Very often the text is the same as a displayName of one of the codings.

                              Control0..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              266. Observation.category:studyType
                              Slice NamestudyType
                              Definition

                              Hier kann die fachspezifische Eingrenzung innerhalb der Laboratoriumsmedizin anhand entsprechender Kategorie-Codes angegeben werden. Beispiele für eine fachspezifische Eingrenzung sind: "Klinische Chemie", "Hämatologie", "Serologie", "Toxikologie", "Urindiagnostik", "Fertilitätsdiagnostik". Es besteht auch die Option, eine allgemeine Kategorie für "Labor" zu vergeben.


                              A code that classifies the general type of observation being made.

                              ShortBezeichnung für Fachbereich, unter dem Laboruntersuchungen gruppiert werden, Inhalt identisch zu Observation_Laboratory_Study_Group.category:studyTypeClassification of type of observation
                              Comments

                              In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                              Control0..1*
                              BindingThe codes SHOULD be taken from ObservationCategoryCodeshttp://hl7.org/fhir/ValueSet/observation-category|4.0.1
                              (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                              Codes for high level observation categories.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              Used for filtering what observations are retrieved and displayed.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              268. Observation.category:studyType.extension
                              Definition

                              An Extension


                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortExtensionAdditional content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control10..*
                              TypeExtension
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and ClosedOpen, and can be differentiated using the following discriminators:
                              • value @ url
                              • 270. Observation.category:studyType.extension:studyType
                                Slice NamestudyType
                                Definition

                                Diese Extension dient als Unterscheidungsmerkmal für den Diskriminator

                                ShortExtension
                                Control1..1
                                TypeExtension(KBV_EX_MIO_LAB_Diskriminator) (Extension Type: string)
                                Is Modifierfalse
                                Must Supporttrue
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                272. Observation.category:studyType.extension:studyType.extension
                                Definition

                                An Extension


                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortExtensionAdditional content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..0*
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                SlicingThis element introduces a set of slices on Observation.category.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 274. Observation.category:studyType.extension:studyType.url
                                  Definition

                                  Source of the definition for the extension code - a logical name or a URL.

                                  Shortidentifies the meaning of the extension
                                  Comments

                                  The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                  Control1..1
                                  Typeuri
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Diskriminator
                                  276. Observation.category:studyType.extension:studyType.value[x]
                                  Definition

                                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                  ShortValue of extension
                                  Control10..1
                                  Typestring, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Summaryfalse
                                  Pattern ValuestudyType
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  278. Observation.category:studyType.coding
                                  Definition

                                  Benennung des labormedizinischen Bereiches als Code.


                                  A reference to a code defined by a terminology system.

                                  ShortCode defined by a terminology system
                                  Comments

                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                  Control0..*
                                  TypeCoding
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  Requirements

                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  SlicingThis element introduces a set of slices on Observation.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ $this
                                  • 280. Observation.category:studyType.coding.system
                                    Definition

                                    The identification of the code system that defines the meaning of the symbol in the code.

                                    ShortIdentity of the terminology system
                                    Comments

                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                    Control10..1
                                    Typeuri
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Need to be unambiguous about the source of the definition of the symbol.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    282. Observation.category:studyType.coding.code
                                    Definition

                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                    ShortSymbol in syntax defined by the system
                                    Control10..1
                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Need to refer to a particular code in the system.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    284. Observation.category:studyType.coding.display
                                    Definition

                                    A representation of the meaning of the code in the system, following the rules of the system.

                                    ShortRepresentation defined by the system
                                    Control10..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    286. Observation.category:studyType.coding:loinc
                                    Slice Nameloinc
                                    Definition

                                    LOINC®-Code für Fachbereich/Spezialgebiet der Labormedizin


                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                    Control0..1*
                                    BindingFor example codes, see For codes, see KBV_VS_MIO_LAB_Laboratory_Specialties_LOINC (1.0.0-update)
                                    (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Laboratory_Specialties_LOINC|1.0.0-update)
                                    TypeCoding
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                    Pattern Value{
                                      "system" : "http://loinc.org"
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    288. Observation.category:studyType.coding:loinc.system
                                    Definition

                                    The identification of the code system that defines the meaning of the symbol in the code.

                                    ShortIdentity of the terminology system
                                    Comments

                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                    Control10..1
                                    Typeuri
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Need to be unambiguous about the source of the definition of the symbol.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    290. Observation.category:studyType.coding:loinc.version
                                    Definition

                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                    ShortVersion of the system - if relevant
                                    Comments

                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                    Control10..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    292. Observation.category:studyType.coding:loinc.code
                                    Definition

                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                    ShortSymbol in syntax defined by the system
                                    Control10..1
                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Need to refer to a particular code in the system.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    294. Observation.category:studyType.coding:loinc.display
                                    Definition

                                    A representation of the meaning of the code in the system, following the rules of the system.

                                    ShortRepresentation defined by the system
                                    Control10..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    296. Observation.category:studyType.coding:loinc.userSelected
                                    Definition

                                    Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                    ShortIf this coding was chosen directly by the user
                                    Comments

                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                    Control0..01
                                    Typeboolean
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    298. Observation.category:studyType.text
                                    Definition

                                    Benennung des labormedizinischen Bereiches als Freitext.


                                    A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                    ShortPlain text representation of the concept
                                    Comments

                                    Very often the text is the same as a displayName of one of the codings.

                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    300. Observation.category:testProfile
                                    Slice NametestProfile
                                    Definition

                                    Unter Test-Profil werden zusammengehörige Labortests oder eine Gruppe von Einzeluntersuchungen aus einem Verfahren zusammengefasst.


                                    A code that classifies the general type of observation being made.

                                    ShortBezeichnung für fachlich-medizinischen Bezug, unter dem Laboruntersuchungen gruppiert werden, Inhalt identisch zu Observation_Laboratory_Study_Group.category:testProfileClassification of type of observation
                                    Comments

                                    In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                                    Control0..1*
                                    BindingThe codes SHOULD be taken from ObservationCategoryCodeshttp://hl7.org/fhir/ValueSet/observation-category|4.0.1
                                    (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                                    Codes for high level observation categories.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Requirements

                                    Used for filtering what observations are retrieved and displayed.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    302. Observation.category:testProfile.extension
                                    Definition

                                    An Extension


                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortExtensionAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control10..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and ClosedOpen, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 304. Observation.category:testProfile.extension:testProfile
                                      Slice NametestProfile
                                      Definition

                                      Diese Extension dient als Unterscheidungsmerkmal für den Diskriminator

                                      ShortExtension
                                      Control1..1
                                      TypeExtension(KBV_EX_MIO_LAB_Diskriminator) (Extension Type: string)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      306. Observation.category:testProfile.extension:testProfile.extension
                                      Definition

                                      An Extension


                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortExtensionAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..0*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      SlicingThis element introduces a set of slices on Observation.category.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 308. Observation.category:testProfile.extension:testProfile.url
                                        Definition

                                        Source of the definition for the extension code - a logical name or a URL.

                                        Shortidentifies the meaning of the extension
                                        Comments

                                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                        Control1..1
                                        Typeuri
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Diskriminator
                                        310. Observation.category:testProfile.extension:testProfile.value[x]
                                        Definition

                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                        ShortValue of extension
                                        Control10..1
                                        Typestring, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summaryfalse
                                        Pattern ValuetestProfile
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        312. Observation.category:testProfile.coding
                                        Definition

                                        Benennung eines Test-Profils als Code.


                                        A reference to a code defined by a terminology system.

                                        ShortCode defined by a terminology system
                                        Comments

                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                        Control0..*
                                        BindingFor example codes, see For codes, see KBV_VS_MIO_LAB_Laboruntersuchungsgruppe (1.0.0-update)
                                        (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Laboruntersuchungsgruppe|1.0.0-update)
                                        TypeCoding
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summarytrue
                                        Requirements

                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        SlicingThis element introduces a set of slices on Observation.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ $this
                                        • 314. Observation.category:testProfile.coding.system
                                          Definition

                                          The identification of the code system that defines the meaning of the symbol in the code.

                                          ShortIdentity of the terminology system
                                          Comments

                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                          Control10..1
                                          Typeuri
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          Need to be unambiguous about the source of the definition of the symbol.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          316. Observation.category:testProfile.coding.version
                                          Definition

                                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                          ShortVersion of the system - if relevant
                                          Comments

                                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          318. Observation.category:testProfile.coding.code
                                          Definition

                                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                          ShortSymbol in syntax defined by the system
                                          Control10..1
                                          Typecode
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          Need to refer to a particular code in the system.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          320. Observation.category:testProfile.coding.display
                                          Definition

                                          A representation of the meaning of the code in the system, following the rules of the system.

                                          ShortRepresentation defined by the system
                                          Control10..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          322. Observation.category:testProfile.coding.userSelected
                                          Definition

                                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                          ShortIf this coding was chosen directly by the user
                                          Comments

                                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                          Control0..01
                                          Typeboolean
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          324. Observation.category:testProfile.text
                                          Definition

                                          Benennung des Test-Profils als Freitext.


                                          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                          ShortPlain text representation of the concept
                                          Comments

                                          Very often the text is the same as a displayName of one of the codings.

                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          326. Observation.code
                                          Definition

                                          Hier wird die konkrete einzelne Laboruntersuchung spezifiziert.


                                          Describes what was observed. Sometimes this is called the observation "name".

                                          ShortType of observation (code / type)
                                          Comments

                                          All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                          Control1..1
                                          BindingFor example codes, see LOINCCodeshttp://hl7.org/fhir/ValueSet/observation-codes|4.0.1
                                          (example to http://hl7.org/fhir/ValueSet/observation-codes|4.0.1)

                                          Codes identifying names of simple observations.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          Knowing what kind of observation is being made is essential to understanding the observation.

                                          Alternate NamesName
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          328. Observation.code.extension:data-absent-reason
                                          Slice Namedata-absent-reason
                                          Definition

                                          Begründung für die Nicht-Vergabe eines LOINC®-Codes zur Laboruntersuchung

                                          ShortGrund für das Nichtvorhandensein eines LOINC®-Codes
                                          Control0..1
                                          TypeExtension(Data Absent Reason) (Extension Type: code)
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          330. Observation.code.extension:data-absent-reason.extension
                                          Definition

                                          An Extension


                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortExtensionAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..0*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          SlicingThis element introduces a set of slices on Observation.code.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 332. Observation.code.extension:data-absent-reason.url
                                            Definition

                                            Source of the definition for the extension code - a logical name or a URL.

                                            Shortidentifies the meaning of the extension
                                            Comments

                                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                            Control1..1
                                            Typeuri
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/data-absent-reason
                                            334. Observation.code.extension:data-absent-reason.value[x]
                                            Definition

                                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                            ShortValue of extension
                                            Control10..1
                                            BindingThe codes SHALL be taken from For codes, see KBV_VS_MIO_LAB_Data_Absent_Reason (1.0.0-update)
                                            (required to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Data_Absent_Reason|1.0.0-update)
                                            Typecode, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            336. Observation.code.coding
                                            Definition

                                            In diesem Element wird ein LOINC®-Code für die Laboruntersuchung angegeben, inklusive Anzeigename (Display Name) sowie Name und Version des Codesystems.

                                            Die Angabe des LOINC®-Codes ist verbindlich. Falls dies nicht möglich ist, muss der Grund für das Nichtvorhandensein eines Codes (DataAbsentReason) angegeben werden.


                                            A reference to a code defined by a terminology system.

                                            ShortCode defined by a terminology system
                                            Comments

                                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                            Control0..1*
                                            TypeCoding
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                            Pattern Value{
                                              "system" : "http://loinc.org"
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            338. Observation.code.coding.system
                                            Definition

                                            The identification of the code system that defines the meaning of the symbol in the code.

                                            ShortIdentity of the terminology system
                                            Comments

                                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                            Control10..1
                                            Typeuri
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

                                            Need to be unambiguous about the source of the definition of the symbol.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            340. Observation.code.coding.version
                                            Definition

                                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                            ShortVersion of the system - if relevant
                                            Comments

                                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                            Control10..1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            342. Observation.code.coding.code
                                            Definition

                                            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                            ShortSymbol in syntax defined by the system
                                            Control10..1
                                            Typecode
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

                                            Need to refer to a particular code in the system.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            344. Observation.code.coding.display
                                            Definition

                                            A representation of the meaning of the code in the system, following the rules of the system.

                                            ShortRepresentation defined by the system
                                            Control10..1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

                                            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            346. Observation.code.coding.userSelected
                                            Definition

                                            Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                            ShortIf this coding was chosen directly by the user
                                            Comments

                                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                            Control0..01
                                            Typeboolean
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Requirements

                                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            348. Observation.code.text
                                            Definition

                                            Die Freitext-Bezeichnung erlaubt es, in den verwendenden/verarbeitenden Systemen den Einrichtungs-spezifischen bzw. Verwender-spezifischen Bezeichner für eine Laboruntersuchung weiterhin zu verwenden.

                                            Für den Fall, dass anstelle des LOINC®-Codes ein Grund für das Nichtvorhandensein eines Codes (DataAbsentReason) vergeben wird, muss die Freitext-Bezeichnung befüllt sein.


                                            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                            ShortVerwender-spezifische (vom Long Common Name des LOINC®-Codes ggf. abweichende) Bezeichnung für die LaboruntersuchungPlain text representation of the concept
                                            Comments

                                            Very often the text is the same as a displayName of one of the codings.

                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

                                            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            350. Observation.subject
                                            Definition

                                            Hier wird die zu behandelnde Person referenziert.


                                            The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

                                            ShortZu behandelnde PersonWho and/or what the observation is about
                                            Comments

                                            One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

                                            Control10..1
                                            TypeReference(KBV_PR_MIO_LAB_Patient, Patient, Group, Device, Location)
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

                                            Observations have no value if you don't know who or what they're about.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            352. Observation.subject.identifier
                                            Definition

                                            An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                            ShortLogical reference, when literal reference is not known
                                            Comments

                                            When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                            When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                            Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                            Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                            NoteThis is a business identifier, not a resource identifier (see discussion)
                                            Control10..1
                                            TypeIdentifier(Identifier-Profil für die 10-stellige Krankenversichertennummer)
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            354. Observation.focus
                                            Definition

                                            The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.

                                            ShortWhat the observation is about, when it is not about the subject of record
                                            Comments

                                            Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.

                                            Control0..0*
                                            TypeReference(Resource)
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            356. Observation.encounter
                                            Definition

                                            The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.

                                            ShortHealthcare event during which this observation is made
                                            Comments

                                            This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

                                            Control0..01
                                            TypeReference(Encounter)
                                            Is Modifierfalse
                                            Summarytrue
                                            Requirements

                                            For some observations it may be important to know the link between an observation and a particular encounter.

                                            Alternate NamesContext
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            358. Observation.effective[x]
                                            Definition

                                            Der Klinische Bezugszeitpunkt ist wichtig, um die Laboruntersuchung im Zeitverlauf einordnen zu können.

                                            Die Redundanz ist beabsichtigt. Es geht darum, einen Zeitpunkt ermitteln zu können, der für Studien-Statistiken als vergleichsrelevant eingestuft wird. Da im klinischen Alltag nicht sicher gestellt ist, dass grundsätzlich und immer der Zeitpunkt der Materialentnahme auch dokumentiert wird, wurde dieser Algorithmus festgelegt, um die Dokumentation eines statistischen relevanten Zeitpunktes zu garantieren:

                                            • WENN der Entnahmezeitpunkt des Probenmaterials angeben ist, so gilt der Entnahmezeitpunkt;
                                            • WENN der Sammelzeitraum-bis angegeben ist, so gilt der bis-Zeitpunkt;
                                            • SONST gilt (hilfsweise) der Laboreingangszeitpunkt: Zeitpunkt des Eingangs der Probe im Labor.

                                            The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.

                                            ShortKlinischer BezugszeitpunktClinically relevant time/time-period for observation
                                            Comments

                                            At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

                                            Control10..1
                                            TypedateTime, Period, Timing, instant
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

                                            Knowing when an observation was deemed true is important to its relevance as well as determining trends.

                                            Alternate NamesOccurrence
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            date-1: Datetime must be at least day, month and year. (($this as dateTime).toString().length() >= 10)
                                            360. Observation.issued
                                            Definition

                                            Zeitstempel oder Zeitangabe zur Dokumentation der einzelnen Laboruntersuchung.


                                            The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.

                                            ShortDokumentationszeitpunktDate/Time this version was made available
                                            Comments

                                            For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.

                                            Control10..1
                                            Typeinstant
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            362. Observation.performer
                                            Definition

                                            Hier wird das durchführende Labor in Bezug auf die einzelne Laboruntersuchung benannt.

                                            Zur Beachtung: im Laborgesamtbefund wird das durchführende Labor (als DiagnosticReport.performer) dokumentiert. Für selbst erbrachte Laborleistungen muss aus Gründen der EU-Kompatibilität auch immer zur Einzeluntersuchung das durchführende Labor (Observation.performer) dokumentiert werden, dieses kann aus dem Laborgesamtbefund abgeleitet werden.

                                            Wenn das auftragnehmende Labor die einzelne Laboruntersuchung nicht in Eigenleistung erbringt sondern an ein Speziallabor weiterleitet, sogenannte Fremdleistung, muss hier das durchführende sekundäre Labor als durchführendes Labor dokumentiert werden.


                                            Who was responsible for asserting the observed value as "true".

                                            ShortWho is responsible for the observation
                                            Control10..*
                                            TypeReference(KBV_PR_MIO_LAB_Practitioner, KBV_PR_MIO_LAB_PractitionerRole, KBV_PR_MIO_LAB_Organization, Practitioner, PractitionerRole, Organization, CareTeam, Patient, RelatedPerson)
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Must Support TypesNo must-support rules about the choice of types/profiles
                                            Summarytrue
                                            Requirements

                                            May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            364. Observation.performer.reference
                                            Definition

                                            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                            ShortLiteral reference, Relative, internal or absolute URL
                                            Comments

                                            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                            Control10..1
                                            This element is affected by the following invariants: ref-1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            366. Observation.value[x]
                                            Definition

                                            Messergebnisse können quantitativ oder qualitativ sein.


                                            The information determined as a result of making the observation, if the information has a simple value.

                                            ShortActual result
                                            Comments

                                            An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                            Control0..1
                                            This element is affected by the following invariants: obs-7
                                            TypeChoice of: Quantity, CodeableConcept, string, Range, Ratio, dateTime, boolean, SampledData, Period, integer, time
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Must Support TypesNo must-support rules about the choice of types/profiles
                                            Summarytrue
                                            Requirements

                                            An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            SlicingThis element introduces a set of slices on Observation.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                            • type @ $this
                                            • 368. Observation.value[x]:valueQuantity
                                              Slice NamevalueQuantity
                                              Definition

                                              Hier wird der Ergebniswert als Quantität angegeben.


                                              The information determined as a result of making the observation, if the information has a simple value.

                                              ShortActual result
                                              Comments

                                              An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                              Control0..1
                                              This element is affected by the following invariants: obs-7
                                              TypeQuantity, dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                              Pattern Value{
                                                "system" : "http://unitsofmeasure.org"
                                              }
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              370. Observation.value[x]:valueQuantity.value
                                              Definition

                                              The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                              ShortNumerical value (with implicit precision)
                                              Comments

                                              The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                              Control10..1
                                              Typedecimal
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              Precision is handled implicitly in almost all cases of measurement.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              372. Observation.value[x]:valueQuantity.comparator
                                              Definition

                                              How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                              Short< | <= | >= | > - how to understand the value
                                              Control0..1
                                              BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                                              (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                              How the Quantity should be understood and represented.

                                              Typecode
                                              Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                              Meaning if MissingIf there is no comparator, then there is no modification of the value
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              374. Observation.value[x]:valueQuantity.unit
                                              Definition

                                              A human-readable form of the unit.

                                              ShortUnit representation
                                              Control10..1
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              376. Observation.value[x]:valueQuantity.system
                                              Definition

                                              The identification of the system that provides the coded form of the unit.

                                              ShortSystem that defines coded unit form
                                              Control10..1
                                              This element is affected by the following invariants: qty-3
                                              Typeuri
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              Need to know the system that defines the coded form of the unit.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              378. Observation.value[x]:valueQuantity.code
                                              Definition

                                              A computer processable form of the unit in some unit representation system.

                                              ShortCoded form of the unit
                                              Comments

                                              The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                              Control10..1
                                              Typecode
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              380. Observation.value[x]:valueCodeableConcept
                                              Slice NamevalueCodeableConcept
                                              Definition

                                              Qualitative Messergebnisse sind - je nach Messgröße oder Skalierung:

                                              Ordinal, d.h. numerische, in der Regel ganzzahlige Ordnungswerte, die den Vergleich (z. B. kleiner als, größer als) ermöglichen oder zur Vergabe einer Punktebewertung ("Benotung") herangezogen werden, beispielsweise eine Schmerzskala (z.B. von 1 bis 10)

                                              Nominal, d.h. Festwerte ohne Rangordnung, beispielsweise in der Mikrobiologie: Krankheitserreger (z.B. Escherichia Coli; Staphylococcus aureus als Bezeichner oder als Code.) oder Angabe zum Nachweis (z.B. vorhanden / nicht vorhanden).


                                              The information determined as a result of making the observation, if the information has a simple value.

                                              ShortQualitatives Messergebnis (z.B. nominal oder ordinal)Actual result
                                              Comments

                                              An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                              Control0..1
                                              This element is affected by the following invariants: obs-7
                                              TypeCodeableConcept, dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, Range
                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              382. Observation.value[x]:valueCodeableConcept.coding
                                              Definition

                                              Qualitatives Messergebnis in codierter Form.


                                              A reference to a code defined by a terminology system.

                                              ShortCode defined by a terminology system
                                              Comments

                                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                              Control0..*
                                              TypeCoding
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              Allows for alternative encodings within a code system, and translations to other code systems.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              SlicingThis element introduces a set of slices on Observation.value[x].coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ $this
                                              • 384. Observation.value[x]:valueCodeableConcept.coding.system
                                                Definition

                                                The identification of the code system that defines the meaning of the symbol in the code.

                                                ShortIdentity of the terminology system
                                                Comments

                                                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                Control10..1
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need to be unambiguous about the source of the definition of the symbol.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                386. Observation.value[x]:valueCodeableConcept.coding.code
                                                Definition

                                                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                ShortSymbol in syntax defined by the system
                                                Control10..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need to refer to a particular code in the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                388. Observation.value[x]:valueCodeableConcept.coding.display
                                                Definition

                                                A representation of the meaning of the code in the system, following the rules of the system.

                                                ShortRepresentation defined by the system
                                                Control10..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                390. Observation.value[x]:valueCodeableConcept.coding:snomed
                                                Slice Namesnomed
                                                Definition

                                                Darstellung des qualitativen Messergebnisses als SNOMED CT®-Code.


                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                Control0..1*
                                                BindingFor example codes, see For codes, see KBV_VS_MIO_LAB_Observation_Laboratory_Study_Value_SNOMED_CT (1.0.0-update)
                                                (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Observation_Laboratory_Study_Value_SNOMED_CT|1.0.0-update)
                                                TypeCoding
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                Pattern Value{
                                                  "system" : "http://snomed.info/sct"
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                392. Observation.value[x]:valueCodeableConcept.coding:snomed.system
                                                Definition

                                                The identification of the code system that defines the meaning of the symbol in the code.

                                                ShortIdentity of the terminology system
                                                Comments

                                                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                Control10..1
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to be unambiguous about the source of the definition of the symbol.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                394. Observation.value[x]:valueCodeableConcept.coding:snomed.version
                                                Definition

                                                The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                ShortVersion of the system - if relevant
                                                Comments

                                                Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                Control10..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                396. Observation.value[x]:valueCodeableConcept.coding:snomed.code
                                                Definition

                                                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                ShortSymbol in syntax defined by the system
                                                Control10..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to refer to a particular code in the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                398. Observation.value[x]:valueCodeableConcept.coding:snomed.display
                                                Definition

                                                A representation of the meaning of the code in the system, following the rules of the system.

                                                ShortRepresentation defined by the system
                                                Control10..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                400. Observation.value[x]:valueCodeableConcept.coding:snomed.userSelected
                                                Definition

                                                Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                ShortIf this coding was chosen directly by the user
                                                Comments

                                                Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                Control0..01
                                                Typeboolean
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                402. Observation.value[x]:valueCodeableConcept.text
                                                Definition

                                                Qualitatives Messergebnis als Freitext.


                                                A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                ShortPlain text representation of the concept
                                                Comments

                                                Very often the text is the same as a displayName of one of the codings.

                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                404. Observation.value[x]:valueRatio
                                                Slice NamevalueRatio
                                                Definition

                                                Eine bisher gebräuchliche Ergebnisdarstellung von Antikörper-Bestimmungen ist der Verdünnungstiter, bei welchem die Antikörper noch nachweisbar sind. Umgangssprachlich häufig nur als "Titer" bezeichnet. Die Titerangabe setzt sich aus zwei ins Verhältnis gesetzten Quantitäten (Zähler, Nenner) zusammen. Wenn zur Ergebnisdarstellung ein Komparator benötigt wird, dann gelten die mathematischen Regeln, beispielsweise ist 1:32 ein kleinerer Wert als 1:16.


                                                The information determined as a result of making the observation, if the information has a simple value.

                                                ShortActual result
                                                Comments

                                                An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                Control0..1
                                                This element is affected by the following invariants: obs-7
                                                TypeRatio, dateTime, boolean, string, SampledData, Quantity, Period, integer, time, Range, CodeableConcept
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                406. Observation.value[x]:valueRatio.numerator
                                                Definition

                                                Hier wird der Zähler zum Ergebniswert Ratio angegeben.


                                                The value of the numerator.

                                                ShortNumerator value
                                                Control10..1
                                                TypeQuantity
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Pattern Value{
                                                  "system" : "http://unitsofmeasure.org"
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                408. Observation.value[x]:valueRatio.numerator.value
                                                Definition

                                                The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                ShortNumerical value (with implicit precision)
                                                Comments

                                                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                Control10..1
                                                Typedecimal
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Precision is handled implicitly in almost all cases of measurement.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                410. Observation.value[x]:valueRatio.numerator.comparator
                                                Definition

                                                How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                Short< | <= | >= | > - how to understand the value
                                                Control0..1
                                                BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                How the Quantity should be understood and represented.

                                                Typecode
                                                Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                412. Observation.value[x]:valueRatio.numerator.unit
                                                Definition

                                                A human-readable form of the unit.

                                                ShortUnit representation
                                                Control10..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                414. Observation.value[x]:valueRatio.numerator.system
                                                Definition

                                                The identification of the system that provides the coded form of the unit.

                                                ShortSystem that defines coded unit form
                                                Control10..1
                                                This element is affected by the following invariants: qty-3
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to know the system that defines the coded form of the unit.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                416. Observation.value[x]:valueRatio.numerator.code
                                                Definition

                                                A computer processable form of the unit in some unit representation system.

                                                ShortCoded form of the unit
                                                Comments

                                                The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                Control10..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                418. Observation.value[x]:valueRatio.denominator
                                                Definition

                                                Hier wird der Nenner zum Ergebniswert Ratio angegeben.


                                                The value of the denominator.

                                                ShortDenominator value
                                                Control10..1
                                                TypeQuantity
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Pattern Value{
                                                  "system" : "http://unitsofmeasure.org"
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                420. Observation.value[x]:valueRatio.denominator.value
                                                Definition

                                                The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                ShortNumerical value (with implicit precision)
                                                Comments

                                                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                Control10..1
                                                Typedecimal
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Precision is handled implicitly in almost all cases of measurement.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                422. Observation.value[x]:valueRatio.denominator.comparator
                                                Definition

                                                How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                Short< | <= | >= | > - how to understand the value
                                                Control0..1
                                                BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                How the Quantity should be understood and represented.

                                                Typecode
                                                Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                424. Observation.value[x]:valueRatio.denominator.unit
                                                Definition

                                                A human-readable form of the unit.

                                                ShortUnit representation
                                                Control10..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                426. Observation.value[x]:valueRatio.denominator.system
                                                Definition

                                                The identification of the system that provides the coded form of the unit.

                                                ShortSystem that defines coded unit form
                                                Control10..1
                                                This element is affected by the following invariants: qty-3
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to know the system that defines the coded form of the unit.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                428. Observation.value[x]:valueRatio.denominator.code
                                                Definition

                                                A computer processable form of the unit in some unit representation system.

                                                ShortCoded form of the unit
                                                Comments

                                                The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                Control10..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                430. Observation.value[x]:valueRange
                                                Slice NamevalueRange
                                                Definition

                                                Für Messergebnisse, die nicht als genau ein Wert, sondern als ein Wertebereich/Werteintervall angegeben werden.


                                                The information determined as a result of making the observation, if the information has a simple value.

                                                ShortActual result
                                                Comments

                                                An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                Control0..1
                                                This element is affected by the following invariants: obs-7
                                                TypeRange, dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, CodeableConcept
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                432. Observation.value[x]:valueRange.low
                                                Definition

                                                Untere Grenze eines Ergebnisbereiches, Ergebnisintervalls. Die Einheiten von Obergrenze und Untergrenze müssen identisch sein.


                                                The low limit. The boundary is inclusive.

                                                ShortLow limit
                                                Comments

                                                If the low element is missing, the low boundary is not known.

                                                Control10..1
                                                TypeQuantity(SimpleQuantity)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Pattern Value{
                                                  "system" : "http://unitsofmeasure.org"
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                434. Observation.value[x]:valueRange.low.value
                                                Definition

                                                The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                ShortNumerical value (with implicit precision)
                                                Comments

                                                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                Control10..1
                                                Typedecimal
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Precision is handled implicitly in almost all cases of measurement.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                436. Observation.value[x]:valueRange.low.comparator
                                                Definition

                                                Not allowed to be used in this context


                                                How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                Short< | <= | >= | > - how to understand the value
                                                Control0..01
                                                BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                How the Quantity should be understood and represented.

                                                Typecode
                                                Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                438. Observation.value[x]:valueRange.low.unit
                                                Definition

                                                A human-readable form of the unit.

                                                ShortUnit representation
                                                Control10..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                440. Observation.value[x]:valueRange.low.system
                                                Definition

                                                The identification of the system that provides the coded form of the unit.

                                                ShortSystem that defines coded unit form
                                                Control10..1
                                                This element is affected by the following invariants: qty-3
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to know the system that defines the coded form of the unit.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                442. Observation.value[x]:valueRange.low.code
                                                Definition

                                                A computer processable form of the unit in some unit representation system.

                                                ShortCoded form of the unit
                                                Comments

                                                The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                Control10..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                444. Observation.value[x]:valueRange.high
                                                Definition

                                                Obere Grenze eines Ergebnisbereiches, Ergebnisintervalls. Die Einheiten von Obergrenze und Untergrenze müssen identisch sein.


                                                The high limit. The boundary is inclusive.

                                                ShortHigh limit
                                                Comments

                                                If the high element is missing, the high boundary is not known.

                                                Control10..1
                                                TypeQuantity(SimpleQuantity)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Pattern Value{
                                                  "system" : "http://unitsofmeasure.org"
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                446. Observation.value[x]:valueRange.high.value
                                                Definition

                                                The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                ShortNumerical value (with implicit precision)
                                                Comments

                                                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                Control10..1
                                                Typedecimal
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Precision is handled implicitly in almost all cases of measurement.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                448. Observation.value[x]:valueRange.high.comparator
                                                Definition

                                                Not allowed to be used in this context


                                                How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                Short< | <= | >= | > - how to understand the value
                                                Control0..01
                                                BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                How the Quantity should be understood and represented.

                                                Typecode
                                                Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                450. Observation.value[x]:valueRange.high.unit
                                                Definition

                                                A human-readable form of the unit.

                                                ShortUnit representation
                                                Control10..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                452. Observation.value[x]:valueRange.high.system
                                                Definition

                                                The identification of the system that provides the coded form of the unit.

                                                ShortSystem that defines coded unit form
                                                Control10..1
                                                This element is affected by the following invariants: qty-3
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to know the system that defines the coded form of the unit.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                454. Observation.value[x]:valueRange.high.code
                                                Definition

                                                A computer processable form of the unit in some unit representation system.

                                                ShortCoded form of the unit
                                                Comments

                                                The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                Control10..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                456. Observation.value[x]:valueString
                                                Slice NamevalueString
                                                Definition

                                                Textergebnis als Freitext. Dieses Feld ist für Beobachtungen vorgesehen, bei denen für das Resultat keine numerischen oder codierten Werte benötigt werden. Beispiele sind qualitative Beschreibungen oder freitextliche Kommentare.


                                                The information determined as a result of making the observation, if the information has a simple value.

                                                ShortErgebnis uncodiert in TextformActual result
                                                Comments

                                                An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                Control0..1
                                                This element is affected by the following invariants: obs-7
                                                Typestring, dateTime, boolean, SampledData, Quantity, Period, Ratio, integer, time, Range, CodeableConcept
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                458. Observation.dataAbsentReason
                                                Definition

                                                Begründung für die Nicht-Verfügbarkeit eines Messergebnisses. Die Angabe eines Messergebnisses ist gefordert ("required"). Wenn kein Messergebnis zur Verfügung steht, wird in der FHIR®-Struktur ein "dataAbsentReason" angegeben. Der Inhalt dieser Begründung soll der System-anwendenden Person angezeigt werden


                                                Provides a reason why the expected value in the element Observation.value[x] is missing.

                                                ShortWhy the result is missing
                                                Comments

                                                Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".

                                                The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

                                                Control0..1
                                                This element is affected by the following invariants: obs-6
                                                BindingUnless not suitable, these codes SHALL be taken from DataAbsentReasonhttp://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1
                                                (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1)

                                                Codes specifying why the result (Observation.value[x]) is missing.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Requirements

                                                For many results it is necessary to handle exceptional values in measurements.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                460. Observation.dataAbsentReason.coding
                                                Definition

                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                Control10..1*
                                                TypeCoding
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                462. Observation.dataAbsentReason.coding.system
                                                Definition

                                                The identification of the code system that defines the meaning of the symbol in the code.

                                                ShortIdentity of the terminology system
                                                Comments

                                                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                Control10..1
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to be unambiguous about the source of the definition of the symbol.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                464. Observation.dataAbsentReason.coding.version
                                                Definition

                                                The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                ShortVersion of the system - if relevant
                                                Comments

                                                Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                466. Observation.dataAbsentReason.coding.code
                                                Definition

                                                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                ShortSymbol in syntax defined by the system
                                                Control10..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to refer to a particular code in the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                468. Observation.dataAbsentReason.coding.display
                                                Definition

                                                A representation of the meaning of the code in the system, following the rules of the system.

                                                ShortRepresentation defined by the system
                                                Control10..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                470. Observation.dataAbsentReason.coding.userSelected
                                                Definition

                                                Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                ShortIf this coding was chosen directly by the user
                                                Comments

                                                Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                Control0..01
                                                Typeboolean
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                472. Observation.dataAbsentReason.text
                                                Definition

                                                A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                ShortPlain text representation of the concept
                                                Comments

                                                Very often the text is the same as a displayName of one of the codings.

                                                Control0..01
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                474. Observation.interpretation
                                                Definition

                                                Medizinisch relevante Bewertung zur einzelnen Laboruntersuchung. Die Interpretation kann als Code und/oder Text vorliegen. Die Angabe einer Interpretation ist optional, bei nicht vorhandener Klassifikation wird hier nichts übermittelt. Empfehlung: eine dokumentierte Interpretation sollte mindestens einen Interpretationscode enthalten.


                                                A categorical assessment of an observation value. For example, high, low, normal.

                                                ShortMedizinische Interpretation des einzelnen LaborergebnissesHigh, low, normal, etc.
                                                Comments

                                                Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                                                Control0..*
                                                BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodeshttp://hl7.org/fhir/ValueSet/observation-interpretation|4.0.1
                                                (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation|4.0.1)

                                                Codes identifying interpretations of observations.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Requirements

                                                For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                Alternate NamesAbnormal Flag
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                476. Observation.interpretation.coding
                                                Definition

                                                Hier kann die Interpretation als codierte Information angegeben werden.


                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                Control0..*
                                                TypeCoding
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                SlicingThis element introduces a set of slices on Observation.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ $this
                                                • 478. Observation.interpretation.coding.system
                                                  Definition

                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                  ShortIdentity of the terminology system
                                                  Comments

                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                  Control10..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  480. Observation.interpretation.coding.code
                                                  Definition

                                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                  ShortSymbol in syntax defined by the system
                                                  Control10..1
                                                  Typecode
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Need to refer to a particular code in the system.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  482. Observation.interpretation.coding.display
                                                  Definition

                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                  ShortRepresentation defined by the system
                                                  Control10..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  484. Observation.interpretation.coding:hl7Interpretation
                                                  Slice Namehl7Interpretation
                                                  Definition

                                                  Für die codierte Interpretation wird eine Auswahl von Interpretationscodes als Option angeboten. Die Nutzung der hinterlegten Codes ist abhängig vom Kontext.


                                                  A reference to a code defined by a terminology system.

                                                  ShortCode defined by a terminology system
                                                  Comments

                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                  Control0..1*
                                                  BindingUnless not suitable, these codes SHALL be taken from For codes, see ObservationInterpretationCodes
                                                  (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)
                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                  Pattern Value{
                                                    "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
                                                  }
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  486. Observation.interpretation.coding:hl7Interpretation.system
                                                  Definition

                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                  ShortIdentity of the terminology system
                                                  Comments

                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                  Control10..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  488. Observation.interpretation.coding:hl7Interpretation.version
                                                  Definition

                                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                  ShortVersion of the system - if relevant
                                                  Comments

                                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  490. Observation.interpretation.coding:hl7Interpretation.code
                                                  Definition

                                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                  ShortSymbol in syntax defined by the system
                                                  Control10..1
                                                  Typecode
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Need to refer to a particular code in the system.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  492. Observation.interpretation.coding:hl7Interpretation.display
                                                  Definition

                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                  ShortRepresentation defined by the system
                                                  Control10..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  494. Observation.interpretation.coding:hl7Interpretation.userSelected
                                                  Definition

                                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                  ShortIf this coding was chosen directly by the user
                                                  Comments

                                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                  Control0..01
                                                  Typeboolean
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  496. Observation.interpretation.coding:snomed
                                                  Slice Namesnomed
                                                  Definition

                                                  Hier kann ein Code aus SNOMED-CT® angegeben werden.


                                                  A reference to a code defined by a terminology system.

                                                  ShortCode defined by a terminology system
                                                  Comments

                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                  Control0..1*
                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                  Pattern Value{
                                                    "system" : "http://snomed.info/sct"
                                                  }
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  498. Observation.interpretation.coding:snomed.system
                                                  Definition

                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                  ShortIdentity of the terminology system
                                                  Comments

                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                  Control10..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  500. Observation.interpretation.coding:snomed.version
                                                  Definition

                                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                  ShortVersion of the system - if relevant
                                                  Comments

                                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                  Control10..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  502. Observation.interpretation.coding:snomed.code
                                                  Definition

                                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                  ShortSymbol in syntax defined by the system
                                                  Control10..1
                                                  Typecode
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Need to refer to a particular code in the system.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  504. Observation.interpretation.coding:snomed.display
                                                  Definition

                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                  ShortRepresentation defined by the system
                                                  Control10..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  506. Observation.interpretation.coding:snomed.userSelected
                                                  Definition

                                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                  ShortIf this coding was chosen directly by the user
                                                  Comments

                                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                  Control0..01
                                                  Typeboolean
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  508. Observation.interpretation.text
                                                  Definition

                                                  Hier kann eine medizinisch relevante Bewertung als Freitext eingegeben werden. Unter Eigenschaften sind mögliche Werte gelistet, die in dieses Feld hineinpassen könnten, beispielsweise ein Textfeld  aus dem LDT zur Interpretation des Ergebnisses.


                                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                  ShortPlain text representation of the concept
                                                  Comments

                                                  Very often the text is the same as a displayName of one of the codings.

                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  510. Observation.note
                                                  Definition

                                                  Die ergänzenden Angaben beziehen sich genau auf diese Einzeluntersuchung. Neben dem Element (Interpretation) ist dieses Feld für weitere, über die rein medizinische Interpretation hinausgehende Kommentierungen gedacht.


                                                  Comments about the observation or the results.

                                                  ShortComments about the observation
                                                  Comments

                                                  May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

                                                  Control0..*
                                                  TypeAnnotation
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Need to be able to provide free text additional information.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  512. Observation.note.author[x]
                                                  Definition

                                                  The individual responsible for making the annotation.

                                                  ShortIndividual responsible for the annotation
                                                  Comments

                                                  Organization is used when there's no need for specific attribution as to who made the comment.

                                                  Control0..01
                                                  TypeChoice of: Reference(Practitioner, Patient, RelatedPerson, Organization), string
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  514. Observation.note.time
                                                  Definition

                                                  Indicates when this particular annotation was made.

                                                  ShortWhen the annotation was made
                                                  Control0..01
                                                  TypedateTime
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  516. Observation.note.text
                                                  Definition

                                                  The text of the annotation in markdown format.

                                                  ShortThe annotation - text content (as markdown)
                                                  Control1..1
                                                  Typemarkdown
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  518. Observation.bodySite
                                                  Definition

                                                  Indicates the site on the subject's body where the observation was made (i.e. the target site).

                                                  ShortObserved body part
                                                  Comments

                                                  Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.

                                                  If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.

                                                  Control0..01
                                                  BindingFor example codes, see SNOMEDCTBodyStructureshttp://hl7.org/fhir/ValueSet/body-site|4.0.1
                                                  (example to http://hl7.org/fhir/ValueSet/body-site|4.0.1)

                                                  Codes describing anatomical locations. May include laterality.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  520. Observation.method
                                                  Definition

                                                  Der LOINC®-Code impliziert über die LOINC®-Achse METHOD bereits eine Untersuchungsmethode, unter der Voraussetzung, dass der Part METHOD einen Wert beinhaltet. Die "Untersuchungsmethode, ergänzende Spezifizierung" kann in Bezug auf die LOINC®-spezifizierte Laboruntersuchung ergänzt werden, falls der Wert für die LOINC®-Achse METHOD nicht ausreichend spezifisch ist oder gar nicht vorhanden ist.

                                                  Ein Beispiel: die Laboruntersuchung (Observation_Laboratory_Study.code) ist mit dem LOINC®-Code 26453-1 "Erythrocytes [#/volume] in Blood" ohne Angabe zur Methode codiert. Als ergänzende Spezifizieruung wird für die Untersuchungsmethode (Observation_Laboratory_Study.method) der SNOMED CT®-Code 702659008 |Automated count| zugeordnet.


                                                  Indicates the mechanism used to perform the observation.

                                                  ShortUntersuchungsmethode, ergänzende Spezifizierung (z.B. postkoordinierend)How it was done
                                                  Comments

                                                  Only used if not implicit in code for Observation.code.

                                                  Control0..1
                                                  BindingFor example codes, see ObservationMethodshttp://hl7.org/fhir/ValueSet/observation-methods|4.0.1
                                                  (example to http://hl7.org/fhir/ValueSet/observation-methods|4.0.1)

                                                  Methods for simple observations.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  522. Observation.method.coding
                                                  Definition

                                                  Hier kann die Untersuchungsmethode als codierte Information angegeben werden.


                                                  A reference to a code defined by a terminology system.

                                                  ShortCode defined by a terminology system
                                                  Comments

                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                  Control0..*
                                                  BindingFor example codes, see For codes, see Untersuchungsmethode SNOMED CT®
                                                  (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Observation_Methods)
                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  524. Observation.method.coding.system
                                                  Definition

                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                  ShortIdentity of the terminology system
                                                  Comments

                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                  Control10..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  526. Observation.method.coding.version
                                                  Definition

                                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                  ShortVersion of the system - if relevant
                                                  Comments

                                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  528. Observation.method.coding.code
                                                  Definition

                                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                  ShortSymbol in syntax defined by the system
                                                  Control10..1
                                                  Typecode
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Need to refer to a particular code in the system.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  530. Observation.method.coding.display
                                                  Definition

                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                  ShortRepresentation defined by the system
                                                  Control10..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  532. Observation.method.coding.userSelected
                                                  Definition

                                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                  ShortIf this coding was chosen directly by the user
                                                  Comments

                                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                  Control0..01
                                                  Typeboolean
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  534. Observation.method.text
                                                  Definition

                                                  Hier kann eine Freitext-Bezeichnung der Untersuchungsmethode notiert werden. Mögliche Verwendung:

                                                  • als Freitextergänzung, wenn die Methode durch die Spezifikation Laboruntersuchung (LOINC® Code: METHOD) nicht ausreichend spezifisch codiert werden kann
                                                  • ersatzweise, wenn zur Untersuchungsmethode auch kein passender SNOMED CT®-Code zugeordnet werden kann
                                                  • als ergänzender, dem SNOMED CT®-Code entsprechender Freitext

                                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                  ShortPlain text representation of the concept
                                                  Comments

                                                  Very often the text is the same as a displayName of one of the codings.

                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  536. Observation.specimen
                                                  Definition

                                                  Eine Laboruntersuchung kann auf einer Primärprobe oder einer weiter verarbeiteten Probe (Sekundärprobe) basieren. Die Zuordnung einer Sekundärprobe zu einer Laboruntersuchung ist dann empfehlenswert, wenn durch die Probenvorbereitung im Labor eine relevante Veränderung des Untersuchungsmaterials erfolgt (z.B. Abtrennung Plasma).

                                                  Ein Beispiel für die Unterscheidung zwischen Primärprobe und Sekundärprobe: als Primärprobe erreicht eine Probenart = Vollblut das Labor. Durch Zentrifugieren im Labor entsteht eine Sekundärprobe mit Probenart = Serum. Die zu analysierende Substanz wird im Serum gemessen.


                                                  The specimen that was used when this observation was made.

                                                  ShortSpecimen used for this observation
                                                  Comments

                                                  Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

                                                  Control0..1
                                                  TypeReference(KBV_PR_MIO_LAB_Specimen, Specimen)
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  538. Observation.specimen.reference
                                                  Definition

                                                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                  ShortLiteral reference, Relative, internal or absolute URL
                                                  Comments

                                                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                  Control10..1
                                                  This element is affected by the following invariants: ref-1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  540. Observation.specimen.type
                                                  Definition

                                                  The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                  The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                  ShortType the reference refers to (e.g. "Patient")
                                                  Comments

                                                  This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                  Control0..01
                                                  BindingUnless not suitable, these codes SHALL be taken from ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types|4.0.1
                                                  (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                  Aa resource (or, for logical models, the URI of the logical model).

                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  542. Observation.specimen.identifier
                                                  Definition

                                                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                  ShortLogical reference, when literal reference is not known
                                                  Comments

                                                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                  Control0..01
                                                  TypeIdentifier
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  544. Observation.specimen.display
                                                  Definition

                                                  Plain text narrative that identifies the resource in addition to the resource reference.

                                                  ShortText alternative for the resource
                                                  Comments

                                                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                  Control0..01
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  546. Observation.device
                                                  Definition

                                                  Hier wird das Gerät bzw. Medizinprodukt referenziert, mit dem die Laboruntersuchung durchgeführt wird.


                                                  The device used to generate the observation data.

                                                  ShortLaboranalysegerät(Measurement) Device
                                                  Comments

                                                  Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

                                                  Control0..1
                                                  TypeReference(KBV_PR_MIO_LAB_Device_Laboratory_Analyzer, Device, DeviceMetric)
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  548. Observation.device.reference
                                                  Definition

                                                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                  ShortLiteral reference, Relative, internal or absolute URL
                                                  Comments

                                                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                  Control10..1
                                                  This element is affected by the following invariants: ref-1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  550. Observation.device.type
                                                  Definition

                                                  The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                  The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                  ShortType the reference refers to (e.g. "Patient")
                                                  Comments

                                                  This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                  Control0..01
                                                  BindingUnless not suitable, these codes SHALL be taken from ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types|4.0.1
                                                  (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                  Aa resource (or, for logical models, the URI of the logical model).

                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  552. Observation.device.identifier
                                                  Definition

                                                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                  ShortLogical reference, when literal reference is not known
                                                  Comments

                                                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                  Control0..01
                                                  TypeIdentifier
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  554. Observation.device.display
                                                  Definition

                                                  Plain text narrative that identifies the resource in addition to the resource reference.

                                                  ShortText alternative for the resource
                                                  Comments

                                                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                  Control0..01
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  556. Observation.referenceRange
                                                  Definition

                                                  Richtgrenzen oder Bewertungsgrenzen zu einer Laboruntersuchung

                                                  • werden herangezogen für die Beurteilung und Einordnung von Messergebnissen
                                                  • sind laborärztliche Entscheidungsgrenzen (mit ggf. juristischer Relevanz)
                                                  • sind ärztliche Entscheidungshilfen im klinischen Allta

                                                  Disclaimer: FHIR® definiert aktuell nur inklusive Richtgrenzen. Für die Praxistauglichkeit besteht aber die Anforderung, auch exklusive Richtgrenzen abbilden zu können. Diese Thematik wurde schon bei HL7® FHIR® platziert, es gibt aber noch keine abschließende Festlegung dazu. Im Informationsmodell sind beide Optionen bereits dargestellt, um diese Anforderung sichtbar zu machen.


                                                  Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two referenceRange elements would be used.

                                                  ShortProvides guide for interpretation
                                                  Comments

                                                  Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                  Control0..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                                                  obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                                                  558. Observation.referenceRange.extension
                                                  Definition

                                                  An Extension


                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortExtensionAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  SlicingThis element introduces a set of slices on Observation.referenceRange.extension. The slices areUnordered and ClosedOpen, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 560. Observation.referenceRange.extension:sourceReferenceRange
                                                    Slice NamesourceReferenceRange
                                                    Definition

                                                    Mögliche Angaben als Quelle für Richtgrenzen können sein:

                                                    • Internationaler Standard
                                                    • Nationaler Standard
                                                    • Literatur
                                                    • Gerätehersteller
                                                    • Beipackzettel
                                                    • Labor-intern
                                                    • nicht angegeben

                                                    Zusätzlich zur Freitextangabe einer LDT-Information ist in FHIR® auch die Codierung möglich (optional).

                                                    ShortQuelle der Richtgrenzen
                                                    Control0..1
                                                    This element is affected by the following invariants: ele-1
                                                    TypeExtension(KBV_EX_MIO_LAB_Source_Reference_Range) (Extension Type: CodeableConcept)
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    562. Observation.referenceRange.extension:sourceReferenceRange.extension
                                                    Definition

                                                    An Extension


                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortExtensionAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..0*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    SlicingThis element introduces a set of slices on Observation.referenceRange.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 564. Observation.referenceRange.extension:sourceReferenceRange.url
                                                      Definition

                                                      Source of the definition for the extension code - a logical name or a URL.

                                                      Shortidentifies the meaning of the extension
                                                      Comments

                                                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                      Control1..1
                                                      Typeuri
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Source_Reference_Range
                                                      566. Observation.referenceRange.extension:sourceReferenceRange.value[x]
                                                      Definition

                                                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                      ShortValue of extension
                                                      Control10..1
                                                      TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      568. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding
                                                      Definition

                                                      A reference to a code defined by a terminology system.

                                                      ShortCode defined by a terminology system
                                                      Comments

                                                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                      Control0..*
                                                      TypeCoding
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

                                                      Allows for alternative encodings within a code system, and translations to other code systems.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      570. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.system
                                                      Definition

                                                      The identification of the code system that defines the meaning of the symbol in the code.

                                                      ShortIdentity of the terminology system
                                                      Comments

                                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                      Control10..1
                                                      Typeuri
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

                                                      Need to be unambiguous about the source of the definition of the symbol.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      572. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.version
                                                      Definition

                                                      The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                      ShortVersion of the system - if relevant
                                                      Comments

                                                      Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      574. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.code
                                                      Definition

                                                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                      ShortSymbol in syntax defined by the system
                                                      Control10..1
                                                      Typecode
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

                                                      Need to refer to a particular code in the system.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      576. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.display
                                                      Definition

                                                      A representation of the meaning of the code in the system, following the rules of the system.

                                                      ShortRepresentation defined by the system
                                                      Control10..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

                                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      578. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.userSelected
                                                      Definition

                                                      Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                      ShortIf this coding was chosen directly by the user
                                                      Comments

                                                      Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                      Control0..01
                                                      Typeboolean
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      580. Observation.referenceRange.extension:sourceReferenceRange.value[x].text
                                                      Definition

                                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                      ShortPlain text representation of the concept
                                                      Comments

                                                      Very often the text is the same as a displayName of one of the codings.

                                                      Control10..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

                                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      582. Observation.referenceRange.extension:noLinearReferenceRange
                                                      Slice NamenoLinearReferenceRange
                                                      Definition

                                                      Kennzeichnung, dass das numerische Ergebnis aus einem NICHT-LINEAREN Wertebereich stammt. Beispiele hierfür sind ganzzahlige Scores oder Titer-Reihen. Umgangssprachlich wird auch von sog. "semiquantitativen" Ergebnissen gesprochen. Seit LOINC® Version 2.76 ist das anhand des LOINC®-Codes offiziell definiert und ablesbar mit Scale = "SemiQn". Das Kennzeichen ist optional und wird vom messenden Labor gesetzt.

                                                      ShortKennzeichen Nicht-linearer Referenzbereich
                                                      Control0..1
                                                      This element is affected by the following invariants: ele-1
                                                      TypeExtension(KBV_EX_MIO_LAB_No_Linear_Reference_Range) (Extension Type: boolean)
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      584. Observation.referenceRange.extension:noLinearReferenceRange.extension
                                                      Definition

                                                      An Extension


                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortExtensionAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..0*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      SlicingThis element introduces a set of slices on Observation.referenceRange.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 586. Observation.referenceRange.extension:noLinearReferenceRange.url
                                                        Definition

                                                        Source of the definition for the extension code - a logical name or a URL.

                                                        Shortidentifies the meaning of the extension
                                                        Comments

                                                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                        Control1..1
                                                        Typeuri
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_No_Linear_Reference_Range
                                                        588. Observation.referenceRange.extension:noLinearReferenceRange.value[x]
                                                        Definition

                                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                        ShortValue of extension
                                                        Control10..1
                                                        Typeboolean, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, Expression, Signature, unsignedInt, time
                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        590. Observation.referenceRange.modifierExtension
                                                        Definition

                                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                        ShortExtensions that cannot be ignored even if unrecognized
                                                        Comments

                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                        Control0..*
                                                        TypeExtension
                                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                        Summarytrue
                                                        Requirements

                                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                        Alternate Namesextensions, user content, modifiers
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                        592. Observation.referenceRange.low
                                                        Definition

                                                        Die untere Richtgrenze ist eine quantitative Grenze. Datentyp und Einheit entsprechen denen beim quantitativen Messergebnis. Unter Eigenschaften sind mögliche Werte gelistet, die in dieses Feld hineinpassen könnten, beispielsweise ein Grenzwert aus dem LDT. Bei diesen Beispielen aus dem LDT gilt es zu beachten, dass die Grenzwerte nur für eine Richtgrenze vom Typ "normal" gelten.

                                                        Disclaimer: FHIR® definiert aktuell nur inklusive Richtgrenzen. Für die Praxistauglichkeit besteht aber die Anforderung, auch exklusive Richtgrenzen abbilden zu können. Diese Thematik wurde schon bei HL7® FHIR® platziert, es gibt aber noch keine abschließende Festlegung dazu. Im Informationsmodell sind beide Optionen bereits dargestellt, um diese Anforderung sichtbar zu machen.


                                                        The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).

                                                        ShortLow Range, if relevant
                                                        Control0..1
                                                        This element is affected by the following invariants: obs-3
                                                        TypeQuantity(SimpleQuantity)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summaryfalse
                                                        Pattern Value{
                                                          "system" : "http://unitsofmeasure.org"
                                                        }
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        594. Observation.referenceRange.low.value
                                                        Definition

                                                        Numerischer Wert für eine gemessene Größe, eine Zahl mit optionalen Dezimalstellen.


                                                        The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                        ShortNumerical value (with implicit precision)
                                                        Comments

                                                        The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                        Control10..1
                                                        Typedecimal
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Precision is handled implicitly in almost all cases of measurement.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        596. Observation.referenceRange.low.comparator
                                                        Definition

                                                        Not allowed to be used in this context


                                                        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                        Short< | <= | >= | > - how to understand the value
                                                        Control0..01
                                                        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                        How the Quantity should be understood and represented.

                                                        Typecode
                                                        Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        598. Observation.referenceRange.low.unit
                                                        Definition

                                                        Die Einheit leitet sich aus der Messgröße (gemessene Eigenschaft und Mengenmaß) ab. Ein Beispiel: Wenn die Messgröße "Massekonzentration pro Volumen" ist, kommen als Einheiten mg/dl oder g/dl in Frage. Nur UCUM-Einheiten sind zulässig.

                                                        Nicht immer werden Richtgrenzen mit Einheiten angegeben. Ein typisches Bespiel hierfür: zum Immunitätsnachweis aus einer Probe werden Verdünnungsreihen von 1:2, 1:4, 1:8, 1:16, 1:32 usw. hergestellt. Die Verdünnungen gibt man auf Zellkulturen, die dann mit einem Virus infiziert werden. Die höchste Verdünnungsstufe, bei der noch eine Infektion der Zellen vollständig verhindert wird, also noch ausreichend Antikörper vorhanden sind, wird als Titer angegeben. Dieser Titer wird ohne Einheiten angeben.


                                                        A human-readable form of the unit.

                                                        ShortUnit representation
                                                        Control10..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        600. Observation.referenceRange.low.system
                                                        Definition

                                                        The identification of the system that provides the coded form of the unit.

                                                        ShortSystem that defines coded unit form
                                                        Control10..1
                                                        This element is affected by the following invariants: qty-3
                                                        Typeuri
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need to know the system that defines the coded form of the unit.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        602. Observation.referenceRange.low.code
                                                        Definition

                                                        A computer processable form of the unit in some unit representation system.

                                                        ShortCoded form of the unit
                                                        Comments

                                                        The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                        Control10..1
                                                        Typecode
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        604. Observation.referenceRange.high
                                                        Definition

                                                        Die obere Richtgrenze ist eine quantitative Grenze. Datentyp und Einheit entsprechen denen beim quantitativen Messergebnis. Unter Eigenschaften sind mögliche Werte gelistet, die in dieses Feld hineinpassen könnten, beispielsweise ein Grenzwert aus dem LDT. Bei diesen Beispielen aus dem LDT gilt es zu beachten, dass die Grenzwerte nur für eine Richtgrenze vom Typ "normal" gelten.

                                                        Disclaimer: FHIR® definiert aktuell nur inklusive Richtgrenzen. Für die Praxistauglichkeit besteht aber die Anforderung, auch exklusive Richtgrenzen abbilden zu können. Diese Thematik wurde schon bei HL7® FHIR® platziert, es gibt aber noch keine abschließende Festlegung dazu. Im Informationsmodell sind beide Optionen bereits dargestellt, um diese Anforderung sichtbar zu machen.


                                                        The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).

                                                        ShortHigh Range, if relevant
                                                        Control0..1
                                                        This element is affected by the following invariants: obs-3
                                                        TypeQuantity(SimpleQuantity)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summaryfalse
                                                        Pattern Value{
                                                          "system" : "http://unitsofmeasure.org"
                                                        }
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        606. Observation.referenceRange.high.value
                                                        Definition

                                                        Numerischer Wert für eine gemessene Größe, eine Zahl mit optionalen Dezimalstellen.


                                                        The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                        ShortNumerical value (with implicit precision)
                                                        Comments

                                                        The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                        Control10..1
                                                        Typedecimal
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Precision is handled implicitly in almost all cases of measurement.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        608. Observation.referenceRange.high.comparator
                                                        Definition

                                                        Not allowed to be used in this context


                                                        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                        Short< | <= | >= | > - how to understand the value
                                                        Control0..01
                                                        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                        How the Quantity should be understood and represented.

                                                        Typecode
                                                        Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        610. Observation.referenceRange.high.unit
                                                        Definition

                                                        Die Einheit leitet sich aus der Messgröße (gemessene Eigenschaft und Mengenmaß) ab. Ein Beispiel: Wenn die Messgröße "Massekonzentration pro Volumen" ist, kommen als Einheiten mg/dl oder g/dl in Frage. Nur UCUM-Einheiten sind zulässig.

                                                        Nicht immer werden Richtgrenzen mit Einheiten angegeben. Ein typisches Bespiel hierfür: zum Immunitätsnachweis aus einer Probe werden Verdünnungsreihen von 1:2, 1:4, 1:8, 1:16, 1:32 usw. hergestellt. Die Verdünnungen gibt man auf Zellkulturen, die dann mit einem Virus infiziert werden. Die höchste Verdünnungsstufe, bei der noch eine Infektion der Zellen vollständig verhindert wird, also noch ausreichend Antikörper vorhanden sind, wird als Titer angegeben. Dieser Titer wird ohne Einheiten angeben.


                                                        A human-readable form of the unit.

                                                        ShortUnit representation
                                                        Control10..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        612. Observation.referenceRange.high.system
                                                        Definition

                                                        The identification of the system that provides the coded form of the unit.

                                                        ShortSystem that defines coded unit form
                                                        Control10..1
                                                        This element is affected by the following invariants: qty-3
                                                        Typeuri
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need to know the system that defines the coded form of the unit.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        614. Observation.referenceRange.high.code
                                                        Definition

                                                        A computer processable form of the unit in some unit representation system.

                                                        ShortCoded form of the unit
                                                        Comments

                                                        The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                        Control10..1
                                                        Typecode
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        616. Observation.referenceRange.type
                                                        Definition

                                                        Die Typisierung von Richtgrenzen bezieht sich auf die Indikation einer Laboruntersuchung. Beispiele sind:

                                                        • Referenzbereich, zur Feststellung oder Ausschluss von Erkrankungen
                                                        • Therapeutischer Bereich, zur Einstellung einer medikamentösen Therapie
                                                        • Zielbereich, zur Kontrolle medizinischer Maßnahmen
                                                        • Perzentilen (z. B. circannuale 2,5-97,5, als 95% eines gesunden Kollektivs)
                                                        • Erwartungsbereiche aufgrund endokrinologischer Konstitution

                                                        Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.

                                                        ShortReference range qualifier
                                                        Comments

                                                        This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.

                                                        Control10..1
                                                        BindingThe codes SHOULD be taken from ObservationReferenceRangeMeaningCodeshttp://hl7.org/fhir/ValueSet/referencerange-meaning|4.0.1
                                                        (preferred to http://hl7.org/fhir/ValueSet/referencerange-meaning|4.0.1)

                                                        Code for the meaning of a reference range.

                                                        TypeCodeableConcept
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summaryfalse
                                                        Requirements

                                                        Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        618. Observation.referenceRange.type.coding
                                                        Definition

                                                        Hier wird der Richtgrenzen-Typ in codierter Form angegeben.

                                                        Für die codierte Richtgrenzen-Typisierung wird eine Auswahl von HL7®-Codes als (bevorzugte) Option angeboten. Die Nutzung der hinterlegten Codes ist abhängig vom Kontext.


                                                        A reference to a code defined by a terminology system.

                                                        ShortCode defined by a terminology system
                                                        Comments

                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                        Control0..*
                                                        TypeCoding
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        620. Observation.referenceRange.type.coding.system
                                                        Definition

                                                        The identification of the code system that defines the meaning of the symbol in the code.

                                                        ShortIdentity of the terminology system
                                                        Comments

                                                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                        Control10..1
                                                        Typeuri
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need to be unambiguous about the source of the definition of the symbol.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        622. Observation.referenceRange.type.coding.version
                                                        Definition

                                                        The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                        ShortVersion of the system - if relevant
                                                        Comments

                                                        Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                        NoteThis is a business version Id, not a resource version Id (see discussion)
                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        624. Observation.referenceRange.type.coding.code
                                                        Definition

                                                        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                        ShortSymbol in syntax defined by the system
                                                        Control10..1
                                                        Typecode
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need to refer to a particular code in the system.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        626. Observation.referenceRange.type.coding.display
                                                        Definition

                                                        A representation of the meaning of the code in the system, following the rules of the system.

                                                        ShortRepresentation defined by the system
                                                        Control10..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        628. Observation.referenceRange.type.coding.userSelected
                                                        Definition

                                                        Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                        ShortIf this coding was chosen directly by the user
                                                        Comments

                                                        Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                        Control0..01
                                                        Typeboolean
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        630. Observation.referenceRange.type.text
                                                        Definition

                                                        Hier wird der Richtgrenzen-Typ als Freitext eingegeben.


                                                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                        ShortPlain text representation of the concept
                                                        Comments

                                                        Very often the text is the same as a displayName of one of the codings.

                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        632. Observation.referenceRange.appliesTo
                                                        Definition

                                                        Die Ermittlung von "Normwerten" basiert üblicherweise auf 95% eines gesunden Erwachsenen-Kollektivs. Normwerte sind Grenzwerte, die sich auf ein „Normalkollektiv“ beziehen. Als Normalkollektiv wird definiert: „gesunde“ PatientInnen ohne erhöhtes Risiko. Es kann spezifische Richtgrenzen für andere Kollektive geben. Mögliche Unterscheidungen sind:

                                                        • nach Alter
                                                        • nach klinisch-relevantem Geschlecht (divers, männlich, weiblich)
                                                        • nach Konstitution/Merkmal
                                                        • nach körperlichem Zustand

                                                        Beispielsweise:

                                                        • Biologisch weiblich (female-typical)
                                                        • Biologisch männlich (male-typical)
                                                        • Weiblich, postmenopausal
                                                        • Erwachsene, männlich, 30-50 Jahre
                                                        • Raucher
                                                        • Kind (Beginn des 4. bis zum vollendeten 12. Lebensjahr)

                                                        Bei den Angaben zum Kollektiv können mehrere Angaben kombiniert aufgeführt werden. Zusätzlich zur Freitextangabe einer LDT-Information ist in FHIR® auch die Codierung möglich (optional).


                                                        Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple appliesTo are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.

                                                        ShortReference range population
                                                        Comments

                                                        This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.

                                                        Control0..*
                                                        BindingFor example codes, see ObservationReferenceRangeAppliesToCodeshttp://hl7.org/fhir/ValueSet/referencerange-appliesto|4.0.1
                                                        (example to http://hl7.org/fhir/ValueSet/referencerange-appliesto|4.0.1)

                                                        Codes identifying the population the reference range applies to.

                                                        TypeCodeableConcept
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summaryfalse
                                                        Requirements

                                                        Need to be able to identify the target population for proper interpretation.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        634. Observation.referenceRange.appliesTo.coding
                                                        Definition

                                                        Hier kann der "Kollektiv-Bezug" als codierte Information angegeben werden.

                                                        Dieses ValueSet mit HL7®-Codes für den Kollektivbezug enthält (eHDSI-konform) bislang nur geschlechtsspezifische Bezüge. Viele weitere, mögliche Kollektivbezüge sind noch nicht standardisiert terminologisch abgebildet.


                                                        A reference to a code defined by a terminology system.

                                                        ShortCode defined by a terminology system
                                                        Comments

                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                        Control0..*
                                                        BindingFor example codes, see For codes, see KBV_VS_MIO_LAB_EHDSIReferenceRangeAppliesTo (1.0.0-update)
                                                        (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_EHDSIReferenceRangeAppliesTo|1.0.0-update)
                                                        TypeCoding
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        636. Observation.referenceRange.appliesTo.coding.system
                                                        Definition

                                                        The identification of the code system that defines the meaning of the symbol in the code.

                                                        ShortIdentity of the terminology system
                                                        Comments

                                                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                        Control10..1
                                                        Typeuri
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need to be unambiguous about the source of the definition of the symbol.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        638. Observation.referenceRange.appliesTo.coding.version
                                                        Definition

                                                        The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                        ShortVersion of the system - if relevant
                                                        Comments

                                                        Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                        NoteThis is a business version Id, not a resource version Id (see discussion)
                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        640. Observation.referenceRange.appliesTo.coding.code
                                                        Definition

                                                        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                        ShortSymbol in syntax defined by the system
                                                        Control10..1
                                                        Typecode
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need to refer to a particular code in the system.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        642. Observation.referenceRange.appliesTo.coding.display
                                                        Definition

                                                        A representation of the meaning of the code in the system, following the rules of the system.

                                                        ShortRepresentation defined by the system
                                                        Control10..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        644. Observation.referenceRange.appliesTo.coding.userSelected
                                                        Definition

                                                        Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                        ShortIf this coding was chosen directly by the user
                                                        Comments

                                                        Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                        Control0..01
                                                        Typeboolean
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        646. Observation.referenceRange.appliesTo.text
                                                        Definition

                                                        Freitextangabe zum Kollektiv-Bezug der Richtgrenzen


                                                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                        ShortPlain text representation of the concept
                                                        Comments

                                                        Very often the text is the same as a displayName of one of the codings.

                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        648. Observation.referenceRange.age
                                                        Definition

                                                        The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.

                                                        ShortApplicable age range, if relevant
                                                        Control0..01
                                                        TypeRange
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Requirements

                                                        Some analytes vary greatly over age.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        650. Observation.referenceRange.text
                                                        Definition

                                                        Textbasierter Referenzbereich, der verwendet werden kann, wenn ein quantitativer Bereich nicht geeignet ist.


                                                        Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".

                                                        ShortText based reference range in an observation
                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        652. Observation.hasMember
                                                        Definition

                                                        This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.

                                                        ShortRelated resource that belongs to the Observation group
                                                        Comments

                                                        When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.


                                                        When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

                                                        Control0..0*
                                                        TypeReference(Observation, QuestionnaireResponse, MolecularSequence)
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        654. Observation.derivedFrom
                                                        Definition

                                                        Laboruntersuchungen, die als Berechnung erstellt werden, können auf Laboruntersuchungen beruhen, die hier referenziert werden. Hierbei ist zu beachten, dass die Angabe solch referenzierter Messunge(en) nicht zwingend vollständig ist.


                                                        The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.

                                                        ShortRelated measurements the observation is made from
                                                        Comments

                                                        All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below.

                                                        Control0..*
                                                        TypeReference(KBV_PR_MIO_LAB_Observation_Laboratory_Study, DocumentReference, ImagingStudy, Media, QuestionnaireResponse, Observation, MolecularSequence)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        656. Observation.derivedFrom.reference
                                                        Definition

                                                        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                        ShortLiteral reference, Relative, internal or absolute URL
                                                        Comments

                                                        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                        Control10..1
                                                        This element is affected by the following invariants: ref-1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        658. Observation.derivedFrom.type
                                                        Definition

                                                        The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                        The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                        ShortType the reference refers to (e.g. "Patient")
                                                        Comments

                                                        This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                        Control0..01
                                                        BindingUnless not suitable, these codes SHALL be taken from ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types|4.0.1
                                                        (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                        Aa resource (or, for logical models, the URI of the logical model).

                                                        Typeuri
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        660. Observation.derivedFrom.identifier
                                                        Definition

                                                        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                        ShortLogical reference, when literal reference is not known
                                                        Comments

                                                        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                                        Control0..01
                                                        TypeIdentifier
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        662. Observation.derivedFrom.display
                                                        Definition

                                                        Plain text narrative that identifies the resource in addition to the resource reference.

                                                        ShortText alternative for the resource
                                                        Comments

                                                        This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                        Control0..01
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        664. Observation.component
                                                        Definition

                                                        Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                                        ShortComponent results
                                                        Comments

                                                        For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                        Control0..0*
                                                        TypeBackboneElement
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Requirements

                                                        Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                                                        Guidance on how to interpret the contents of this table can be foundhere

                                                        0. Observation
                                                        Definition

                                                        Dieses Profil bildet eine Laboruntersuchung ab.

                                                        Laboruntersuchungen können als Messung oder als Berechnung erfolgen.

                                                        Eine Laboruntersuchung als Messung beschreibt die quantitative oder qualitative Untersuchung eines spezifischen Laborparameters in einem definierten Probenmaterial; z. B. die Untersuchung des Hämoglobin-(Hb-)Werts als Konzentration im Blut. Der Bezug zur Probe, anhand derer die Messung vorgenommen wurde, muss erkennbar sein.

                                                        Berechnete Laborergebnisse können auf Messungen basieren, z.B. kann die berechnete GFR (glomeruläre Filtrationsrate) auf einem gemessenen Kreatinin-Wert im Serum basieren.

                                                        Invariantsobs-code-1: For Observation.code either a coding or a data absent reason must be provided. When stating a data absent reason, a text for Observation.code must be provided as well. (code.coding.empty() or code.extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').empty() and (code.extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists() implies code.text.exists()))
                                                        2. Observation.meta
                                                        Must Supporttrue
                                                        4. Observation.meta.id
                                                        Control0..0
                                                        6. Observation.meta.versionId
                                                        Must Supporttrue
                                                        8. Observation.meta.lastUpdated
                                                        Must Supporttrue
                                                        10. Observation.meta.source
                                                        Control0..0
                                                        12. Observation.implicitRules
                                                        Control0..0
                                                        14. Observation.language
                                                        Control0..0
                                                        16. Observation.text
                                                        18. Observation.text.status
                                                        Pattern Valueextensions
                                                        20. Observation.contained
                                                        Control0..0
                                                        22. Observation.extension
                                                        Must Supporttrue
                                                        SlicingThis element introduces a set of slices on Observation.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                        • value @ url
                                                        • 24. Observation.extension:externalService
                                                          Slice NameexternalService
                                                          Definition

                                                          Dieses Kennzeichen wird gesetzt, wenn die Laboruntersuchung von einem anderen Labor durchgeführt wird.

                                                          ShortKennzeichen Fremdleistung
                                                          Control0..1
                                                          TypeExtension(KBV_EX_MIO_LAB_External_Service) (Extension Type: boolean)
                                                          Must Supporttrue
                                                          26. Observation.extension:externalService.value[x]
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          28. Observation.extension:associationService
                                                          Slice NameassociationService
                                                          Definition

                                                          Dieses Kennzeichen wird gesetzt, wenn die "Fremdleistung" von einem anderen Labor aus dem eigenen Verbund durchgeführt wird und diese Information aus administrativen Gründen zusätzlich benötigt wird.

                                                          ShortKennzeichen Verbundleistung
                                                          Control0..1
                                                          TypeExtension(KBV_EX_MIO_LAB_Association_Service) (Extension Type: boolean)
                                                          Must Supporttrue
                                                          30. Observation.extension:associationService.value[x]
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          32. Observation.extension:accreditedService
                                                          Slice NameaccreditedService
                                                          Definition

                                                          Diese Angabe betrifft akkreditierte Labore. Basierend auf der Akkreditierung ist gefordert, dass nicht akkreditierte Leistungen gekennzeichnet werden, auch im Laborbefund.

                                                          ShortKennzeichen Akkreditierte Laboruntersuchung
                                                          Control0..1
                                                          TypeExtension(KBV_EX_MIO_LAB_Accredited_Service) (Extension Type: boolean)
                                                          Must Supporttrue
                                                          34. Observation.extension:accreditedService.value[x]
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          36. Observation.extension:zlogValue
                                                          Slice NamezlogValue
                                                          Definition

                                                          Der zlog-Wert ist ein Relativwert, der auf einer logarithmischen Skala angibt, um wie viele Standardabweichungen ein Messwert vom Mittelwert des Referenzkollektivs abweicht. Er kann ergänzend, orientierend zur Bewertung eines Messergebnisses herangezogen werden.

                                                          Berechnung zlog-Wert zum Laborergebnis (x):

                                                          zlog = (log(x) –(log(UG)+log(OG))/2)*3,92/(log(OG)–log(UG))

                                                          (UG),(OG) sind die Unter- und Obergrenzen des Referenzintervalls

                                                          Interpretation des zlog-Wertes:

                                                          • Sein Referenzintervall liegt methodenunabhängig stets zwischen – 1,96 und + 1,96
                                                          • Stark erniedrigte oder erhöhte Laborergebnisse führen zu zlog-Werten um – 5 bzw. + 5.
                                                          Control0..1
                                                          TypeExtension(KBV_EX_MIO_LAB_zlog) (Extension Type: decimal)
                                                          Must Supporttrue
                                                          38. Observation.extension:zlogValue.value[x]
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          40. Observation.extension:alternativeResult
                                                          Slice NamealternativeResult
                                                          Definition

                                                          Hier werden auf eine alternative Einheit umgerechnete Messergebnisse mitgeführt.

                                                          Dies betrifft das quantitative Messergebnis, sowie die Richtgrenzenwerte und die zlog-Wert-Berechnung. Aus diesem Grund sind deren Strukturen hier (noch einmal) enthalten.

                                                          Control0..*
                                                          TypeExtension(KBV_EX_MIO_LAB_Alternative_Result) (Complex Extension)
                                                          Must Supporttrue
                                                          42. Observation.extension:alternativeResult.extension:value
                                                          Slice Namevalue
                                                          Definition

                                                          Hier wird ein Messergebnis mit Alternativeinheit angegeben.

                                                          ShortMessergebnis quantitativ mit Alternativeinheit
                                                          Must Supporttrue
                                                          44. Observation.extension:alternativeResult.extension:value.value[x]
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          46. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity
                                                          Slice NamevalueQuantity
                                                          Definition

                                                          Hier wird der Ergebniswert als Quantität mit Alternativeinheit angegeben.

                                                          ShortErgebniswert mit Alternativeinheit
                                                          TypeQuantity
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          48. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.value
                                                          Must Supporttrue
                                                          50. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.comparator
                                                          Must Supporttrue
                                                          52. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.unit
                                                          Must Supporttrue
                                                          54. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.system
                                                          Must Supporttrue
                                                          56. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.code
                                                          Must Supporttrue
                                                          58. Observation.extension:alternativeResult.extension:value.value[x]:valueRange
                                                          Slice NamevalueRange
                                                          Definition

                                                          Hier wird das Ergebnis als ein Wertebereich/Werteintervall mit Alternativeinheit angegeben.

                                                          ShortErgebnisbereich mit Alternativeinheit
                                                          TypeRange
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          60. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low
                                                          Must Supporttrue
                                                          62. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.value
                                                          Must Supporttrue
                                                          64. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.unit
                                                          Must Supporttrue
                                                          66. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.system
                                                          Must Supporttrue
                                                          68. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.code
                                                          Must Supporttrue
                                                          70. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high
                                                          Must Supporttrue
                                                          72. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.value
                                                          Must Supporttrue
                                                          74. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.unit
                                                          Must Supporttrue
                                                          76. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.system
                                                          Must Supporttrue
                                                          78. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.code
                                                          Must Supporttrue
                                                          80. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio
                                                          Slice NamevalueRatio
                                                          Definition

                                                          Hier wird der Ergebniswert als Ratio mit Alternativeinheiten angegeben.

                                                          ShortRatio mit Alternativeinheit
                                                          TypeRatio
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          82. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator
                                                          Must Supporttrue
                                                          84. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.value
                                                          Must Supporttrue
                                                          86. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.comparator
                                                          Must Supporttrue
                                                          88. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.unit
                                                          Must Supporttrue
                                                          90. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.system
                                                          Must Supporttrue
                                                          92. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.code
                                                          Must Supporttrue
                                                          94. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator
                                                          Must Supporttrue
                                                          96. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.value
                                                          Must Supporttrue
                                                          98. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.unit
                                                          Must Supporttrue
                                                          100. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.system
                                                          Must Supporttrue
                                                          102. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.code
                                                          Must Supporttrue
                                                          104. Observation.extension:alternativeResult.extension:referenceRange
                                                          Slice NamereferenceRange
                                                          Definition

                                                          Richtgrenzen für das quantitative Ergebnis mit Alternativeinheit.

                                                          ShortRichtgrenzen für Alternativeinheit
                                                          Must Supporttrue
                                                          106. Observation.extension:alternativeResult.extension:referenceRange.value[x]
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          108. Observation.extension:alternativeResult.extension:referenceRange.value[x].low
                                                          Must Supporttrue
                                                          110. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.value
                                                          Must Supporttrue
                                                          112. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.unit
                                                          Must Supporttrue
                                                          114. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.system
                                                          Must Supporttrue
                                                          116. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.code
                                                          Must Supporttrue
                                                          118. Observation.extension:alternativeResult.extension:referenceRange.value[x].high
                                                          Must Supporttrue
                                                          120. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.value
                                                          Must Supporttrue
                                                          122. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.unit
                                                          Must Supporttrue
                                                          124. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.system
                                                          Must Supporttrue
                                                          126. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.code
                                                          Must Supporttrue
                                                          128. Observation.extension:alternativeResult.extension:zlog
                                                          Slice Namezlog
                                                          Definition

                                                          Der zlog-Wert ist ein Relativwert, der auf einer logarithmischen Skala angibt, um wie viele Standardabweichungen ein Messwert vom Mittelwert des Referenzkollektivs abweicht. Er kann ergänzend, orientierend zur Bewertung eines Messergebnisses herangezogen werden.

                                                          Berechnung zlog-Wert zum Laborergebnis (x):

                                                          zlog = (log(x) –(log(UG)+log(OG))/2)*3,92/(log(OG)–log(UG))

                                                          (UG),(OG) sind die Unter- und Obergrenzen des Referenzintervalls

                                                          Interpretation des zlog-Wertes:

                                                          • Sein Referenzintervall liegt methodenunabhängig stets zwischen – 1,96 und + 1,96
                                                          • Stark erniedrigte oder erhöhte Laborergebnisse führen zu zlog-Werten um – 5 bzw. + 5.
                                                          Must Supporttrue
                                                          130. Observation.extension:alternativeResult.extension:zlog.value[x]
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Must Supporttrue
                                                          132. Observation.identifier
                                                          NoteThis is a business identifier, not a resource identifier (see discussion)
                                                          Control0..2
                                                          Must Supporttrue
                                                          SlicingThis element introduces a set of slices on Observation.identifier. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                          • value @ type
                                                          • 134. Observation.identifier:resultID
                                                            Slice NameresultID
                                                            Definition

                                                            Eindeutige ID zur Identifizierung der jeweiligen einzelnen Laboruntersuchung. Sie wird durch das auftragnehmende Laboratorium generiert.

                                                            NoteThis is a business identifier, not a resource identifier (see discussion)
                                                            Control0..1
                                                            Must Supporttrue
                                                            136. Observation.identifier:resultID.use
                                                            Control0..0
                                                            138. Observation.identifier:resultID.type
                                                            Control1..?
                                                            Pattern Value{
                                                              "coding" : [{
                                                                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                                                "code" : "OBI",
                                                                "display" : "Observation Instance Identifier"
                                                              }]
                                                            }
                                                            140. Observation.identifier:resultID.type.coding
                                                            Control1..1
                                                            Must Supporttrue
                                                            142. Observation.identifier:resultID.type.coding.system
                                                            Control1..?
                                                            Must Supporttrue
                                                            144. Observation.identifier:resultID.type.coding.version
                                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                                            Control1..?
                                                            Must Supporttrue
                                                            146. Observation.identifier:resultID.type.coding.code
                                                            Control1..?
                                                            Must Supporttrue
                                                            148. Observation.identifier:resultID.type.coding.display
                                                            Control1..?
                                                            Must Supporttrue
                                                            150. Observation.identifier:resultID.type.coding.userSelected
                                                            Control0..0
                                                            152. Observation.identifier:resultID.type.text
                                                            Control0..0
                                                            154. Observation.identifier:resultID.system
                                                            Must Supporttrue
                                                            156. Observation.identifier:resultID.value
                                                            Must Supporttrue
                                                            158. Observation.identifier:resultID.period
                                                            Control0..0
                                                            160. Observation.identifier:resultID.assigner
                                                            Control0..0
                                                            162. Observation.identifier:GTIN
                                                            Slice NameGTIN
                                                            Definition

                                                            Mit der GTIN (kurz für Global Trade Item Number ) kann jeder Artikel, jedes Produkt oder jede Produktvariante weltweit überschneidungsfrei identifiziert werden. Sie fungiert als Zugriffsschlüssel auf in Datenbanken hinterlegte Produktinformationen. Die GTIN ist gleichzeitig die Basis für den Barcode (auch bekannt als Strichcode). Über den Barcode wird sie maschinenlesbar und kann per Scanner automatisch ausgelesen werden.

                                                            Verwendung im Kontext Laborbefund: für die Darstellung von Laboruntersuchungen kann die GTIN herangezogen werden, um die Vergleichbarkeit von Tests zu validieren.

                                                            NoteThis is a business identifier, not a resource identifier (see discussion)
                                                            Control0..1
                                                            Must Supporttrue
                                                            164. Observation.identifier:GTIN.use
                                                            Control0..0
                                                            166. Observation.identifier:GTIN.type
                                                            Control1..?
                                                            Pattern Value{
                                                              "coding" : [{
                                                                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                                                "code" : "UDI",
                                                                "display" : "Universal Device Identifier"
                                                              }]
                                                            }
                                                            168. Observation.identifier:GTIN.type.coding
                                                            Control1..1
                                                            Must Supporttrue
                                                            170. Observation.identifier:GTIN.type.coding.system
                                                            Control1..?
                                                            Must Supporttrue
                                                            172. Observation.identifier:GTIN.type.coding.version
                                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                                            Control1..?
                                                            Must Supporttrue
                                                            174. Observation.identifier:GTIN.type.coding.code
                                                            Control1..?
                                                            Must Supporttrue
                                                            176. Observation.identifier:GTIN.type.coding.display
                                                            Control1..?
                                                            Must Supporttrue
                                                            178. Observation.identifier:GTIN.type.coding.userSelected
                                                            Control0..0
                                                            180. Observation.identifier:GTIN.type.text
                                                            Control0..0
                                                            182. Observation.identifier:GTIN.system
                                                            Must Supporttrue
                                                            184. Observation.identifier:GTIN.value
                                                            Must Supporttrue
                                                            186. Observation.identifier:GTIN.period
                                                            Control0..0
                                                            188. Observation.identifier:GTIN.assigner
                                                            Control0..0
                                                            190. Observation.basedOn
                                                            Control0..0
                                                            192. Observation.partOf
                                                            Control0..0
                                                            194. Observation.status
                                                            Definition

                                                            Bearbeitungsstatus der einzelnen Laboruntersuchung. Die Status-Werte orientieren sich an HL7® FHIR® Version 4.0.1, jedoch wurde der Wert "unknown" aufgrund von Nichtverwendung herausgenommen.

                                                            Must Supporttrue
                                                            196. Observation.category
                                                            Definition

                                                            Zur einzelnen Laboruntersuchung wird das "fachliche Gruppierungsmerkmal" REDUNDANT abgebildet, der Inhalt entspricht exakt dem fachlichen Gruppierungsmerkmal der zugehörigen Untersuchungsgruppe. Dies ermöglicht bei datenbankbasierten Abfragen von Einzeluntersuchungen (z.B. in der ePA) eine direkte Zuordnung zur fachlichen Gruppierung. Das fachliche Gruppierungsmerkmal der Untersuchungsgruppe ist grundsätzlich führend!

                                                            ShortFachliche Bezeichnung für die zugehörige Untersuchungsgruppe, Inhalt identisch zu Observation_Laboratory_Study_Group.category
                                                            Control1..3
                                                            Must Supporttrue
                                                            SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                            • value @ extension.value
                                                            • 198. Observation.category:laboratory
                                                              Slice Namelaboratory
                                                              Control1..1
                                                              Must Supporttrue
                                                              Pattern Value{
                                                                "coding" : [{
                                                                  "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
                                                                  "code" : "laboratory"
                                                                }]
                                                              }
                                                              200. Observation.category:laboratory.extension
                                                              Control1..?
                                                              Must Supporttrue
                                                              SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 202. Observation.category:laboratory.extension:laboratory
                                                                Slice Namelaboratory
                                                                Control1..1
                                                                TypeExtension(KBV_EX_MIO_LAB_Diskriminator) (Extension Type: string)
                                                                Must Supporttrue
                                                                204. Observation.category:laboratory.extension:laboratory.value[x]
                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                Must Supporttrue
                                                                Pattern Valuelaboratory
                                                                206. Observation.category:laboratory.coding
                                                                Must Supporttrue
                                                                208. Observation.category:laboratory.coding.system
                                                                Control1..?
                                                                Must Supporttrue
                                                                210. Observation.category:laboratory.coding.version
                                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                Must Supporttrue
                                                                212. Observation.category:laboratory.coding.code
                                                                Control1..?
                                                                Must Supporttrue
                                                                214. Observation.category:laboratory.coding.display
                                                                Control1..?
                                                                Must Supporttrue
                                                                216. Observation.category:laboratory.coding.userSelected
                                                                Control0..0
                                                                218. Observation.category:laboratory.text
                                                                Must Supporttrue
                                                                220. Observation.category:studyType
                                                                Slice NamestudyType
                                                                Definition

                                                                Hier kann die fachspezifische Eingrenzung innerhalb der Laboratoriumsmedizin anhand entsprechender Kategorie-Codes angegeben werden. Beispiele für eine fachspezifische Eingrenzung sind: "Klinische Chemie", "Hämatologie", "Serologie", "Toxikologie", "Urindiagnostik", "Fertilitätsdiagnostik". Es besteht auch die Option, eine allgemeine Kategorie für "Labor" zu vergeben.

                                                                ShortBezeichnung für Fachbereich, unter dem Laboruntersuchungen gruppiert werden, Inhalt identisch zu Observation_Laboratory_Study_Group.category:studyType
                                                                Control0..1
                                                                Must Supporttrue
                                                                222. Observation.category:studyType.extension
                                                                Control1..?
                                                                Must Supporttrue
                                                                SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 224. Observation.category:studyType.extension:studyType
                                                                  Slice NamestudyType
                                                                  Control1..1
                                                                  TypeExtension(KBV_EX_MIO_LAB_Diskriminator) (Extension Type: string)
                                                                  Must Supporttrue
                                                                  226. Observation.category:studyType.extension:studyType.value[x]
                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                  Must Supporttrue
                                                                  Pattern ValuestudyType
                                                                  228. Observation.category:studyType.coding
                                                                  Definition

                                                                  Benennung des labormedizinischen Bereiches als Code.

                                                                  Must Supporttrue
                                                                  SlicingThis element introduces a set of slices on Observation.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ $this
                                                                  • 230. Observation.category:studyType.coding.system
                                                                    Control1..?
                                                                    232. Observation.category:studyType.coding.code
                                                                    Control1..?
                                                                    234. Observation.category:studyType.coding.display
                                                                    Control1..?
                                                                    236. Observation.category:studyType.coding:loinc
                                                                    Slice Nameloinc
                                                                    Definition

                                                                    LOINC®-Code für Fachbereich/Spezialgebiet der Labormedizin

                                                                    Control0..1
                                                                    BindingFor example codes, see KBV_VS_MIO_LAB_Laboratory_Specialties_LOINC (1.0.0-update)
                                                                    (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Laboratory_Specialties_LOINC|1.0.0-update)
                                                                    Must Supporttrue
                                                                    Pattern Value{
                                                                      "system" : "http://loinc.org"
                                                                    }
                                                                    238. Observation.category:studyType.coding:loinc.system
                                                                    Control1..?
                                                                    Must Supporttrue
                                                                    240. Observation.category:studyType.coding:loinc.version
                                                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                    Control1..?
                                                                    Must Supporttrue
                                                                    242. Observation.category:studyType.coding:loinc.code
                                                                    Control1..?
                                                                    Must Supporttrue
                                                                    244. Observation.category:studyType.coding:loinc.display
                                                                    Control1..?
                                                                    Must Supporttrue
                                                                    246. Observation.category:studyType.coding:loinc.userSelected
                                                                    Control0..0
                                                                    248. Observation.category:studyType.text
                                                                    Definition

                                                                    Benennung des labormedizinischen Bereiches als Freitext.

                                                                    Must Supporttrue
                                                                    250. Observation.category:testProfile
                                                                    Slice NametestProfile
                                                                    Definition

                                                                    Unter Test-Profil werden zusammengehörige Labortests oder eine Gruppe von Einzeluntersuchungen aus einem Verfahren zusammengefasst.

                                                                    ShortBezeichnung für fachlich-medizinischen Bezug, unter dem Laboruntersuchungen gruppiert werden, Inhalt identisch zu Observation_Laboratory_Study_Group.category:testProfile
                                                                    Control0..1
                                                                    Must Supporttrue
                                                                    252. Observation.category:testProfile.extension
                                                                    Control1..?
                                                                    Must Supporttrue
                                                                    SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 254. Observation.category:testProfile.extension:testProfile
                                                                      Slice NametestProfile
                                                                      Control1..1
                                                                      TypeExtension(KBV_EX_MIO_LAB_Diskriminator) (Extension Type: string)
                                                                      Must Supporttrue
                                                                      256. Observation.category:testProfile.extension:testProfile.value[x]
                                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                      Must Supporttrue
                                                                      Pattern ValuetestProfile
                                                                      258. Observation.category:testProfile.coding
                                                                      Definition

                                                                      Benennung eines Test-Profils als Code.

                                                                      BindingFor example codes, see KBV_VS_MIO_LAB_Laboruntersuchungsgruppe (1.0.0-update)
                                                                      (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Laboruntersuchungsgruppe|1.0.0-update)
                                                                      Must Supporttrue
                                                                      SlicingThis element introduces a set of slices on Observation.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ $this
                                                                      • 260. Observation.category:testProfile.coding.system
                                                                        Control1..?
                                                                        Must Supporttrue
                                                                        262. Observation.category:testProfile.coding.version
                                                                        NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                        Must Supporttrue
                                                                        264. Observation.category:testProfile.coding.code
                                                                        Control1..?
                                                                        Must Supporttrue
                                                                        266. Observation.category:testProfile.coding.display
                                                                        Control1..?
                                                                        Must Supporttrue
                                                                        268. Observation.category:testProfile.coding.userSelected
                                                                        Control0..0
                                                                        270. Observation.category:testProfile.text
                                                                        Definition

                                                                        Benennung des Test-Profils als Freitext.

                                                                        Must Supporttrue
                                                                        272. Observation.code
                                                                        Definition

                                                                        Hier wird die konkrete einzelne Laboruntersuchung spezifiziert.

                                                                        Must Supporttrue
                                                                        274. Observation.code.extension:data-absent-reason
                                                                        Slice Namedata-absent-reason
                                                                        Definition

                                                                        Begründung für die Nicht-Vergabe eines LOINC®-Codes zur Laboruntersuchung

                                                                        ShortGrund für das Nichtvorhandensein eines LOINC®-Codes
                                                                        Control0..1
                                                                        TypeExtension(Data Absent Reason) (Extension Type: code)
                                                                        Must Supporttrue
                                                                        276. Observation.code.extension:data-absent-reason.value[x]
                                                                        BindingThe codes SHALL be taken from KBV_VS_MIO_LAB_Data_Absent_Reason (1.0.0-update)
                                                                        (required to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Data_Absent_Reason|1.0.0-update)
                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                        Must Supporttrue
                                                                        278. Observation.code.coding
                                                                        Definition

                                                                        In diesem Element wird ein LOINC®-Code für die Laboruntersuchung angegeben, inklusive Anzeigename (Display Name) sowie Name und Version des Codesystems.

                                                                        Die Angabe des LOINC®-Codes ist verbindlich. Falls dies nicht möglich ist, muss der Grund für das Nichtvorhandensein eines Codes (DataAbsentReason) angegeben werden.

                                                                        Control0..1
                                                                        Must Supporttrue
                                                                        Pattern Value{
                                                                          "system" : "http://loinc.org"
                                                                        }
                                                                        280. Observation.code.coding.system
                                                                        Control1..?
                                                                        Must Supporttrue
                                                                        282. Observation.code.coding.version
                                                                        NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                        Control1..?
                                                                        Must Supporttrue
                                                                        284. Observation.code.coding.code
                                                                        Control1..?
                                                                        Must Supporttrue
                                                                        286. Observation.code.coding.display
                                                                        Control1..?
                                                                        Must Supporttrue
                                                                        288. Observation.code.coding.userSelected
                                                                        Control0..0
                                                                        290. Observation.code.text
                                                                        Definition

                                                                        Die Freitext-Bezeichnung erlaubt es, in den verwendenden/verarbeitenden Systemen den Einrichtungs-spezifischen bzw. Verwender-spezifischen Bezeichner für eine Laboruntersuchung weiterhin zu verwenden.

                                                                        Für den Fall, dass anstelle des LOINC®-Codes ein Grund für das Nichtvorhandensein eines Codes (DataAbsentReason) vergeben wird, muss die Freitext-Bezeichnung befüllt sein.

                                                                        ShortVerwender-spezifische (vom Long Common Name des LOINC®-Codes ggf. abweichende) Bezeichnung für die Laboruntersuchung
                                                                        Must Supporttrue
                                                                        292. Observation.subject
                                                                        Definition

                                                                        Hier wird die zu behandelnde Person referenziert.

                                                                        ShortZu behandelnde Person
                                                                        Control1..?
                                                                        TypeReference(KBV_PR_MIO_LAB_Patient)
                                                                        Must Supporttrue
                                                                        294. Observation.subject.identifier
                                                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                        Control1..?
                                                                        TypeIdentifier(Identifier-Profil für die 10-stellige Krankenversichertennummer)
                                                                        Must Supporttrue
                                                                        296. Observation.focus
                                                                        Control0..0
                                                                        298. Observation.encounter
                                                                        Control0..0
                                                                        300. Observation.effective[x]
                                                                        Definition

                                                                        Der Klinische Bezugszeitpunkt ist wichtig, um die Laboruntersuchung im Zeitverlauf einordnen zu können.

                                                                        Die Redundanz ist beabsichtigt. Es geht darum, einen Zeitpunkt ermitteln zu können, der für Studien-Statistiken als vergleichsrelevant eingestuft wird. Da im klinischen Alltag nicht sicher gestellt ist, dass grundsätzlich und immer der Zeitpunkt der Materialentnahme auch dokumentiert wird, wurde dieser Algorithmus festgelegt, um die Dokumentation eines statistischen relevanten Zeitpunktes zu garantieren:

                                                                        • WENN der Entnahmezeitpunkt des Probenmaterials angeben ist, so gilt der Entnahmezeitpunkt;
                                                                        • WENN der Sammelzeitraum-bis angegeben ist, so gilt der bis-Zeitpunkt;
                                                                        • SONST gilt (hilfsweise) der Laboreingangszeitpunkt: Zeitpunkt des Eingangs der Probe im Labor.
                                                                        ShortKlinischer Bezugszeitpunkt
                                                                        Control1..?
                                                                        TypedateTime, Period, Timing, instant
                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Invariantsdate-1: Datetime must be at least day, month and year. (($this as dateTime).toString().length() >= 10)
                                                                        302. Observation.issued
                                                                        Definition

                                                                        Zeitstempel oder Zeitangabe zur Dokumentation der einzelnen Laboruntersuchung.

                                                                        ShortDokumentationszeitpunkt
                                                                        Control1..?
                                                                        Must Supporttrue
                                                                        304. Observation.performer
                                                                        Definition

                                                                        Hier wird das durchführende Labor in Bezug auf die einzelne Laboruntersuchung benannt.

                                                                        Zur Beachtung: im Laborgesamtbefund wird das durchführende Labor (als DiagnosticReport.performer) dokumentiert. Für selbst erbrachte Laborleistungen muss aus Gründen der EU-Kompatibilität auch immer zur Einzeluntersuchung das durchführende Labor (Observation.performer) dokumentiert werden, dieses kann aus dem Laborgesamtbefund abgeleitet werden.

                                                                        Wenn das auftragnehmende Labor die einzelne Laboruntersuchung nicht in Eigenleistung erbringt sondern an ein Speziallabor weiterleitet, sogenannte Fremdleistung, muss hier das durchführende sekundäre Labor als durchführendes Labor dokumentiert werden.

                                                                        Control1..?
                                                                        TypeReference(KBV_PR_MIO_LAB_Practitioner, KBV_PR_MIO_LAB_PractitionerRole, KBV_PR_MIO_LAB_Organization)
                                                                        Must Supporttrue
                                                                        Must Support TypesNo must-support rules about the choice of types/profiles
                                                                        306. Observation.performer.reference
                                                                        Control1..?
                                                                        Must Supporttrue
                                                                        308. Observation.value[x]
                                                                        Definition

                                                                        Messergebnisse können quantitativ oder qualitativ sein.

                                                                        TypeChoice of: Quantity, CodeableConcept, string, Range, Ratio, dateTime, boolean, SampledData, Period, integer, time
                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Must Support TypesNo must-support rules about the choice of types/profiles
                                                                        SlicingThis element introduces a set of slices on Observation.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                        • type @ $this
                                                                        • 310. Observation.value[x]:valueQuantity
                                                                          Slice NamevalueQuantity
                                                                          Definition

                                                                          Hier wird der Ergebniswert als Quantität angegeben.

                                                                          Control0..1
                                                                          TypeQuantity
                                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                          Must Supporttrue
                                                                          Pattern Value{
                                                                            "system" : "http://unitsofmeasure.org"
                                                                          }
                                                                          312. Observation.value[x]:valueQuantity.value
                                                                          Control1..?
                                                                          Must Supporttrue
                                                                          314. Observation.value[x]:valueQuantity.comparator
                                                                          Must Supporttrue
                                                                          316. Observation.value[x]:valueQuantity.unit
                                                                          Control1..?
                                                                          Must Supporttrue
                                                                          318. Observation.value[x]:valueQuantity.system
                                                                          Control1..?
                                                                          Must Supporttrue
                                                                          320. Observation.value[x]:valueQuantity.code
                                                                          Control1..?
                                                                          Must Supporttrue
                                                                          322. Observation.value[x]:valueCodeableConcept
                                                                          Slice NamevalueCodeableConcept
                                                                          Definition

                                                                          Qualitative Messergebnisse sind - je nach Messgröße oder Skalierung:

                                                                          Ordinal, d.h. numerische, in der Regel ganzzahlige Ordnungswerte, die den Vergleich (z. B. kleiner als, größer als) ermöglichen oder zur Vergabe einer Punktebewertung ("Benotung") herangezogen werden, beispielsweise eine Schmerzskala (z.B. von 1 bis 10)

                                                                          Nominal, d.h. Festwerte ohne Rangordnung, beispielsweise in der Mikrobiologie: Krankheitserreger (z.B. Escherichia Coli; Staphylococcus aureus als Bezeichner oder als Code.) oder Angabe zum Nachweis (z.B. vorhanden / nicht vorhanden).

                                                                          ShortQualitatives Messergebnis (z.B. nominal oder ordinal)
                                                                          Control0..1
                                                                          TypeCodeableConcept
                                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                          Must Supporttrue
                                                                          324. Observation.value[x]:valueCodeableConcept.coding
                                                                          Definition

                                                                          Qualitatives Messergebnis in codierter Form.

                                                                          Must Supporttrue
                                                                          SlicingThis element introduces a set of slices on Observation.value[x].coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ $this
                                                                          • 326. Observation.value[x]:valueCodeableConcept.coding.system
                                                                            Control1..?
                                                                            328. Observation.value[x]:valueCodeableConcept.coding.code
                                                                            Control1..?
                                                                            330. Observation.value[x]:valueCodeableConcept.coding.display
                                                                            Control1..?
                                                                            332. Observation.value[x]:valueCodeableConcept.coding:snomed
                                                                            Slice Namesnomed
                                                                            Definition

                                                                            Darstellung des qualitativen Messergebnisses als SNOMED CT®-Code.

                                                                            Control0..1
                                                                            BindingFor example codes, see KBV_VS_MIO_LAB_Observation_Laboratory_Study_Value_SNOMED_CT (1.0.0-update)
                                                                            (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Observation_Laboratory_Study_Value_SNOMED_CT|1.0.0-update)
                                                                            Must Supporttrue
                                                                            Pattern Value{
                                                                              "system" : "http://snomed.info/sct"
                                                                            }
                                                                            334. Observation.value[x]:valueCodeableConcept.coding:snomed.system
                                                                            Must Supporttrue
                                                                            336. Observation.value[x]:valueCodeableConcept.coding:snomed.version
                                                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            338. Observation.value[x]:valueCodeableConcept.coding:snomed.code
                                                                            Must Supporttrue
                                                                            340. Observation.value[x]:valueCodeableConcept.coding:snomed.display
                                                                            Must Supporttrue
                                                                            342. Observation.value[x]:valueCodeableConcept.coding:snomed.userSelected
                                                                            Control0..0
                                                                            344. Observation.value[x]:valueCodeableConcept.text
                                                                            Definition

                                                                            Qualitatives Messergebnis als Freitext.

                                                                            Must Supporttrue
                                                                            346. Observation.value[x]:valueRatio
                                                                            Slice NamevalueRatio
                                                                            Definition

                                                                            Eine bisher gebräuchliche Ergebnisdarstellung von Antikörper-Bestimmungen ist der Verdünnungstiter, bei welchem die Antikörper noch nachweisbar sind. Umgangssprachlich häufig nur als "Titer" bezeichnet. Die Titerangabe setzt sich aus zwei ins Verhältnis gesetzten Quantitäten (Zähler, Nenner) zusammen. Wenn zur Ergebnisdarstellung ein Komparator benötigt wird, dann gelten die mathematischen Regeln, beispielsweise ist 1:32 ein kleinerer Wert als 1:16.

                                                                            Control0..1
                                                                            TypeRatio
                                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                            Must Supporttrue
                                                                            348. Observation.value[x]:valueRatio.numerator
                                                                            Definition

                                                                            Hier wird der Zähler zum Ergebniswert Ratio angegeben.

                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            Pattern Value{
                                                                              "system" : "http://unitsofmeasure.org"
                                                                            }
                                                                            350. Observation.value[x]:valueRatio.numerator.value
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            352. Observation.value[x]:valueRatio.numerator.comparator
                                                                            Must Supporttrue
                                                                            354. Observation.value[x]:valueRatio.numerator.unit
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            356. Observation.value[x]:valueRatio.numerator.system
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            358. Observation.value[x]:valueRatio.numerator.code
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            360. Observation.value[x]:valueRatio.denominator
                                                                            Definition

                                                                            Hier wird der Nenner zum Ergebniswert Ratio angegeben.

                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            Pattern Value{
                                                                              "system" : "http://unitsofmeasure.org"
                                                                            }
                                                                            362. Observation.value[x]:valueRatio.denominator.value
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            364. Observation.value[x]:valueRatio.denominator.unit
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            366. Observation.value[x]:valueRatio.denominator.system
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            368. Observation.value[x]:valueRatio.denominator.code
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            370. Observation.value[x]:valueRange
                                                                            Slice NamevalueRange
                                                                            Definition

                                                                            Für Messergebnisse, die nicht als genau ein Wert, sondern als ein Wertebereich/Werteintervall angegeben werden.

                                                                            Control0..1
                                                                            TypeRange
                                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                            Must Supporttrue
                                                                            372. Observation.value[x]:valueRange.low
                                                                            Definition

                                                                            Untere Grenze eines Ergebnisbereiches, Ergebnisintervalls. Die Einheiten von Obergrenze und Untergrenze müssen identisch sein.

                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            Pattern Value{
                                                                              "system" : "http://unitsofmeasure.org"
                                                                            }
                                                                            374. Observation.value[x]:valueRange.low.value
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            376. Observation.value[x]:valueRange.low.unit
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            378. Observation.value[x]:valueRange.low.system
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            380. Observation.value[x]:valueRange.low.code
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            382. Observation.value[x]:valueRange.high
                                                                            Definition

                                                                            Obere Grenze eines Ergebnisbereiches, Ergebnisintervalls. Die Einheiten von Obergrenze und Untergrenze müssen identisch sein.

                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            Pattern Value{
                                                                              "system" : "http://unitsofmeasure.org"
                                                                            }
                                                                            384. Observation.value[x]:valueRange.high.value
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            386. Observation.value[x]:valueRange.high.unit
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            388. Observation.value[x]:valueRange.high.system
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            390. Observation.value[x]:valueRange.high.code
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            392. Observation.value[x]:valueString
                                                                            Slice NamevalueString
                                                                            Definition

                                                                            Textergebnis als Freitext. Dieses Feld ist für Beobachtungen vorgesehen, bei denen für das Resultat keine numerischen oder codierten Werte benötigt werden. Beispiele sind qualitative Beschreibungen oder freitextliche Kommentare.

                                                                            ShortErgebnis uncodiert in Textform
                                                                            Control0..1
                                                                            Typestring
                                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Must Supporttrue
                                                                            394. Observation.dataAbsentReason
                                                                            Definition

                                                                            Begründung für die Nicht-Verfügbarkeit eines Messergebnisses. Die Angabe eines Messergebnisses ist gefordert ("required"). Wenn kein Messergebnis zur Verfügung steht, wird in der FHIR®-Struktur ein "dataAbsentReason" angegeben. Der Inhalt dieser Begründung soll der System-anwendenden Person angezeigt werden

                                                                            Must Supporttrue
                                                                            396. Observation.dataAbsentReason.coding
                                                                            Control1..1
                                                                            Must Supporttrue
                                                                            398. Observation.dataAbsentReason.coding.system
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            400. Observation.dataAbsentReason.coding.version
                                                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                            Must Supporttrue
                                                                            402. Observation.dataAbsentReason.coding.code
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            404. Observation.dataAbsentReason.coding.display
                                                                            Control1..?
                                                                            Must Supporttrue
                                                                            406. Observation.dataAbsentReason.coding.userSelected
                                                                            Control0..0
                                                                            408. Observation.dataAbsentReason.text
                                                                            Control0..0
                                                                            410. Observation.interpretation
                                                                            Definition

                                                                            Medizinisch relevante Bewertung zur einzelnen Laboruntersuchung. Die Interpretation kann als Code und/oder Text vorliegen. Die Angabe einer Interpretation ist optional, bei nicht vorhandener Klassifikation wird hier nichts übermittelt. Empfehlung: eine dokumentierte Interpretation sollte mindestens einen Interpretationscode enthalten.

                                                                            ShortMedizinische Interpretation des einzelnen Laborergebnisses
                                                                            Must Supporttrue
                                                                            412. Observation.interpretation.coding
                                                                            Definition

                                                                            Hier kann die Interpretation als codierte Information angegeben werden.

                                                                            Must Supporttrue
                                                                            SlicingThis element introduces a set of slices on Observation.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                            • value @ $this
                                                                            • 414. Observation.interpretation.coding.system
                                                                              Control1..?
                                                                              416. Observation.interpretation.coding.code
                                                                              Control1..?
                                                                              418. Observation.interpretation.coding.display
                                                                              Control1..?
                                                                              420. Observation.interpretation.coding:hl7Interpretation
                                                                              Slice Namehl7Interpretation
                                                                              Definition

                                                                              Für die codierte Interpretation wird eine Auswahl von Interpretationscodes als Option angeboten. Die Nutzung der hinterlegten Codes ist abhängig vom Kontext.

                                                                              Control0..1
                                                                              BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodes
                                                                              (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)
                                                                              Must Supporttrue
                                                                              Pattern Value{
                                                                                "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
                                                                              }
                                                                              422. Observation.interpretation.coding:hl7Interpretation.system
                                                                              Must Supporttrue
                                                                              424. Observation.interpretation.coding:hl7Interpretation.version
                                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                              Must Supporttrue
                                                                              426. Observation.interpretation.coding:hl7Interpretation.code
                                                                              Must Supporttrue
                                                                              428. Observation.interpretation.coding:hl7Interpretation.display
                                                                              Must Supporttrue
                                                                              430. Observation.interpretation.coding:hl7Interpretation.userSelected
                                                                              Control0..0
                                                                              432. Observation.interpretation.coding:snomed
                                                                              Slice Namesnomed
                                                                              Definition

                                                                              Hier kann ein Code aus SNOMED-CT® angegeben werden.

                                                                              Control0..1
                                                                              Must Supporttrue
                                                                              Pattern Value{
                                                                                "system" : "http://snomed.info/sct"
                                                                              }
                                                                              434. Observation.interpretation.coding:snomed.system
                                                                              Must Supporttrue
                                                                              436. Observation.interpretation.coding:snomed.version
                                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                              Control1..?
                                                                              Must Supporttrue
                                                                              438. Observation.interpretation.coding:snomed.code
                                                                              Must Supporttrue
                                                                              440. Observation.interpretation.coding:snomed.display
                                                                              Must Supporttrue
                                                                              442. Observation.interpretation.coding:snomed.userSelected
                                                                              Control0..0
                                                                              444. Observation.interpretation.text
                                                                              Definition

                                                                              Hier kann eine medizinisch relevante Bewertung als Freitext eingegeben werden. Unter Eigenschaften sind mögliche Werte gelistet, die in dieses Feld hineinpassen könnten, beispielsweise ein Textfeld  aus dem LDT zur Interpretation des Ergebnisses.

                                                                              Must Supporttrue
                                                                              446. Observation.note
                                                                              Definition

                                                                              Die ergänzenden Angaben beziehen sich genau auf diese Einzeluntersuchung. Neben dem Element (Interpretation) ist dieses Feld für weitere, über die rein medizinische Interpretation hinausgehende Kommentierungen gedacht.

                                                                              Must Supporttrue
                                                                              448. Observation.note.author[x]
                                                                              Control0..0
                                                                              450. Observation.note.time
                                                                              Control0..0
                                                                              452. Observation.note.text
                                                                              Must Supporttrue
                                                                              454. Observation.bodySite
                                                                              Control0..0
                                                                              456. Observation.method
                                                                              Definition

                                                                              Der LOINC®-Code impliziert über die LOINC®-Achse METHOD bereits eine Untersuchungsmethode, unter der Voraussetzung, dass der Part METHOD einen Wert beinhaltet. Die "Untersuchungsmethode, ergänzende Spezifizierung" kann in Bezug auf die LOINC®-spezifizierte Laboruntersuchung ergänzt werden, falls der Wert für die LOINC®-Achse METHOD nicht ausreichend spezifisch ist oder gar nicht vorhanden ist.

                                                                              Ein Beispiel: die Laboruntersuchung (Observation_Laboratory_Study.code) ist mit dem LOINC®-Code 26453-1 "Erythrocytes [#/volume] in Blood" ohne Angabe zur Methode codiert. Als ergänzende Spezifizieruung wird für die Untersuchungsmethode (Observation_Laboratory_Study.method) der SNOMED CT®-Code 702659008 |Automated count| zugeordnet.

                                                                              ShortUntersuchungsmethode, ergänzende Spezifizierung (z.B. postkoordinierend)
                                                                              Must Supporttrue
                                                                              458. Observation.method.coding
                                                                              Definition

                                                                              Hier kann die Untersuchungsmethode als codierte Information angegeben werden.

                                                                              BindingFor example codes, see Untersuchungsmethode SNOMED CT®
                                                                              (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Observation_Methods)
                                                                              Must Supporttrue
                                                                              460. Observation.method.coding.system
                                                                              Control1..?
                                                                              Must Supporttrue
                                                                              462. Observation.method.coding.version
                                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                              Must Supporttrue
                                                                              464. Observation.method.coding.code
                                                                              Control1..?
                                                                              Must Supporttrue
                                                                              466. Observation.method.coding.display
                                                                              Control1..?
                                                                              Must Supporttrue
                                                                              468. Observation.method.coding.userSelected
                                                                              Control0..0
                                                                              470. Observation.method.text
                                                                              Definition

                                                                              Hier kann eine Freitext-Bezeichnung der Untersuchungsmethode notiert werden. Mögliche Verwendung:

                                                                              • als Freitextergänzung, wenn die Methode durch die Spezifikation Laboruntersuchung (LOINC® Code: METHOD) nicht ausreichend spezifisch codiert werden kann
                                                                              • ersatzweise, wenn zur Untersuchungsmethode auch kein passender SNOMED CT®-Code zugeordnet werden kann
                                                                              • als ergänzender, dem SNOMED CT®-Code entsprechender Freitext
                                                                              Must Supporttrue
                                                                              472. Observation.specimen
                                                                              Definition

                                                                              Eine Laboruntersuchung kann auf einer Primärprobe oder einer weiter verarbeiteten Probe (Sekundärprobe) basieren. Die Zuordnung einer Sekundärprobe zu einer Laboruntersuchung ist dann empfehlenswert, wenn durch die Probenvorbereitung im Labor eine relevante Veränderung des Untersuchungsmaterials erfolgt (z.B. Abtrennung Plasma).

                                                                              Ein Beispiel für die Unterscheidung zwischen Primärprobe und Sekundärprobe: als Primärprobe erreicht eine Probenart = Vollblut das Labor. Durch Zentrifugieren im Labor entsteht eine Sekundärprobe mit Probenart = Serum. Die zu analysierende Substanz wird im Serum gemessen.

                                                                              TypeReference(KBV_PR_MIO_LAB_Specimen)
                                                                              Must Supporttrue
                                                                              474. Observation.specimen.reference
                                                                              Control1..?
                                                                              Must Supporttrue
                                                                              476. Observation.specimen.type
                                                                              Control0..0
                                                                              478. Observation.specimen.identifier
                                                                              NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                              Control0..0
                                                                              480. Observation.specimen.display
                                                                              Control0..0
                                                                              482. Observation.device
                                                                              Definition

                                                                              Hier wird das Gerät bzw. Medizinprodukt referenziert, mit dem die Laboruntersuchung durchgeführt wird.

                                                                              ShortLaboranalysegerät
                                                                              TypeReference(KBV_PR_MIO_LAB_Device_Laboratory_Analyzer)
                                                                              Must Supporttrue
                                                                              484. Observation.device.reference
                                                                              Control1..?
                                                                              Must Supporttrue
                                                                              486. Observation.device.type
                                                                              Control0..0
                                                                              488. Observation.device.identifier
                                                                              NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                              Control0..0
                                                                              490. Observation.device.display
                                                                              Control0..0
                                                                              492. Observation.referenceRange
                                                                              Definition

                                                                              Richtgrenzen oder Bewertungsgrenzen zu einer Laboruntersuchung

                                                                              • werden herangezogen für die Beurteilung und Einordnung von Messergebnissen
                                                                              • sind laborärztliche Entscheidungsgrenzen (mit ggf. juristischer Relevanz)
                                                                              • sind ärztliche Entscheidungshilfen im klinischen Allta

                                                                              Disclaimer: FHIR® definiert aktuell nur inklusive Richtgrenzen. Für die Praxistauglichkeit besteht aber die Anforderung, auch exklusive Richtgrenzen abbilden zu können. Diese Thematik wurde schon bei HL7® FHIR® platziert, es gibt aber noch keine abschließende Festlegung dazu. Im Informationsmodell sind beide Optionen bereits dargestellt, um diese Anforderung sichtbar zu machen.

                                                                              Must Supporttrue
                                                                              494. Observation.referenceRange.extension
                                                                              Must Supporttrue
                                                                              SlicingThis element introduces a set of slices on Observation.referenceRange.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 496. Observation.referenceRange.extension:sourceReferenceRange
                                                                                Slice NamesourceReferenceRange
                                                                                Definition

                                                                                Mögliche Angaben als Quelle für Richtgrenzen können sein:

                                                                                • Internationaler Standard
                                                                                • Nationaler Standard
                                                                                • Literatur
                                                                                • Gerätehersteller
                                                                                • Beipackzettel
                                                                                • Labor-intern
                                                                                • nicht angegeben

                                                                                Zusätzlich zur Freitextangabe einer LDT-Information ist in FHIR® auch die Codierung möglich (optional).

                                                                                ShortQuelle der Richtgrenzen
                                                                                Control0..1
                                                                                TypeExtension(KBV_EX_MIO_LAB_Source_Reference_Range) (Extension Type: CodeableConcept)
                                                                                Must Supporttrue
                                                                                498. Observation.referenceRange.extension:sourceReferenceRange.value[x]
                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                Must Supporttrue
                                                                                500. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding
                                                                                Must Supporttrue
                                                                                502. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.system
                                                                                Must Supporttrue
                                                                                504. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.version
                                                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                Must Supporttrue
                                                                                506. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.code
                                                                                Must Supporttrue
                                                                                508. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.display
                                                                                Must Supporttrue
                                                                                510. Observation.referenceRange.extension:sourceReferenceRange.value[x].text
                                                                                Must Supporttrue
                                                                                512. Observation.referenceRange.extension:noLinearReferenceRange
                                                                                Slice NamenoLinearReferenceRange
                                                                                Definition

                                                                                Kennzeichnung, dass das numerische Ergebnis aus einem NICHT-LINEAREN Wertebereich stammt. Beispiele hierfür sind ganzzahlige Scores oder Titer-Reihen. Umgangssprachlich wird auch von sog. "semiquantitativen" Ergebnissen gesprochen. Seit LOINC® Version 2.76 ist das anhand des LOINC®-Codes offiziell definiert und ablesbar mit Scale = "SemiQn". Das Kennzeichen ist optional und wird vom messenden Labor gesetzt.

                                                                                ShortKennzeichen Nicht-linearer Referenzbereich
                                                                                Control0..1
                                                                                TypeExtension(KBV_EX_MIO_LAB_No_Linear_Reference_Range) (Extension Type: boolean)
                                                                                Must Supporttrue
                                                                                514. Observation.referenceRange.extension:noLinearReferenceRange.value[x]
                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                Must Supporttrue
                                                                                516. Observation.referenceRange.low
                                                                                Definition

                                                                                Die untere Richtgrenze ist eine quantitative Grenze. Datentyp und Einheit entsprechen denen beim quantitativen Messergebnis. Unter Eigenschaften sind mögliche Werte gelistet, die in dieses Feld hineinpassen könnten, beispielsweise ein Grenzwert aus dem LDT. Bei diesen Beispielen aus dem LDT gilt es zu beachten, dass die Grenzwerte nur für eine Richtgrenze vom Typ "normal" gelten.

                                                                                Disclaimer: FHIR® definiert aktuell nur inklusive Richtgrenzen. Für die Praxistauglichkeit besteht aber die Anforderung, auch exklusive Richtgrenzen abbilden zu können. Diese Thematik wurde schon bei HL7® FHIR® platziert, es gibt aber noch keine abschließende Festlegung dazu. Im Informationsmodell sind beide Optionen bereits dargestellt, um diese Anforderung sichtbar zu machen.

                                                                                Must Supporttrue
                                                                                Pattern Value{
                                                                                  "system" : "http://unitsofmeasure.org"
                                                                                }
                                                                                518. Observation.referenceRange.low.value
                                                                                Definition

                                                                                Numerischer Wert für eine gemessene Größe, eine Zahl mit optionalen Dezimalstellen.

                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                520. Observation.referenceRange.low.unit
                                                                                Definition

                                                                                Die Einheit leitet sich aus der Messgröße (gemessene Eigenschaft und Mengenmaß) ab. Ein Beispiel: Wenn die Messgröße "Massekonzentration pro Volumen" ist, kommen als Einheiten mg/dl oder g/dl in Frage. Nur UCUM-Einheiten sind zulässig.

                                                                                Nicht immer werden Richtgrenzen mit Einheiten angegeben. Ein typisches Bespiel hierfür: zum Immunitätsnachweis aus einer Probe werden Verdünnungsreihen von 1:2, 1:4, 1:8, 1:16, 1:32 usw. hergestellt. Die Verdünnungen gibt man auf Zellkulturen, die dann mit einem Virus infiziert werden. Die höchste Verdünnungsstufe, bei der noch eine Infektion der Zellen vollständig verhindert wird, also noch ausreichend Antikörper vorhanden sind, wird als Titer angegeben. Dieser Titer wird ohne Einheiten angeben.

                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                522. Observation.referenceRange.low.system
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                524. Observation.referenceRange.low.code
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                526. Observation.referenceRange.high
                                                                                Definition

                                                                                Die obere Richtgrenze ist eine quantitative Grenze. Datentyp und Einheit entsprechen denen beim quantitativen Messergebnis. Unter Eigenschaften sind mögliche Werte gelistet, die in dieses Feld hineinpassen könnten, beispielsweise ein Grenzwert aus dem LDT. Bei diesen Beispielen aus dem LDT gilt es zu beachten, dass die Grenzwerte nur für eine Richtgrenze vom Typ "normal" gelten.

                                                                                Disclaimer: FHIR® definiert aktuell nur inklusive Richtgrenzen. Für die Praxistauglichkeit besteht aber die Anforderung, auch exklusive Richtgrenzen abbilden zu können. Diese Thematik wurde schon bei HL7® FHIR® platziert, es gibt aber noch keine abschließende Festlegung dazu. Im Informationsmodell sind beide Optionen bereits dargestellt, um diese Anforderung sichtbar zu machen.

                                                                                Must Supporttrue
                                                                                Pattern Value{
                                                                                  "system" : "http://unitsofmeasure.org"
                                                                                }
                                                                                528. Observation.referenceRange.high.value
                                                                                Definition

                                                                                Numerischer Wert für eine gemessene Größe, eine Zahl mit optionalen Dezimalstellen.

                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                530. Observation.referenceRange.high.unit
                                                                                Definition

                                                                                Die Einheit leitet sich aus der Messgröße (gemessene Eigenschaft und Mengenmaß) ab. Ein Beispiel: Wenn die Messgröße "Massekonzentration pro Volumen" ist, kommen als Einheiten mg/dl oder g/dl in Frage. Nur UCUM-Einheiten sind zulässig.

                                                                                Nicht immer werden Richtgrenzen mit Einheiten angegeben. Ein typisches Bespiel hierfür: zum Immunitätsnachweis aus einer Probe werden Verdünnungsreihen von 1:2, 1:4, 1:8, 1:16, 1:32 usw. hergestellt. Die Verdünnungen gibt man auf Zellkulturen, die dann mit einem Virus infiziert werden. Die höchste Verdünnungsstufe, bei der noch eine Infektion der Zellen vollständig verhindert wird, also noch ausreichend Antikörper vorhanden sind, wird als Titer angegeben. Dieser Titer wird ohne Einheiten angeben.

                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                532. Observation.referenceRange.high.system
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                534. Observation.referenceRange.high.code
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                536. Observation.referenceRange.type
                                                                                Definition

                                                                                Die Typisierung von Richtgrenzen bezieht sich auf die Indikation einer Laboruntersuchung. Beispiele sind:

                                                                                • Referenzbereich, zur Feststellung oder Ausschluss von Erkrankungen
                                                                                • Therapeutischer Bereich, zur Einstellung einer medikamentösen Therapie
                                                                                • Zielbereich, zur Kontrolle medizinischer Maßnahmen
                                                                                • Perzentilen (z. B. circannuale 2,5-97,5, als 95% eines gesunden Kollektivs)
                                                                                • Erwartungsbereiche aufgrund endokrinologischer Konstitution
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                538. Observation.referenceRange.type.coding
                                                                                Definition

                                                                                Hier wird der Richtgrenzen-Typ in codierter Form angegeben.

                                                                                Für die codierte Richtgrenzen-Typisierung wird eine Auswahl von HL7®-Codes als (bevorzugte) Option angeboten. Die Nutzung der hinterlegten Codes ist abhängig vom Kontext.

                                                                                Must Supporttrue
                                                                                540. Observation.referenceRange.type.coding.system
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                542. Observation.referenceRange.type.coding.version
                                                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                Must Supporttrue
                                                                                544. Observation.referenceRange.type.coding.code
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                546. Observation.referenceRange.type.coding.display
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                548. Observation.referenceRange.type.coding.userSelected
                                                                                Control0..0
                                                                                550. Observation.referenceRange.type.text
                                                                                Definition

                                                                                Hier wird der Richtgrenzen-Typ als Freitext eingegeben.

                                                                                Must Supporttrue
                                                                                552. Observation.referenceRange.appliesTo
                                                                                Definition

                                                                                Die Ermittlung von "Normwerten" basiert üblicherweise auf 95% eines gesunden Erwachsenen-Kollektivs. Normwerte sind Grenzwerte, die sich auf ein „Normalkollektiv“ beziehen. Als Normalkollektiv wird definiert: „gesunde“ PatientInnen ohne erhöhtes Risiko. Es kann spezifische Richtgrenzen für andere Kollektive geben. Mögliche Unterscheidungen sind:

                                                                                • nach Alter
                                                                                • nach klinisch-relevantem Geschlecht (divers, männlich, weiblich)
                                                                                • nach Konstitution/Merkmal
                                                                                • nach körperlichem Zustand

                                                                                Beispielsweise:

                                                                                • Biologisch weiblich (female-typical)
                                                                                • Biologisch männlich (male-typical)
                                                                                • Weiblich, postmenopausal
                                                                                • Erwachsene, männlich, 30-50 Jahre
                                                                                • Raucher
                                                                                • Kind (Beginn des 4. bis zum vollendeten 12. Lebensjahr)

                                                                                Bei den Angaben zum Kollektiv können mehrere Angaben kombiniert aufgeführt werden. Zusätzlich zur Freitextangabe einer LDT-Information ist in FHIR® auch die Codierung möglich (optional).

                                                                                Must Supporttrue
                                                                                554. Observation.referenceRange.appliesTo.coding
                                                                                Definition

                                                                                Hier kann der "Kollektiv-Bezug" als codierte Information angegeben werden.

                                                                                Dieses ValueSet mit HL7®-Codes für den Kollektivbezug enthält (eHDSI-konform) bislang nur geschlechtsspezifische Bezüge. Viele weitere, mögliche Kollektivbezüge sind noch nicht standardisiert terminologisch abgebildet.

                                                                                BindingFor example codes, see KBV_VS_MIO_LAB_EHDSIReferenceRangeAppliesTo (1.0.0-update)
                                                                                (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_EHDSIReferenceRangeAppliesTo|1.0.0-update)
                                                                                Must Supporttrue
                                                                                556. Observation.referenceRange.appliesTo.coding.system
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                558. Observation.referenceRange.appliesTo.coding.version
                                                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                Must Supporttrue
                                                                                560. Observation.referenceRange.appliesTo.coding.code
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                562. Observation.referenceRange.appliesTo.coding.display
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                564. Observation.referenceRange.appliesTo.coding.userSelected
                                                                                Control0..0
                                                                                566. Observation.referenceRange.appliesTo.text
                                                                                Definition

                                                                                Freitextangabe zum Kollektiv-Bezug der Richtgrenzen

                                                                                Must Supporttrue
                                                                                568. Observation.referenceRange.age
                                                                                Control0..0
                                                                                570. Observation.referenceRange.text
                                                                                Definition

                                                                                Textbasierter Referenzbereich, der verwendet werden kann, wenn ein quantitativer Bereich nicht geeignet ist.

                                                                                Must Supporttrue
                                                                                572. Observation.hasMember
                                                                                Control0..0
                                                                                574. Observation.derivedFrom
                                                                                Definition

                                                                                Laboruntersuchungen, die als Berechnung erstellt werden, können auf Laboruntersuchungen beruhen, die hier referenziert werden. Hierbei ist zu beachten, dass die Angabe solch referenzierter Messunge(en) nicht zwingend vollständig ist.

                                                                                TypeReference(KBV_PR_MIO_LAB_Observation_Laboratory_Study)
                                                                                Must Supporttrue
                                                                                576. Observation.derivedFrom.reference
                                                                                Control1..?
                                                                                Must Supporttrue
                                                                                578. Observation.derivedFrom.type
                                                                                Control0..0
                                                                                580. Observation.derivedFrom.identifier
                                                                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                Control0..0
                                                                                582. Observation.derivedFrom.display
                                                                                Control0..0
                                                                                584. Observation.component
                                                                                Control0..0

                                                                                Guidance on how to interpret the contents of this table can be foundhere

                                                                                0. Observation
                                                                                Definition

                                                                                Dieses Profil bildet eine Laboruntersuchung ab.

                                                                                Laboruntersuchungen können als Messung oder als Berechnung erfolgen.

                                                                                Eine Laboruntersuchung als Messung beschreibt die quantitative oder qualitative Untersuchung eines spezifischen Laborparameters in einem definierten Probenmaterial; z. B. die Untersuchung des Hämoglobin-(Hb-)Werts als Konzentration im Blut. Der Bezug zur Probe, anhand derer die Messung vorgenommen wurde, muss erkennbar sein.

                                                                                Berechnete Laborergebnisse können auf Messungen basieren, z.B. kann die berechnete GFR (glomeruläre Filtrationsrate) auf einem gemessenen Kreatinin-Wert im Serum basieren.

                                                                                ShortMeasurements and simple assertions
                                                                                Comments

                                                                                Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.

                                                                                Control0..*
                                                                                Is Modifierfalse
                                                                                Summaryfalse
                                                                                Alternate NamesVital Signs, Measurement, Results, Tests
                                                                                Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                                                                                dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                                                                                dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                                                                                dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                                                                                dom-6: A resource should have narrative for robust management (text.`div`.exists())
                                                                                obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
                                                                                obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty())
                                                                                obs-code-1: For Observation.code either a coding or a data absent reason must be provided. When stating a data absent reason, a text for Observation.code must be provided as well. (code.coding.empty() or code.extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').empty() and (code.extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists() implies code.text.exists()))
                                                                                2. Observation.id
                                                                                Definition

                                                                                The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                                                                                ShortLogical id of this artifact
                                                                                Comments

                                                                                The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                                                                                Control0..1
                                                                                Typeid
                                                                                Is Modifierfalse
                                                                                Summarytrue
                                                                                4. Observation.meta
                                                                                Definition

                                                                                The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                                                                                ShortMetadata about the resource
                                                                                Control0..1
                                                                                TypeMeta
                                                                                Is Modifierfalse
                                                                                Must Supporttrue
                                                                                Summarytrue
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                6. Observation.meta.id
                                                                                Definition

                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                ShortUnique id for inter-element referencing
                                                                                Control0..0
                                                                                Typestring
                                                                                Is Modifierfalse
                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                Summaryfalse
                                                                                8. Observation.meta.extension
                                                                                Definition

                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                ShortAdditional content defined by implementations
                                                                                Comments

                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                Control0..*
                                                                                TypeExtension
                                                                                Is Modifierfalse
                                                                                Summaryfalse
                                                                                Alternate Namesextensions, user content
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                SlicingThis element introduces a set of slices on Observation.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                • value @ url
                                                                                • 10. Observation.meta.versionId
                                                                                  Definition

                                                                                  The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                                                                                  ShortVersion specific identifier
                                                                                  Comments

                                                                                  The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

                                                                                  Control0..1
                                                                                  Typeid
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Must Supporttrue
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  12. Observation.meta.lastUpdated
                                                                                  Definition

                                                                                  When the resource last changed - e.g. when the version changed.

                                                                                  ShortWhen the resource version last changed
                                                                                  Comments

                                                                                  This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

                                                                                  Control0..1
                                                                                  Typeinstant
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Must Supporttrue
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  14. Observation.meta.source
                                                                                  Definition

                                                                                  A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                                                                                  ShortIdentifies where the resource comes from
                                                                                  Comments

                                                                                  In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

                                                                                  This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

                                                                                  Control0..0
                                                                                  Typeuri
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  16. Observation.meta.profile
                                                                                  Definition

                                                                                  A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                                                                                  ShortProfiles this resource claims to conform to
                                                                                  Comments

                                                                                  It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

                                                                                  Control0..*
                                                                                  Typecanonical(StructureDefinition)
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  18. Observation.meta.security
                                                                                  Definition

                                                                                  Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                                                                                  ShortSecurity Labels applied to this resource
                                                                                  Comments

                                                                                  The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                                                                                  Control0..*
                                                                                  BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                                                                  (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

                                                                                  Security Labels from the Healthcare Privacy and Security Classification System.

                                                                                  TypeCoding
                                                                                  Is Modifierfalse
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  20. Observation.meta.tag
                                                                                  Definition

                                                                                  Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                                                                                  ShortTags applied to this resource
                                                                                  Comments

                                                                                  The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

                                                                                  Control0..*
                                                                                  BindingFor example codes, see CommonTags
                                                                                  (example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

                                                                                  Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

                                                                                  TypeCoding
                                                                                  Is Modifierfalse
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  22. Observation.implicitRules
                                                                                  Definition

                                                                                  A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                                                                                  ShortA set of rules under which this content was created
                                                                                  Comments

                                                                                  Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                                                                                  Control0..0
                                                                                  Typeuri
                                                                                  Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  24. Observation.language
                                                                                  Definition

                                                                                  The base language in which the resource is written.

                                                                                  ShortLanguage of the resource content
                                                                                  Comments

                                                                                  Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                                                                                  Control0..0
                                                                                  BindingThe codes SHOULD be taken from CommonLanguages
                                                                                  (preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

                                                                                  A human language.

                                                                                  Additional BindingsPurpose
                                                                                  AllLanguagesMax Binding
                                                                                  Typecode
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summaryfalse
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  26. Observation.text
                                                                                  Definition

                                                                                  A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                                                                                  ShortText summary of the resource, for human interpretation
                                                                                  Comments

                                                                                  Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                                                                                  Control0..1
                                                                                  TypeNarrative
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Alternate Namesnarrative, html, xhtml, display
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  28. Observation.text.id
                                                                                  Definition

                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                  ShortUnique id for inter-element referencing
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  Summaryfalse
                                                                                  30. Observation.text.extension
                                                                                  Definition

                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                  ShortAdditional content defined by implementations
                                                                                  Comments

                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                  Control0..*
                                                                                  TypeExtension
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Alternate Namesextensions, user content
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                  SlicingThis element introduces a set of slices on Observation.text.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                  • value @ url
                                                                                  • 32. Observation.text.status
                                                                                    Definition

                                                                                    The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

                                                                                    Shortgenerated | extensions | additional | empty
                                                                                    Control1..1
                                                                                    BindingThe codes SHALL be taken from NarrativeStatus
                                                                                    (required to http://hl7.org/fhir/ValueSet/narrative-status|4.0.1)

                                                                                    The status of a resource narrative.

                                                                                    Typecode
                                                                                    Is Modifierfalse
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summaryfalse
                                                                                    Pattern Valueextensions
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    34. Observation.text.div
                                                                                    Definition

                                                                                    The actual narrative content, a stripped down version of XHTML.

                                                                                    ShortLimited xhtml content
                                                                                    Comments

                                                                                    The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

                                                                                    Control1..1
                                                                                    Typexhtml
                                                                                    Is Modifierfalse
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summaryfalse
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
                                                                                    txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())
                                                                                    36. Observation.contained
                                                                                    Definition

                                                                                    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                                                                                    ShortContained, inline Resources
                                                                                    Comments

                                                                                    This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                                                                                    Control0..0
                                                                                    TypeResource
                                                                                    Is Modifierfalse
                                                                                    Summaryfalse
                                                                                    Alternate Namesinline resources, anonymous resources, contained resources
                                                                                    38. Observation.extension
                                                                                    Definition

                                                                                    An Extension

                                                                                    ShortExtension
                                                                                    Control0..*
                                                                                    TypeExtension
                                                                                    Is Modifierfalse
                                                                                    Must Supporttrue
                                                                                    Summaryfalse
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                    SlicingThis element introduces a set of slices on Observation.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                    • value @ url
                                                                                    • 40. Observation.extension:externalService
                                                                                      Slice NameexternalService
                                                                                      Definition

                                                                                      Dieses Kennzeichen wird gesetzt, wenn die Laboruntersuchung von einem anderen Labor durchgeführt wird.

                                                                                      ShortKennzeichen Fremdleistung
                                                                                      Control0..1
                                                                                      This element is affected by the following invariants: ele-1
                                                                                      TypeExtension(KBV_EX_MIO_LAB_External_Service) (Extension Type: boolean)
                                                                                      Is Modifierfalse
                                                                                      Must Supporttrue
                                                                                      Summaryfalse
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                      42. Observation.extension:externalService.id
                                                                                      Definition

                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                      ShortUnique id for inter-element referencing
                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                      Summaryfalse
                                                                                      44. Observation.extension:externalService.extension
                                                                                      Definition

                                                                                      An Extension

                                                                                      ShortExtension
                                                                                      Control0..0
                                                                                      TypeExtension
                                                                                      Is Modifierfalse
                                                                                      Summaryfalse
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                      SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                      • value @ url
                                                                                      • 46. Observation.extension:externalService.url
                                                                                        Definition

                                                                                        Source of the definition for the extension code - a logical name or a URL.

                                                                                        Shortidentifies the meaning of the extension
                                                                                        Comments

                                                                                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                        Control1..1
                                                                                        Typeuri
                                                                                        Is Modifierfalse
                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                        Summaryfalse
                                                                                        Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_External_Service
                                                                                        48. Observation.extension:externalService.value[x]
                                                                                        Definition

                                                                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                        ShortValue of extension
                                                                                        Control1..1
                                                                                        Typeboolean
                                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Must Supporttrue
                                                                                        Summaryfalse
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        50. Observation.extension:associationService
                                                                                        Slice NameassociationService
                                                                                        Definition

                                                                                        Dieses Kennzeichen wird gesetzt, wenn die "Fremdleistung" von einem anderen Labor aus dem eigenen Verbund durchgeführt wird und diese Information aus administrativen Gründen zusätzlich benötigt wird.

                                                                                        ShortKennzeichen Verbundleistung
                                                                                        Control0..1
                                                                                        This element is affected by the following invariants: ele-1
                                                                                        TypeExtension(KBV_EX_MIO_LAB_Association_Service) (Extension Type: boolean)
                                                                                        Is Modifierfalse
                                                                                        Must Supporttrue
                                                                                        Summaryfalse
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                        52. Observation.extension:associationService.id
                                                                                        Definition

                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                        ShortUnique id for inter-element referencing
                                                                                        Control0..1
                                                                                        Typestring
                                                                                        Is Modifierfalse
                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                        Summaryfalse
                                                                                        54. Observation.extension:associationService.extension
                                                                                        Definition

                                                                                        An Extension

                                                                                        ShortExtension
                                                                                        Control0..0
                                                                                        TypeExtension
                                                                                        Is Modifierfalse
                                                                                        Summaryfalse
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                        SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                        • value @ url
                                                                                        • 56. Observation.extension:associationService.url
                                                                                          Definition

                                                                                          Source of the definition for the extension code - a logical name or a URL.

                                                                                          Shortidentifies the meaning of the extension
                                                                                          Comments

                                                                                          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                          Control1..1
                                                                                          Typeuri
                                                                                          Is Modifierfalse
                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                          Summaryfalse
                                                                                          Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Association_Service
                                                                                          58. Observation.extension:associationService.value[x]
                                                                                          Definition

                                                                                          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                          ShortValue of extension
                                                                                          Control1..1
                                                                                          Typeboolean
                                                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Must Supporttrue
                                                                                          Summaryfalse
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          60. Observation.extension:accreditedService
                                                                                          Slice NameaccreditedService
                                                                                          Definition

                                                                                          Diese Angabe betrifft akkreditierte Labore. Basierend auf der Akkreditierung ist gefordert, dass nicht akkreditierte Leistungen gekennzeichnet werden, auch im Laborbefund.

                                                                                          ShortKennzeichen Akkreditierte Laboruntersuchung
                                                                                          Control0..1
                                                                                          This element is affected by the following invariants: ele-1
                                                                                          TypeExtension(KBV_EX_MIO_LAB_Accredited_Service) (Extension Type: boolean)
                                                                                          Is Modifierfalse
                                                                                          Must Supporttrue
                                                                                          Summaryfalse
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                          62. Observation.extension:accreditedService.id
                                                                                          Definition

                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                          ShortUnique id for inter-element referencing
                                                                                          Control0..1
                                                                                          Typestring
                                                                                          Is Modifierfalse
                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                          Summaryfalse
                                                                                          64. Observation.extension:accreditedService.extension
                                                                                          Definition

                                                                                          An Extension

                                                                                          ShortExtension
                                                                                          Control0..0
                                                                                          TypeExtension
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                          SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                          • value @ url
                                                                                          • 66. Observation.extension:accreditedService.url
                                                                                            Definition

                                                                                            Source of the definition for the extension code - a logical name or a URL.

                                                                                            Shortidentifies the meaning of the extension
                                                                                            Comments

                                                                                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                            Control1..1
                                                                                            Typeuri
                                                                                            Is Modifierfalse
                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                            Summaryfalse
                                                                                            Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Accredited_Service
                                                                                            68. Observation.extension:accreditedService.value[x]
                                                                                            Definition

                                                                                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                            ShortValue of extension
                                                                                            Control1..1
                                                                                            Typeboolean
                                                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                            Is Modifierfalse
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Must Supporttrue
                                                                                            Summaryfalse
                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            70. Observation.extension:zlogValue
                                                                                            Slice NamezlogValue
                                                                                            Definition

                                                                                            Der zlog-Wert ist ein Relativwert, der auf einer logarithmischen Skala angibt, um wie viele Standardabweichungen ein Messwert vom Mittelwert des Referenzkollektivs abweicht. Er kann ergänzend, orientierend zur Bewertung eines Messergebnisses herangezogen werden.

                                                                                            Berechnung zlog-Wert zum Laborergebnis (x):

                                                                                            zlog = (log(x) –(log(UG)+log(OG))/2)*3,92/(log(OG)–log(UG))

                                                                                            (UG),(OG) sind die Unter- und Obergrenzen des Referenzintervalls

                                                                                            Interpretation des zlog-Wertes:

                                                                                            • Sein Referenzintervall liegt methodenunabhängig stets zwischen – 1,96 und + 1,96
                                                                                            • Stark erniedrigte oder erhöhte Laborergebnisse führen zu zlog-Werten um – 5 bzw. + 5.
                                                                                            ShortExtension
                                                                                            Control0..1
                                                                                            This element is affected by the following invariants: ele-1
                                                                                            TypeExtension(KBV_EX_MIO_LAB_zlog) (Extension Type: decimal)
                                                                                            Is Modifierfalse
                                                                                            Must Supporttrue
                                                                                            Summaryfalse
                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                            72. Observation.extension:zlogValue.id
                                                                                            Definition

                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                            ShortUnique id for inter-element referencing
                                                                                            Control0..1
                                                                                            Typestring
                                                                                            Is Modifierfalse
                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                            Summaryfalse
                                                                                            74. Observation.extension:zlogValue.extension
                                                                                            Definition

                                                                                            An Extension

                                                                                            ShortExtension
                                                                                            Control0..0
                                                                                            TypeExtension
                                                                                            Is Modifierfalse
                                                                                            Summaryfalse
                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                            SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                            • value @ url
                                                                                            • 76. Observation.extension:zlogValue.url
                                                                                              Definition

                                                                                              Source of the definition for the extension code - a logical name or a URL.

                                                                                              Shortidentifies the meaning of the extension
                                                                                              Comments

                                                                                              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                              Control1..1
                                                                                              Typeuri
                                                                                              Is Modifierfalse
                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                              Summaryfalse
                                                                                              Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_zlog
                                                                                              78. Observation.extension:zlogValue.value[x]
                                                                                              Definition

                                                                                              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                              ShortValue of extension
                                                                                              Control1..1
                                                                                              Typedecimal
                                                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Must Supporttrue
                                                                                              Summaryfalse
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              80. Observation.extension:alternativeResult
                                                                                              Slice NamealternativeResult
                                                                                              Definition

                                                                                              Hier werden auf eine alternative Einheit umgerechnete Messergebnisse mitgeführt.

                                                                                              Dies betrifft das quantitative Messergebnis, sowie die Richtgrenzenwerte und die zlog-Wert-Berechnung. Aus diesem Grund sind deren Strukturen hier (noch einmal) enthalten.

                                                                                              ShortExtension
                                                                                              Control0..*
                                                                                              This element is affected by the following invariants: ele-1
                                                                                              TypeExtension(KBV_EX_MIO_LAB_Alternative_Result) (Complex Extension)
                                                                                              Is Modifierfalse
                                                                                              Must Supporttrue
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                              82. Observation.extension:alternativeResult.id
                                                                                              Definition

                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                              ShortUnique id for inter-element referencing
                                                                                              Control0..1
                                                                                              Typestring
                                                                                              Is Modifierfalse
                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                              Summaryfalse
                                                                                              84. Observation.extension:alternativeResult.extension
                                                                                              Definition

                                                                                              An Extension

                                                                                              ShortExtension
                                                                                              Control1..*
                                                                                              TypeExtension
                                                                                              Is Modifierfalse
                                                                                              Summaryfalse
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                              SlicingThis element introduces a set of slices on Observation.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                              • value @ url
                                                                                              • 86. Observation.extension:alternativeResult.extension:value
                                                                                                Slice Namevalue
                                                                                                Definition

                                                                                                Hier wird ein Messergebnis mit Alternativeinheit angegeben.

                                                                                                ShortMessergebnis quantitativ mit Alternativeinheit
                                                                                                Control1..1
                                                                                                TypeExtension
                                                                                                Is Modifierfalse
                                                                                                Must Supporttrue
                                                                                                Summaryfalse
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                88. Observation.extension:alternativeResult.extension:value.id
                                                                                                Definition

                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                ShortUnique id for inter-element referencing
                                                                                                Control0..1
                                                                                                Typestring
                                                                                                Is Modifierfalse
                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                Summaryfalse
                                                                                                90. Observation.extension:alternativeResult.extension:value.extension
                                                                                                Definition

                                                                                                An Extension

                                                                                                ShortExtension
                                                                                                Control0..0
                                                                                                TypeExtension
                                                                                                Is Modifierfalse
                                                                                                Summaryfalse
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                SlicingThis element introduces a set of slices on Observation.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                • value @ url
                                                                                                • 92. Observation.extension:alternativeResult.extension:value.url
                                                                                                  Definition

                                                                                                  Source of the definition for the extension code - a logical name or a URL.

                                                                                                  Shortidentifies the meaning of the extension
                                                                                                  Comments

                                                                                                  The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                  Control1..1
                                                                                                  Typeuri
                                                                                                  Is Modifierfalse
                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                  Summaryfalse
                                                                                                  Fixed Valuevalue
                                                                                                  94. Observation.extension:alternativeResult.extension:value.value[x]
                                                                                                  Definition

                                                                                                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                  ShortValue of extension
                                                                                                  Control1..1
                                                                                                  TypeChoice of: Quantity, Range, Ratio
                                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                  Is Modifierfalse
                                                                                                  Must Supporttrue
                                                                                                  Must Support TypesNo must-support rules about the choice of types/profiles
                                                                                                  Summaryfalse
                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  SlicingThis element introduces a set of slices on Observation.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                  • type @ $this
                                                                                                  • 96. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity
                                                                                                    Slice NamevalueQuantity
                                                                                                    Definition

                                                                                                    Hier wird der Ergebniswert als Quantität mit Alternativeinheit angegeben.

                                                                                                    ShortErgebniswert mit Alternativeinheit
                                                                                                    Control0..1
                                                                                                    TypeQuantity
                                                                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                    Is Modifierfalse
                                                                                                    Must Supporttrue
                                                                                                    Summaryfalse
                                                                                                    Pattern Value{
                                                                                                      "system" : "http://unitsofmeasure.org"
                                                                                                    }
                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                    98. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.id
                                                                                                    Definition

                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                    ShortUnique id for inter-element referencing
                                                                                                    Control0..1
                                                                                                    Typestring
                                                                                                    Is Modifierfalse
                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                    Summaryfalse
                                                                                                    100. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.extension
                                                                                                    Definition

                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                    ShortAdditional content defined by implementations
                                                                                                    Comments

                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                    Control0..*
                                                                                                    TypeExtension
                                                                                                    Is Modifierfalse
                                                                                                    Summaryfalse
                                                                                                    Alternate Namesextensions, user content
                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                    SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                    • value @ url
                                                                                                    • 102. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.value
                                                                                                      Definition

                                                                                                      The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                      ShortNumerical value (with implicit precision)
                                                                                                      Comments

                                                                                                      The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                      Control1..1
                                                                                                      Typedecimal
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Must Supporttrue
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Precision is handled implicitly in almost all cases of measurement.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      104. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.comparator
                                                                                                      Definition

                                                                                                      How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                                                                      Short< | <= | >= | > - how to understand the value
                                                                                                      Control0..1
                                                                                                      BindingThe codes SHALL be taken from QuantityComparator
                                                                                                      (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                      How the Quantity should be understood and represented.

                                                                                                      Typecode
                                                                                                      Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Must Supporttrue
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                      Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      106. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.unit
                                                                                                      Definition

                                                                                                      A human-readable form of the unit.

                                                                                                      ShortUnit representation
                                                                                                      Control1..1
                                                                                                      Typestring
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Must Supporttrue
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      108. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.system
                                                                                                      Definition

                                                                                                      The identification of the system that provides the coded form of the unit.

                                                                                                      ShortSystem that defines coded unit form
                                                                                                      Control1..1
                                                                                                      This element is affected by the following invariants: qty-3
                                                                                                      Typeuri
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Must Supporttrue
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Need to know the system that defines the coded form of the unit.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      110. Observation.extension:alternativeResult.extension:value.value[x]:valueQuantity.code
                                                                                                      Definition

                                                                                                      A computer processable form of the unit in some unit representation system.

                                                                                                      ShortCoded form of the unit
                                                                                                      Comments

                                                                                                      The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                      Control1..1
                                                                                                      Typecode
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Must Supporttrue
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      112. Observation.extension:alternativeResult.extension:value.value[x]:valueRange
                                                                                                      Slice NamevalueRange
                                                                                                      Definition

                                                                                                      Hier wird das Ergebnis als ein Wertebereich/Werteintervall mit Alternativeinheit angegeben.

                                                                                                      ShortErgebnisbereich mit Alternativeinheit
                                                                                                      Control0..1
                                                                                                      TypeRange
                                                                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                      Is Modifierfalse
                                                                                                      Must Supporttrue
                                                                                                      Summaryfalse
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      114. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.id
                                                                                                      Definition

                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                      ShortUnique id for inter-element referencing
                                                                                                      Control0..1
                                                                                                      Typestring
                                                                                                      Is Modifierfalse
                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                      Summaryfalse
                                                                                                      116. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.extension
                                                                                                      Definition

                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                      ShortAdditional content defined by implementations
                                                                                                      Comments

                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                      Control0..*
                                                                                                      TypeExtension
                                                                                                      Is Modifierfalse
                                                                                                      Summaryfalse
                                                                                                      Alternate Namesextensions, user content
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                      SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                      • value @ url
                                                                                                      • 118. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low
                                                                                                        Definition

                                                                                                        The low limit. The boundary is inclusive.

                                                                                                        ShortLow limit
                                                                                                        Comments

                                                                                                        If the low element is missing, the low boundary is not known.

                                                                                                        Control0..1
                                                                                                        TypeQuantity(SimpleQuantity)
                                                                                                        Is Modifierfalse
                                                                                                        Must Supporttrue
                                                                                                        Summarytrue
                                                                                                        Pattern Value{
                                                                                                          "system" : "http://unitsofmeasure.org"
                                                                                                        }
                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                        120. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.id
                                                                                                        Definition

                                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                        ShortUnique id for inter-element referencing
                                                                                                        Control0..1
                                                                                                        Typestring
                                                                                                        Is Modifierfalse
                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                        Summaryfalse
                                                                                                        122. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.extension
                                                                                                        Definition

                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                        ShortAdditional content defined by implementations
                                                                                                        Comments

                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                        Control0..*
                                                                                                        TypeExtension
                                                                                                        Is Modifierfalse
                                                                                                        Summaryfalse
                                                                                                        Alternate Namesextensions, user content
                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                        SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                        • value @ url
                                                                                                        • 124. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.value
                                                                                                          Definition

                                                                                                          The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                          ShortNumerical value (with implicit precision)
                                                                                                          Comments

                                                                                                          The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                          Control1..1
                                                                                                          Typedecimal
                                                                                                          Is Modifierfalse
                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                          Must Supporttrue
                                                                                                          Summarytrue
                                                                                                          Requirements

                                                                                                          Precision is handled implicitly in almost all cases of measurement.

                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          126. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.comparator
                                                                                                          Definition

                                                                                                          Not allowed to be used in this context

                                                                                                          Short< | <= | >= | > - how to understand the value
                                                                                                          Control0..0
                                                                                                          BindingThe codes SHALL be taken from QuantityComparator
                                                                                                          (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                          How the Quantity should be understood and represented.

                                                                                                          Typecode
                                                                                                          Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                          Summarytrue
                                                                                                          Requirements

                                                                                                          Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                          Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          128. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.unit
                                                                                                          Definition

                                                                                                          A human-readable form of the unit.

                                                                                                          ShortUnit representation
                                                                                                          Control1..1
                                                                                                          Typestring
                                                                                                          Is Modifierfalse
                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                          Must Supporttrue
                                                                                                          Summarytrue
                                                                                                          Requirements

                                                                                                          There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          130. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.system
                                                                                                          Definition

                                                                                                          The identification of the system that provides the coded form of the unit.

                                                                                                          ShortSystem that defines coded unit form
                                                                                                          Control1..1
                                                                                                          This element is affected by the following invariants: qty-3
                                                                                                          Typeuri
                                                                                                          Is Modifierfalse
                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                          Must Supporttrue
                                                                                                          Summarytrue
                                                                                                          Requirements

                                                                                                          Need to know the system that defines the coded form of the unit.

                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          132. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.low.code
                                                                                                          Definition

                                                                                                          A computer processable form of the unit in some unit representation system.

                                                                                                          ShortCoded form of the unit
                                                                                                          Comments

                                                                                                          The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                          Control1..1
                                                                                                          Typecode
                                                                                                          Is Modifierfalse
                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                          Must Supporttrue
                                                                                                          Summarytrue
                                                                                                          Requirements

                                                                                                          Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          134. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high
                                                                                                          Definition

                                                                                                          The high limit. The boundary is inclusive.

                                                                                                          ShortHigh limit
                                                                                                          Comments

                                                                                                          If the high element is missing, the high boundary is not known.

                                                                                                          Control0..1
                                                                                                          TypeQuantity(SimpleQuantity)
                                                                                                          Is Modifierfalse
                                                                                                          Must Supporttrue
                                                                                                          Summarytrue
                                                                                                          Pattern Value{
                                                                                                            "system" : "http://unitsofmeasure.org"
                                                                                                          }
                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          136. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.id
                                                                                                          Definition

                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                          ShortUnique id for inter-element referencing
                                                                                                          Control0..1
                                                                                                          Typestring
                                                                                                          Is Modifierfalse
                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                          Summaryfalse
                                                                                                          138. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.extension
                                                                                                          Definition

                                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                          ShortAdditional content defined by implementations
                                                                                                          Comments

                                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                          Control0..*
                                                                                                          TypeExtension
                                                                                                          Is Modifierfalse
                                                                                                          Summaryfalse
                                                                                                          Alternate Namesextensions, user content
                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                          SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].high.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                          • value @ url
                                                                                                          • 140. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.value
                                                                                                            Definition

                                                                                                            The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                            ShortNumerical value (with implicit precision)
                                                                                                            Comments

                                                                                                            The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                            Control1..1
                                                                                                            Typedecimal
                                                                                                            Is Modifierfalse
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Must Supporttrue
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            Precision is handled implicitly in almost all cases of measurement.

                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            142. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.comparator
                                                                                                            Definition

                                                                                                            Not allowed to be used in this context

                                                                                                            Short< | <= | >= | > - how to understand the value
                                                                                                            Control0..0
                                                                                                            BindingThe codes SHALL be taken from QuantityComparator
                                                                                                            (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                            How the Quantity should be understood and represented.

                                                                                                            Typecode
                                                                                                            Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                            Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            144. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.unit
                                                                                                            Definition

                                                                                                            A human-readable form of the unit.

                                                                                                            ShortUnit representation
                                                                                                            Control1..1
                                                                                                            Typestring
                                                                                                            Is Modifierfalse
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Must Supporttrue
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            146. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.system
                                                                                                            Definition

                                                                                                            The identification of the system that provides the coded form of the unit.

                                                                                                            ShortSystem that defines coded unit form
                                                                                                            Control1..1
                                                                                                            This element is affected by the following invariants: qty-3
                                                                                                            Typeuri
                                                                                                            Is Modifierfalse
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Must Supporttrue
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            Need to know the system that defines the coded form of the unit.

                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            148. Observation.extension:alternativeResult.extension:value.value[x]:valueRange.high.code
                                                                                                            Definition

                                                                                                            A computer processable form of the unit in some unit representation system.

                                                                                                            ShortCoded form of the unit
                                                                                                            Comments

                                                                                                            The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                            Control1..1
                                                                                                            Typecode
                                                                                                            Is Modifierfalse
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Must Supporttrue
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            150. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio
                                                                                                            Slice NamevalueRatio
                                                                                                            Definition

                                                                                                            Hier wird der Ergebniswert als Ratio mit Alternativeinheiten angegeben.

                                                                                                            ShortRatio mit Alternativeinheit
                                                                                                            Control0..1
                                                                                                            TypeRatio
                                                                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                            Is Modifierfalse
                                                                                                            Must Supporttrue
                                                                                                            Summaryfalse
                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            152. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.id
                                                                                                            Definition

                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                            ShortUnique id for inter-element referencing
                                                                                                            Control0..1
                                                                                                            Typestring
                                                                                                            Is Modifierfalse
                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                            Summaryfalse
                                                                                                            154. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.extension
                                                                                                            Definition

                                                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                            ShortAdditional content defined by implementations
                                                                                                            Comments

                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                            Control0..*
                                                                                                            TypeExtension
                                                                                                            Is Modifierfalse
                                                                                                            Summaryfalse
                                                                                                            Alternate Namesextensions, user content
                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                            SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                            • value @ url
                                                                                                            • 156. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator
                                                                                                              Definition

                                                                                                              The value of the numerator.

                                                                                                              ShortNumerator value
                                                                                                              Control1..1
                                                                                                              TypeQuantity
                                                                                                              Is Modifierfalse
                                                                                                              Must Supporttrue
                                                                                                              Summarytrue
                                                                                                              Pattern Value{
                                                                                                                "system" : "http://unitsofmeasure.org"
                                                                                                              }
                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              158. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.id
                                                                                                              Definition

                                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                              ShortUnique id for inter-element referencing
                                                                                                              Control0..1
                                                                                                              Typestring
                                                                                                              Is Modifierfalse
                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                              Summaryfalse
                                                                                                              160. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.extension
                                                                                                              Definition

                                                                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                              ShortAdditional content defined by implementations
                                                                                                              Comments

                                                                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                              Control0..*
                                                                                                              TypeExtension
                                                                                                              Is Modifierfalse
                                                                                                              Summaryfalse
                                                                                                              Alternate Namesextensions, user content
                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                              SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].numerator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                              • value @ url
                                                                                                              • 162. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.value
                                                                                                                Definition

                                                                                                                The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                                ShortNumerical value (with implicit precision)
                                                                                                                Comments

                                                                                                                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                Control1..1
                                                                                                                Typedecimal
                                                                                                                Is Modifierfalse
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Must Supporttrue
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                164. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.comparator
                                                                                                                Definition

                                                                                                                How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                                                                                Short< | <= | >= | > - how to understand the value
                                                                                                                Control0..1
                                                                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                How the Quantity should be understood and represented.

                                                                                                                Typecode
                                                                                                                Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Must Supporttrue
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                166. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.unit
                                                                                                                Definition

                                                                                                                A human-readable form of the unit.

                                                                                                                ShortUnit representation
                                                                                                                Control1..1
                                                                                                                Typestring
                                                                                                                Is Modifierfalse
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Must Supporttrue
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                168. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.system
                                                                                                                Definition

                                                                                                                The identification of the system that provides the coded form of the unit.

                                                                                                                ShortSystem that defines coded unit form
                                                                                                                Control1..1
                                                                                                                This element is affected by the following invariants: qty-3
                                                                                                                Typeuri
                                                                                                                Is Modifierfalse
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Must Supporttrue
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                Need to know the system that defines the coded form of the unit.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                170. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.numerator.code
                                                                                                                Definition

                                                                                                                A computer processable form of the unit in some unit representation system.

                                                                                                                ShortCoded form of the unit
                                                                                                                Comments

                                                                                                                The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                Control1..1
                                                                                                                Typecode
                                                                                                                Is Modifierfalse
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Must Supporttrue
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                172. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator
                                                                                                                Definition

                                                                                                                The value of the denominator.

                                                                                                                ShortDenominator value
                                                                                                                Control1..1
                                                                                                                TypeQuantity
                                                                                                                Is Modifierfalse
                                                                                                                Must Supporttrue
                                                                                                                Summarytrue
                                                                                                                Pattern Value{
                                                                                                                  "system" : "http://unitsofmeasure.org"
                                                                                                                }
                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                174. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.id
                                                                                                                Definition

                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                Control0..1
                                                                                                                Typestring
                                                                                                                Is Modifierfalse
                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                Summaryfalse
                                                                                                                176. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.extension
                                                                                                                Definition

                                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                ShortAdditional content defined by implementations
                                                                                                                Comments

                                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                Control0..*
                                                                                                                TypeExtension
                                                                                                                Is Modifierfalse
                                                                                                                Summaryfalse
                                                                                                                Alternate Namesextensions, user content
                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].denominator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                • value @ url
                                                                                                                • 178. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.value
                                                                                                                  Definition

                                                                                                                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                                  ShortNumerical value (with implicit precision)
                                                                                                                  Comments

                                                                                                                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                  Control1..1
                                                                                                                  Typedecimal
                                                                                                                  Is Modifierfalse
                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                  Must Supporttrue
                                                                                                                  Summarytrue
                                                                                                                  Requirements

                                                                                                                  Precision is handled implicitly in almost all cases of measurement.

                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  180. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.comparator
                                                                                                                  Definition

                                                                                                                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                                                                                  Short< | <= | >= | > - how to understand the value
                                                                                                                  Control0..1
                                                                                                                  BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                  How the Quantity should be understood and represented.

                                                                                                                  Typecode
                                                                                                                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                  Summarytrue
                                                                                                                  Requirements

                                                                                                                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  182. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.unit
                                                                                                                  Definition

                                                                                                                  A human-readable form of the unit.

                                                                                                                  ShortUnit representation
                                                                                                                  Control1..1
                                                                                                                  Typestring
                                                                                                                  Is Modifierfalse
                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                  Must Supporttrue
                                                                                                                  Summarytrue
                                                                                                                  Requirements

                                                                                                                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  184. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.system
                                                                                                                  Definition

                                                                                                                  The identification of the system that provides the coded form of the unit.

                                                                                                                  ShortSystem that defines coded unit form
                                                                                                                  Control1..1
                                                                                                                  This element is affected by the following invariants: qty-3
                                                                                                                  Typeuri
                                                                                                                  Is Modifierfalse
                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                  Must Supporttrue
                                                                                                                  Summarytrue
                                                                                                                  Requirements

                                                                                                                  Need to know the system that defines the coded form of the unit.

                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  186. Observation.extension:alternativeResult.extension:value.value[x]:valueRatio.denominator.code
                                                                                                                  Definition

                                                                                                                  A computer processable form of the unit in some unit representation system.

                                                                                                                  ShortCoded form of the unit
                                                                                                                  Comments

                                                                                                                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                  Control1..1
                                                                                                                  Typecode
                                                                                                                  Is Modifierfalse
                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                  Must Supporttrue
                                                                                                                  Summarytrue
                                                                                                                  Requirements

                                                                                                                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  188. Observation.extension:alternativeResult.extension:referenceRange
                                                                                                                  Slice NamereferenceRange
                                                                                                                  Definition

                                                                                                                  Richtgrenzen für das quantitative Ergebnis mit Alternativeinheit.

                                                                                                                  ShortRichtgrenzen für Alternativeinheit
                                                                                                                  Control0..1
                                                                                                                  TypeExtension
                                                                                                                  Is Modifierfalse
                                                                                                                  Must Supporttrue
                                                                                                                  Summaryfalse
                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                  190. Observation.extension:alternativeResult.extension:referenceRange.id
                                                                                                                  Definition

                                                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                  ShortUnique id for inter-element referencing
                                                                                                                  Control0..1
                                                                                                                  Typestring
                                                                                                                  Is Modifierfalse
                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                  Summaryfalse
                                                                                                                  192. Observation.extension:alternativeResult.extension:referenceRange.extension
                                                                                                                  Definition

                                                                                                                  An Extension

                                                                                                                  ShortExtension
                                                                                                                  Control0..0
                                                                                                                  TypeExtension
                                                                                                                  Is Modifierfalse
                                                                                                                  Summaryfalse
                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                  SlicingThis element introduces a set of slices on Observation.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                  • value @ url
                                                                                                                  • 194. Observation.extension:alternativeResult.extension:referenceRange.url
                                                                                                                    Definition

                                                                                                                    Source of the definition for the extension code - a logical name or a URL.

                                                                                                                    Shortidentifies the meaning of the extension
                                                                                                                    Comments

                                                                                                                    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                                    Control1..1
                                                                                                                    Typeuri
                                                                                                                    Is Modifierfalse
                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                    Summaryfalse
                                                                                                                    Fixed ValuereferenceRange
                                                                                                                    196. Observation.extension:alternativeResult.extension:referenceRange.value[x]
                                                                                                                    Definition

                                                                                                                    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                                    ShortValue of extension
                                                                                                                    Control1..1
                                                                                                                    TypeRange
                                                                                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                    Is Modifierfalse
                                                                                                                    Must Supporttrue
                                                                                                                    Summaryfalse
                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                    198. Observation.extension:alternativeResult.extension:referenceRange.value[x].id
                                                                                                                    Definition

                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                    Control0..1
                                                                                                                    Typestring
                                                                                                                    Is Modifierfalse
                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                    Summaryfalse
                                                                                                                    200. Observation.extension:alternativeResult.extension:referenceRange.value[x].extension
                                                                                                                    Definition

                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                    ShortAdditional content defined by implementations
                                                                                                                    Comments

                                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                    Control0..*
                                                                                                                    TypeExtension
                                                                                                                    Is Modifierfalse
                                                                                                                    Summaryfalse
                                                                                                                    Alternate Namesextensions, user content
                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                    SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                    • value @ url
                                                                                                                    • 202. Observation.extension:alternativeResult.extension:referenceRange.value[x].low
                                                                                                                      Definition

                                                                                                                      The low limit. The boundary is inclusive.

                                                                                                                      ShortLow limit
                                                                                                                      Comments

                                                                                                                      If the low element is missing, the low boundary is not known.

                                                                                                                      Control0..1
                                                                                                                      TypeQuantity(SimpleQuantity)
                                                                                                                      Is Modifierfalse
                                                                                                                      Must Supporttrue
                                                                                                                      Summarytrue
                                                                                                                      Pattern Value{
                                                                                                                        "system" : "http://unitsofmeasure.org"
                                                                                                                      }
                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      204. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.id
                                                                                                                      Definition

                                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                      ShortUnique id for inter-element referencing
                                                                                                                      Control0..1
                                                                                                                      Typestring
                                                                                                                      Is Modifierfalse
                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                      Summaryfalse
                                                                                                                      206. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.extension
                                                                                                                      Definition

                                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                      ShortAdditional content defined by implementations
                                                                                                                      Comments

                                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                      Control0..*
                                                                                                                      TypeExtension
                                                                                                                      Is Modifierfalse
                                                                                                                      Summaryfalse
                                                                                                                      Alternate Namesextensions, user content
                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                      SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                      • value @ url
                                                                                                                      • 208. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.value
                                                                                                                        Definition

                                                                                                                        The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                                        ShortNumerical value (with implicit precision)
                                                                                                                        Comments

                                                                                                                        The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                        Control1..1
                                                                                                                        Typedecimal
                                                                                                                        Is Modifierfalse
                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                        Must Supporttrue
                                                                                                                        Summarytrue
                                                                                                                        Requirements

                                                                                                                        Precision is handled implicitly in almost all cases of measurement.

                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        210. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.comparator
                                                                                                                        Definition

                                                                                                                        Not allowed to be used in this context

                                                                                                                        Short< | <= | >= | > - how to understand the value
                                                                                                                        Control0..0
                                                                                                                        BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                        How the Quantity should be understood and represented.

                                                                                                                        Typecode
                                                                                                                        Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                        Summarytrue
                                                                                                                        Requirements

                                                                                                                        Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        212. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.unit
                                                                                                                        Definition

                                                                                                                        A human-readable form of the unit.

                                                                                                                        ShortUnit representation
                                                                                                                        Control1..1
                                                                                                                        Typestring
                                                                                                                        Is Modifierfalse
                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                        Must Supporttrue
                                                                                                                        Summarytrue
                                                                                                                        Requirements

                                                                                                                        There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        214. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.system
                                                                                                                        Definition

                                                                                                                        The identification of the system that provides the coded form of the unit.

                                                                                                                        ShortSystem that defines coded unit form
                                                                                                                        Control1..1
                                                                                                                        This element is affected by the following invariants: qty-3
                                                                                                                        Typeuri
                                                                                                                        Is Modifierfalse
                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                        Must Supporttrue
                                                                                                                        Summarytrue
                                                                                                                        Requirements

                                                                                                                        Need to know the system that defines the coded form of the unit.

                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        216. Observation.extension:alternativeResult.extension:referenceRange.value[x].low.code
                                                                                                                        Definition

                                                                                                                        A computer processable form of the unit in some unit representation system.

                                                                                                                        ShortCoded form of the unit
                                                                                                                        Comments

                                                                                                                        The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                        Control1..1
                                                                                                                        Typecode
                                                                                                                        Is Modifierfalse
                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                        Must Supporttrue
                                                                                                                        Summarytrue
                                                                                                                        Requirements

                                                                                                                        Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        218. Observation.extension:alternativeResult.extension:referenceRange.value[x].high
                                                                                                                        Definition

                                                                                                                        The high limit. The boundary is inclusive.

                                                                                                                        ShortHigh limit
                                                                                                                        Comments

                                                                                                                        If the high element is missing, the high boundary is not known.

                                                                                                                        Control0..1
                                                                                                                        TypeQuantity(SimpleQuantity)
                                                                                                                        Is Modifierfalse
                                                                                                                        Must Supporttrue
                                                                                                                        Summarytrue
                                                                                                                        Pattern Value{
                                                                                                                          "system" : "http://unitsofmeasure.org"
                                                                                                                        }
                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        220. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.id
                                                                                                                        Definition

                                                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                        ShortUnique id for inter-element referencing
                                                                                                                        Control0..1
                                                                                                                        Typestring
                                                                                                                        Is Modifierfalse
                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                        Summaryfalse
                                                                                                                        222. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.extension
                                                                                                                        Definition

                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                        ShortAdditional content defined by implementations
                                                                                                                        Comments

                                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                        Control0..*
                                                                                                                        TypeExtension
                                                                                                                        Is Modifierfalse
                                                                                                                        Summaryfalse
                                                                                                                        Alternate Namesextensions, user content
                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                        SlicingThis element introduces a set of slices on Observation.extension.extension.value[x].high.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                        • value @ url
                                                                                                                        • 224. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.value
                                                                                                                          Definition

                                                                                                                          The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                                          ShortNumerical value (with implicit precision)
                                                                                                                          Comments

                                                                                                                          The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                          Control1..1
                                                                                                                          Typedecimal
                                                                                                                          Is Modifierfalse
                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                          Must Supporttrue
                                                                                                                          Summarytrue
                                                                                                                          Requirements

                                                                                                                          Precision is handled implicitly in almost all cases of measurement.

                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                          226. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.comparator
                                                                                                                          Definition

                                                                                                                          Not allowed to be used in this context

                                                                                                                          Short< | <= | >= | > - how to understand the value
                                                                                                                          Control0..0
                                                                                                                          BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                          (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                          How the Quantity should be understood and represented.

                                                                                                                          Typecode
                                                                                                                          Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                          Summarytrue
                                                                                                                          Requirements

                                                                                                                          Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                          Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                          228. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.unit
                                                                                                                          Definition

                                                                                                                          A human-readable form of the unit.

                                                                                                                          ShortUnit representation
                                                                                                                          Control1..1
                                                                                                                          Typestring
                                                                                                                          Is Modifierfalse
                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                          Must Supporttrue
                                                                                                                          Summarytrue
                                                                                                                          Requirements

                                                                                                                          There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                          230. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.system
                                                                                                                          Definition

                                                                                                                          The identification of the system that provides the coded form of the unit.

                                                                                                                          ShortSystem that defines coded unit form
                                                                                                                          Control1..1
                                                                                                                          This element is affected by the following invariants: qty-3
                                                                                                                          Typeuri
                                                                                                                          Is Modifierfalse
                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                          Must Supporttrue
                                                                                                                          Summarytrue
                                                                                                                          Requirements

                                                                                                                          Need to know the system that defines the coded form of the unit.

                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                          232. Observation.extension:alternativeResult.extension:referenceRange.value[x].high.code
                                                                                                                          Definition

                                                                                                                          A computer processable form of the unit in some unit representation system.

                                                                                                                          ShortCoded form of the unit
                                                                                                                          Comments

                                                                                                                          The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                          Control1..1
                                                                                                                          Typecode
                                                                                                                          Is Modifierfalse
                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                          Must Supporttrue
                                                                                                                          Summarytrue
                                                                                                                          Requirements

                                                                                                                          Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                          234. Observation.extension:alternativeResult.extension:zlog
                                                                                                                          Slice Namezlog
                                                                                                                          Definition

                                                                                                                          Der zlog-Wert ist ein Relativwert, der auf einer logarithmischen Skala angibt, um wie viele Standardabweichungen ein Messwert vom Mittelwert des Referenzkollektivs abweicht. Er kann ergänzend, orientierend zur Bewertung eines Messergebnisses herangezogen werden.

                                                                                                                          Berechnung zlog-Wert zum Laborergebnis (x):

                                                                                                                          zlog = (log(x) –(log(UG)+log(OG))/2)*3,92/(log(OG)–log(UG))

                                                                                                                          (UG),(OG) sind die Unter- und Obergrenzen des Referenzintervalls

                                                                                                                          Interpretation des zlog-Wertes:

                                                                                                                          • Sein Referenzintervall liegt methodenunabhängig stets zwischen – 1,96 und + 1,96
                                                                                                                          • Stark erniedrigte oder erhöhte Laborergebnisse führen zu zlog-Werten um – 5 bzw. + 5.
                                                                                                                          ShortExtension
                                                                                                                          Control0..1
                                                                                                                          TypeExtension
                                                                                                                          Is Modifierfalse
                                                                                                                          Must Supporttrue
                                                                                                                          Summaryfalse
                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                          236. Observation.extension:alternativeResult.extension:zlog.id
                                                                                                                          Definition

                                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                          ShortUnique id for inter-element referencing
                                                                                                                          Control0..1
                                                                                                                          Typestring
                                                                                                                          Is Modifierfalse
                                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                          Summaryfalse
                                                                                                                          238. Observation.extension:alternativeResult.extension:zlog.extension
                                                                                                                          Definition

                                                                                                                          An Extension

                                                                                                                          ShortExtension
                                                                                                                          Control0..0
                                                                                                                          TypeExtension
                                                                                                                          Is Modifierfalse
                                                                                                                          Summaryfalse
                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                          SlicingThis element introduces a set of slices on Observation.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                          • value @ url
                                                                                                                          • 240. Observation.extension:alternativeResult.extension:zlog.url
                                                                                                                            Definition

                                                                                                                            Source of the definition for the extension code - a logical name or a URL.

                                                                                                                            Shortidentifies the meaning of the extension
                                                                                                                            Comments

                                                                                                                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                                            Control1..1
                                                                                                                            Typeuri
                                                                                                                            Is Modifierfalse
                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                            Summaryfalse
                                                                                                                            Fixed Valuezlog
                                                                                                                            242. Observation.extension:alternativeResult.extension:zlog.value[x]
                                                                                                                            Definition

                                                                                                                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                                            ShortValue of extension
                                                                                                                            Control1..1
                                                                                                                            Typedecimal
                                                                                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                            Is Modifierfalse
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Must Supporttrue
                                                                                                                            Summaryfalse
                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            244. Observation.extension:alternativeResult.url
                                                                                                                            Definition

                                                                                                                            Source of the definition for the extension code - a logical name or a URL.

                                                                                                                            Shortidentifies the meaning of the extension
                                                                                                                            Comments

                                                                                                                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                                            Control1..1
                                                                                                                            Typeuri
                                                                                                                            Is Modifierfalse
                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                            Summaryfalse
                                                                                                                            Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Alternative_Result
                                                                                                                            246. Observation.extension:alternativeResult.value[x]
                                                                                                                            Definition

                                                                                                                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                                            ShortValue of extension
                                                                                                                            Control0..0
                                                                                                                            TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                                                                                                                            Is Modifierfalse
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Summaryfalse
                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            248. Observation.modifierExtension
                                                                                                                            Definition

                                                                                                                            May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                                                            ShortExtensions that cannot be ignored
                                                                                                                            Comments

                                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                            Control0..*
                                                                                                                            TypeExtension
                                                                                                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                                                                                                            Summaryfalse
                                                                                                                            Requirements

                                                                                                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                                                            Alternate Namesextensions, user content
                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                            250. Observation.identifier
                                                                                                                            Definition

                                                                                                                            A unique identifier assigned to this observation.

                                                                                                                            ShortBusiness Identifier for observation
                                                                                                                            NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                                                            Control0..2
                                                                                                                            TypeIdentifier
                                                                                                                            Is Modifierfalse
                                                                                                                            Must Supporttrue
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            Allows observations to be distinguished and referenced.

                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            SlicingThis element introduces a set of slices on Observation.identifier. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                                            • value @ type
                                                                                                                            • 252. Observation.identifier:resultID
                                                                                                                              Slice NameresultID
                                                                                                                              Definition

                                                                                                                              Eindeutige ID zur Identifizierung der jeweiligen einzelnen Laboruntersuchung. Sie wird durch das auftragnehmende Laboratorium generiert.

                                                                                                                              ShortBusiness Identifier for observation
                                                                                                                              NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                                                              Control0..1
                                                                                                                              TypeIdentifier
                                                                                                                              Is Modifierfalse
                                                                                                                              Must Supporttrue
                                                                                                                              Summarytrue
                                                                                                                              Requirements

                                                                                                                              Allows observations to be distinguished and referenced.

                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                              254. Observation.identifier:resultID.id
                                                                                                                              Definition

                                                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                              ShortUnique id for inter-element referencing
                                                                                                                              Control0..1
                                                                                                                              Typestring
                                                                                                                              Is Modifierfalse
                                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                              Summaryfalse
                                                                                                                              256. Observation.identifier:resultID.extension
                                                                                                                              Definition

                                                                                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                              ShortAdditional content defined by implementations
                                                                                                                              Comments

                                                                                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                              Control0..*
                                                                                                                              TypeExtension
                                                                                                                              Is Modifierfalse
                                                                                                                              Summaryfalse
                                                                                                                              Alternate Namesextensions, user content
                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                              SlicingThis element introduces a set of slices on Observation.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                              • value @ url
                                                                                                                              • 258. Observation.identifier:resultID.use
                                                                                                                                Definition

                                                                                                                                The purpose of this identifier.

                                                                                                                                Shortusual | official | temp | secondary | old (If known)
                                                                                                                                Comments

                                                                                                                                Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                                                                                                Control0..0
                                                                                                                                BindingThe codes SHALL be taken from IdentifierUse
                                                                                                                                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                                                                                                                Identifies the purpose for this identifier, if known .

                                                                                                                                Typecode
                                                                                                                                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                Summarytrue
                                                                                                                                Requirements

                                                                                                                                Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                260. Observation.identifier:resultID.type
                                                                                                                                Definition

                                                                                                                                A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                                                                                                ShortDescription of identifier
                                                                                                                                Comments

                                                                                                                                This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                                                                                                Control1..1
                                                                                                                                BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                                                                                                (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                                                                                                                                A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                                                                                                                TypeCodeableConcept
                                                                                                                                Is Modifierfalse
                                                                                                                                Summarytrue
                                                                                                                                Requirements

                                                                                                                                Allows users to make use of identifiers when the identifier system is not known.

                                                                                                                                Pattern Value{
                                                                                                                                  "coding" : [{
                                                                                                                                    "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                                                                                                                    "code" : "OBI",
                                                                                                                                    "display" : "Observation Instance Identifier"
                                                                                                                                  }]
                                                                                                                                }
                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                262. Observation.identifier:resultID.type.id
                                                                                                                                Definition

                                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                                Control0..1
                                                                                                                                Typestring
                                                                                                                                Is Modifierfalse
                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                Summaryfalse
                                                                                                                                264. Observation.identifier:resultID.type.extension
                                                                                                                                Definition

                                                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                ShortAdditional content defined by implementations
                                                                                                                                Comments

                                                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                Control0..*
                                                                                                                                TypeExtension
                                                                                                                                Is Modifierfalse
                                                                                                                                Summaryfalse
                                                                                                                                Alternate Namesextensions, user content
                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                SlicingThis element introduces a set of slices on Observation.identifier.type.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                • value @ url
                                                                                                                                • 266. Observation.identifier:resultID.type.coding
                                                                                                                                  Definition

                                                                                                                                  A reference to a code defined by a terminology system.

                                                                                                                                  ShortCode defined by a terminology system
                                                                                                                                  Comments

                                                                                                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                  Control1..1
                                                                                                                                  TypeCoding
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Must Supporttrue
                                                                                                                                  Summarytrue
                                                                                                                                  Requirements

                                                                                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  268. Observation.identifier:resultID.type.coding.id
                                                                                                                                  Definition

                                                                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                  ShortUnique id for inter-element referencing
                                                                                                                                  Control0..1
                                                                                                                                  Typestring
                                                                                                                                  Is Modifierfalse
                                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                  Summaryfalse
                                                                                                                                  270. Observation.identifier:resultID.type.coding.extension
                                                                                                                                  Definition

                                                                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                  ShortAdditional content defined by implementations
                                                                                                                                  Comments

                                                                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                  Control0..*
                                                                                                                                  TypeExtension
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Summaryfalse
                                                                                                                                  Alternate Namesextensions, user content
                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                  SlicingThis element introduces a set of slices on Observation.identifier.type.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                  • value @ url
                                                                                                                                  • 272. Observation.identifier:resultID.type.coding.system
                                                                                                                                    Definition

                                                                                                                                    The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                    ShortIdentity of the terminology system
                                                                                                                                    Comments

                                                                                                                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                    Control1..1
                                                                                                                                    Typeuri
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                    Must Supporttrue
                                                                                                                                    Summarytrue
                                                                                                                                    Requirements

                                                                                                                                    Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    274. Observation.identifier:resultID.type.coding.version
                                                                                                                                    Definition

                                                                                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                    ShortVersion of the system - if relevant
                                                                                                                                    Comments

                                                                                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                    Control1..1
                                                                                                                                    Typestring
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                    Must Supporttrue
                                                                                                                                    Summarytrue
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    276. Observation.identifier:resultID.type.coding.code
                                                                                                                                    Definition

                                                                                                                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                    ShortSymbol in syntax defined by the system
                                                                                                                                    Control1..1
                                                                                                                                    Typecode
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                    Must Supporttrue
                                                                                                                                    Summarytrue
                                                                                                                                    Requirements

                                                                                                                                    Need to refer to a particular code in the system.

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    278. Observation.identifier:resultID.type.coding.display
                                                                                                                                    Definition

                                                                                                                                    A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                    ShortRepresentation defined by the system
                                                                                                                                    Control1..1
                                                                                                                                    Typestring
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                    Must Supporttrue
                                                                                                                                    Summarytrue
                                                                                                                                    Requirements

                                                                                                                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    280. Observation.identifier:resultID.type.coding.userSelected
                                                                                                                                    Definition

                                                                                                                                    Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                    ShortIf this coding was chosen directly by the user
                                                                                                                                    Comments

                                                                                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                    Control0..0
                                                                                                                                    Typeboolean
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                    Summarytrue
                                                                                                                                    Requirements

                                                                                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    282. Observation.identifier:resultID.type.text
                                                                                                                                    Definition

                                                                                                                                    A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                                                                    ShortPlain text representation of the concept
                                                                                                                                    Comments

                                                                                                                                    Very often the text is the same as a displayName of one of the codings.

                                                                                                                                    Control0..0
                                                                                                                                    Typestring
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                    Summarytrue
                                                                                                                                    Requirements

                                                                                                                                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    284. Observation.identifier:resultID.system
                                                                                                                                    Definition

                                                                                                                                    Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                                                                                                    ShortThe namespace for the identifier value
                                                                                                                                    Comments

                                                                                                                                    Identifier.system is always case sensitive.

                                                                                                                                    Control0..1
                                                                                                                                    Typeuri
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                    Must Supporttrue
                                                                                                                                    Summarytrue
                                                                                                                                    Requirements

                                                                                                                                    There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                                                                                                    ExampleGeneral: http://www.acme.com/identifiers/patient
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    286. Observation.identifier:resultID.value
                                                                                                                                    Definition

                                                                                                                                    The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                                                                                                    ShortThe value that is unique
                                                                                                                                    Comments

                                                                                                                                    If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                                                                                                    Control0..1
                                                                                                                                    Typestring
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                    Must Supporttrue
                                                                                                                                    Summarytrue
                                                                                                                                    ExampleGeneral: 123456
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    288. Observation.identifier:resultID.period
                                                                                                                                    Definition

                                                                                                                                    Time period during which identifier is/was valid for use.

                                                                                                                                    ShortTime period when id is/was valid for use
                                                                                                                                    Control0..0
                                                                                                                                    TypePeriod
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summarytrue
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    290. Observation.identifier:resultID.assigner
                                                                                                                                    Definition

                                                                                                                                    Organization that issued/manages the identifier.

                                                                                                                                    ShortOrganization that issued id (may be just text)
                                                                                                                                    Comments

                                                                                                                                    The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                                                                                                    Control0..0
                                                                                                                                    TypeReference(Organization)
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summarytrue
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    292. Observation.identifier:GTIN
                                                                                                                                    Slice NameGTIN
                                                                                                                                    Definition

                                                                                                                                    Mit der GTIN (kurz für Global Trade Item Number ) kann jeder Artikel, jedes Produkt oder jede Produktvariante weltweit überschneidungsfrei identifiziert werden. Sie fungiert als Zugriffsschlüssel auf in Datenbanken hinterlegte Produktinformationen. Die GTIN ist gleichzeitig die Basis für den Barcode (auch bekannt als Strichcode). Über den Barcode wird sie maschinenlesbar und kann per Scanner automatisch ausgelesen werden.

                                                                                                                                    Verwendung im Kontext Laborbefund: für die Darstellung von Laboruntersuchungen kann die GTIN herangezogen werden, um die Vergleichbarkeit von Tests zu validieren.

                                                                                                                                    ShortBusiness Identifier for observation
                                                                                                                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                                                                    Control0..1
                                                                                                                                    TypeIdentifier
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Must Supporttrue
                                                                                                                                    Summarytrue
                                                                                                                                    Requirements

                                                                                                                                    Allows observations to be distinguished and referenced.

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    294. Observation.identifier:GTIN.id
                                                                                                                                    Definition

                                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                                    Control0..1
                                                                                                                                    Typestring
                                                                                                                                    Is Modifierfalse
                                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                    Summaryfalse
                                                                                                                                    296. Observation.identifier:GTIN.extension
                                                                                                                                    Definition

                                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                    ShortAdditional content defined by implementations
                                                                                                                                    Comments

                                                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                    Control0..*
                                                                                                                                    TypeExtension
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Alternate Namesextensions, user content
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                    SlicingThis element introduces a set of slices on Observation.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                    • value @ url
                                                                                                                                    • 298. Observation.identifier:GTIN.use
                                                                                                                                      Definition

                                                                                                                                      The purpose of this identifier.

                                                                                                                                      Shortusual | official | temp | secondary | old (If known)
                                                                                                                                      Comments

                                                                                                                                      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                                                                                                      Control0..0
                                                                                                                                      BindingThe codes SHALL be taken from IdentifierUse
                                                                                                                                      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                                                                                                                      Identifies the purpose for this identifier, if known .

                                                                                                                                      Typecode
                                                                                                                                      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                      Summarytrue
                                                                                                                                      Requirements

                                                                                                                                      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      300. Observation.identifier:GTIN.type
                                                                                                                                      Definition

                                                                                                                                      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                                                                                                      ShortDescription of identifier
                                                                                                                                      Comments

                                                                                                                                      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                                                                                                      Control1..1
                                                                                                                                      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                                                                                                                                      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                                                                                                                      TypeCodeableConcept
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Summarytrue
                                                                                                                                      Requirements

                                                                                                                                      Allows users to make use of identifiers when the identifier system is not known.

                                                                                                                                      Pattern Value{
                                                                                                                                        "coding" : [{
                                                                                                                                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                                                                                                                          "code" : "UDI",
                                                                                                                                          "display" : "Universal Device Identifier"
                                                                                                                                        }]
                                                                                                                                      }
                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      302. Observation.identifier:GTIN.type.id
                                                                                                                                      Definition

                                                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                      ShortUnique id for inter-element referencing
                                                                                                                                      Control0..1
                                                                                                                                      Typestring
                                                                                                                                      Is Modifierfalse
                                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                      Summaryfalse
                                                                                                                                      304. Observation.identifier:GTIN.type.extension
                                                                                                                                      Definition

                                                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                      ShortAdditional content defined by implementations
                                                                                                                                      Comments

                                                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                      Control0..*
                                                                                                                                      TypeExtension
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Summaryfalse
                                                                                                                                      Alternate Namesextensions, user content
                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                      SlicingThis element introduces a set of slices on Observation.identifier.type.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                      • value @ url
                                                                                                                                      • 306. Observation.identifier:GTIN.type.coding
                                                                                                                                        Definition

                                                                                                                                        A reference to a code defined by a terminology system.

                                                                                                                                        ShortCode defined by a terminology system
                                                                                                                                        Comments

                                                                                                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                        Control1..1
                                                                                                                                        TypeCoding
                                                                                                                                        Is Modifierfalse
                                                                                                                                        Must Supporttrue
                                                                                                                                        Summarytrue
                                                                                                                                        Requirements

                                                                                                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                        308. Observation.identifier:GTIN.type.coding.id
                                                                                                                                        Definition

                                                                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                        ShortUnique id for inter-element referencing
                                                                                                                                        Control0..1
                                                                                                                                        Typestring
                                                                                                                                        Is Modifierfalse
                                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                        Summaryfalse
                                                                                                                                        310. Observation.identifier:GTIN.type.coding.extension
                                                                                                                                        Definition

                                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                        ShortAdditional content defined by implementations
                                                                                                                                        Comments

                                                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                        Control0..*
                                                                                                                                        TypeExtension
                                                                                                                                        Is Modifierfalse
                                                                                                                                        Summaryfalse
                                                                                                                                        Alternate Namesextensions, user content
                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                        SlicingThis element introduces a set of slices on Observation.identifier.type.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                        • value @ url
                                                                                                                                        • 312. Observation.identifier:GTIN.type.coding.system
                                                                                                                                          Definition

                                                                                                                                          The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                          ShortIdentity of the terminology system
                                                                                                                                          Comments

                                                                                                                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                          Control1..1
                                                                                                                                          Typeuri
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                          Must Supporttrue
                                                                                                                                          Summarytrue
                                                                                                                                          Requirements

                                                                                                                                          Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          314. Observation.identifier:GTIN.type.coding.version
                                                                                                                                          Definition

                                                                                                                                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                          ShortVersion of the system - if relevant
                                                                                                                                          Comments

                                                                                                                                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                          Control1..1
                                                                                                                                          Typestring
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                          Must Supporttrue
                                                                                                                                          Summarytrue
                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          316. Observation.identifier:GTIN.type.coding.code
                                                                                                                                          Definition

                                                                                                                                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                          ShortSymbol in syntax defined by the system
                                                                                                                                          Control1..1
                                                                                                                                          Typecode
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                          Must Supporttrue
                                                                                                                                          Summarytrue
                                                                                                                                          Requirements

                                                                                                                                          Need to refer to a particular code in the system.

                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          318. Observation.identifier:GTIN.type.coding.display
                                                                                                                                          Definition

                                                                                                                                          A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                          ShortRepresentation defined by the system
                                                                                                                                          Control1..1
                                                                                                                                          Typestring
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                          Must Supporttrue
                                                                                                                                          Summarytrue
                                                                                                                                          Requirements

                                                                                                                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          320. Observation.identifier:GTIN.type.coding.userSelected
                                                                                                                                          Definition

                                                                                                                                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                          ShortIf this coding was chosen directly by the user
                                                                                                                                          Comments

                                                                                                                                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                          Control0..0
                                                                                                                                          Typeboolean
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                          Summarytrue
                                                                                                                                          Requirements

                                                                                                                                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          322. Observation.identifier:GTIN.type.text
                                                                                                                                          Definition

                                                                                                                                          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                                                                          ShortPlain text representation of the concept
                                                                                                                                          Comments

                                                                                                                                          Very often the text is the same as a displayName of one of the codings.

                                                                                                                                          Control0..0
                                                                                                                                          Typestring
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                          Summarytrue
                                                                                                                                          Requirements

                                                                                                                                          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          324. Observation.identifier:GTIN.system
                                                                                                                                          Definition

                                                                                                                                          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                                                                                                          ShortThe namespace for the identifier value
                                                                                                                                          Comments

                                                                                                                                          Identifier.system is always case sensitive.

                                                                                                                                          Control0..1
                                                                                                                                          Typeuri
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                          Must Supporttrue
                                                                                                                                          Summarytrue
                                                                                                                                          Requirements

                                                                                                                                          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                                                                                                          ExampleGeneral: http://www.acme.com/identifiers/patient
                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          326. Observation.identifier:GTIN.value
                                                                                                                                          Definition

                                                                                                                                          The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                                                                                                          ShortThe value that is unique
                                                                                                                                          Comments

                                                                                                                                          If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                                                                                                          Control0..1
                                                                                                                                          Typestring
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                          Must Supporttrue
                                                                                                                                          Summarytrue
                                                                                                                                          ExampleGeneral: 123456
                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          328. Observation.identifier:GTIN.period
                                                                                                                                          Definition

                                                                                                                                          Time period during which identifier is/was valid for use.

                                                                                                                                          ShortTime period when id is/was valid for use
                                                                                                                                          Control0..0
                                                                                                                                          TypePeriod
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Summarytrue
                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          330. Observation.identifier:GTIN.assigner
                                                                                                                                          Definition

                                                                                                                                          Organization that issued/manages the identifier.

                                                                                                                                          ShortOrganization that issued id (may be just text)
                                                                                                                                          Comments

                                                                                                                                          The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                                                                                                          Control0..0
                                                                                                                                          TypeReference(Organization)
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Summarytrue
                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          332. Observation.basedOn
                                                                                                                                          Definition

                                                                                                                                          A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.

                                                                                                                                          ShortFulfills plan, proposal or order
                                                                                                                                          Control0..0
                                                                                                                                          TypeReference(CarePlan, DeviceRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Summarytrue
                                                                                                                                          Requirements

                                                                                                                                          Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

                                                                                                                                          Alternate NamesFulfills
                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          334. Observation.partOf
                                                                                                                                          Definition

                                                                                                                                          A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.

                                                                                                                                          ShortPart of referenced event
                                                                                                                                          Comments

                                                                                                                                          To link an Observation to an Encounter use encounter. See the Notes below for guidance on referencing another Observation.

                                                                                                                                          Control0..0
                                                                                                                                          TypeReference(MedicationAdministration, MedicationDispense, MedicationStatement, Procedure, Immunization, ImagingStudy)
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Summarytrue
                                                                                                                                          Alternate NamesContainer
                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          336. Observation.status
                                                                                                                                          Definition

                                                                                                                                          Bearbeitungsstatus der einzelnen Laboruntersuchung. Die Status-Werte orientieren sich an HL7® FHIR® Version 4.0.1, jedoch wurde der Wert "unknown" aufgrund von Nichtverwendung herausgenommen.

                                                                                                                                          Shortregistered | preliminary | final | amended +
                                                                                                                                          Comments

                                                                                                                                          This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                                                                                                                                          Control1..1
                                                                                                                                          BindingThe codes SHALL be taken from ObservationStatus
                                                                                                                                          (required to http://hl7.org/fhir/ValueSet/observation-status|4.0.1)

                                                                                                                                          Codes providing the status of an observation.

                                                                                                                                          Typecode
                                                                                                                                          Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                          Must Supporttrue
                                                                                                                                          Summarytrue
                                                                                                                                          Requirements

                                                                                                                                          Need to track the status of individual results. Some results are finalized before the whole report is finalized.

                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          338. Observation.category
                                                                                                                                          Definition

                                                                                                                                          Zur einzelnen Laboruntersuchung wird das "fachliche Gruppierungsmerkmal" REDUNDANT abgebildet, der Inhalt entspricht exakt dem fachlichen Gruppierungsmerkmal der zugehörigen Untersuchungsgruppe. Dies ermöglicht bei datenbankbasierten Abfragen von Einzeluntersuchungen (z.B. in der ePA) eine direkte Zuordnung zur fachlichen Gruppierung. Das fachliche Gruppierungsmerkmal der Untersuchungsgruppe ist grundsätzlich führend!

                                                                                                                                          ShortFachliche Bezeichnung für die zugehörige Untersuchungsgruppe, Inhalt identisch zu Observation_Laboratory_Study_Group.category
                                                                                                                                          Comments

                                                                                                                                          In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                                                                                                                                          Control1..3
                                                                                                                                          BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                                                                                                          (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                                                                                                                                          Codes for high level observation categories.

                                                                                                                                          TypeCodeableConcept
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Must Supporttrue
                                                                                                                                          Summaryfalse
                                                                                                                                          Requirements

                                                                                                                                          Used for filtering what observations are retrieved and displayed.

                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                                                          • value @ extension.value
                                                                                                                                          • 340. Observation.category:laboratory
                                                                                                                                            Slice Namelaboratory
                                                                                                                                            Definition

                                                                                                                                            A code that classifies the general type of observation being made.

                                                                                                                                            ShortClassification of type of observation
                                                                                                                                            Comments

                                                                                                                                            In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                                                                                                                                            Control1..1
                                                                                                                                            BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                                                                                                            (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                                                                                                                                            Codes for high level observation categories.

                                                                                                                                            TypeCodeableConcept
                                                                                                                                            Is Modifierfalse
                                                                                                                                            Must Supporttrue
                                                                                                                                            Summaryfalse
                                                                                                                                            Requirements

                                                                                                                                            Used for filtering what observations are retrieved and displayed.

                                                                                                                                            Pattern Value{
                                                                                                                                              "coding" : [{
                                                                                                                                                "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
                                                                                                                                                "code" : "laboratory"
                                                                                                                                              }]
                                                                                                                                            }
                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                            342. Observation.category:laboratory.id
                                                                                                                                            Definition

                                                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                            ShortUnique id for inter-element referencing
                                                                                                                                            Control0..1
                                                                                                                                            Typestring
                                                                                                                                            Is Modifierfalse
                                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                            Summaryfalse
                                                                                                                                            344. Observation.category:laboratory.extension
                                                                                                                                            Definition

                                                                                                                                            An Extension

                                                                                                                                            ShortExtension
                                                                                                                                            Control1..*
                                                                                                                                            TypeExtension
                                                                                                                                            Is Modifierfalse
                                                                                                                                            Must Supporttrue
                                                                                                                                            Summaryfalse
                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                            SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                                                            • value @ url
                                                                                                                                            • 346. Observation.category:laboratory.extension:laboratory
                                                                                                                                              Slice Namelaboratory
                                                                                                                                              Definition

                                                                                                                                              Diese Extension dient als Unterscheidungsmerkmal für den Diskriminator

                                                                                                                                              ShortExtension
                                                                                                                                              Control1..1
                                                                                                                                              TypeExtension(KBV_EX_MIO_LAB_Diskriminator) (Extension Type: string)
                                                                                                                                              Is Modifierfalse
                                                                                                                                              Must Supporttrue
                                                                                                                                              Summaryfalse
                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                              348. Observation.category:laboratory.extension:laboratory.id
                                                                                                                                              Definition

                                                                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                              ShortUnique id for inter-element referencing
                                                                                                                                              Control0..1
                                                                                                                                              Typestring
                                                                                                                                              Is Modifierfalse
                                                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                              Summaryfalse
                                                                                                                                              350. Observation.category:laboratory.extension:laboratory.extension
                                                                                                                                              Definition

                                                                                                                                              An Extension

                                                                                                                                              ShortExtension
                                                                                                                                              Control0..0
                                                                                                                                              TypeExtension
                                                                                                                                              Is Modifierfalse
                                                                                                                                              Summaryfalse
                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                              SlicingThis element introduces a set of slices on Observation.category.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                              • value @ url
                                                                                                                                              • 352. Observation.category:laboratory.extension:laboratory.url
                                                                                                                                                Definition

                                                                                                                                                Source of the definition for the extension code - a logical name or a URL.

                                                                                                                                                Shortidentifies the meaning of the extension
                                                                                                                                                Comments

                                                                                                                                                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                                                                Control1..1
                                                                                                                                                Typeuri
                                                                                                                                                Is Modifierfalse
                                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                Summaryfalse
                                                                                                                                                Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Diskriminator
                                                                                                                                                354. Observation.category:laboratory.extension:laboratory.value[x]
                                                                                                                                                Definition

                                                                                                                                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                                                                ShortValue of extension
                                                                                                                                                Control1..1
                                                                                                                                                Typestring
                                                                                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                Is Modifierfalse
                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                Must Supporttrue
                                                                                                                                                Summaryfalse
                                                                                                                                                Pattern Valuelaboratory
                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                356. Observation.category:laboratory.coding
                                                                                                                                                Definition

                                                                                                                                                A reference to a code defined by a terminology system.

                                                                                                                                                ShortCode defined by a terminology system
                                                                                                                                                Comments

                                                                                                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                Control0..*
                                                                                                                                                TypeCoding
                                                                                                                                                Is Modifierfalse
                                                                                                                                                Must Supporttrue
                                                                                                                                                Summarytrue
                                                                                                                                                Requirements

                                                                                                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                358. Observation.category:laboratory.coding.id
                                                                                                                                                Definition

                                                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                                                Control0..1
                                                                                                                                                Typestring
                                                                                                                                                Is Modifierfalse
                                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                Summaryfalse
                                                                                                                                                360. Observation.category:laboratory.coding.extension
                                                                                                                                                Definition

                                                                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                ShortAdditional content defined by implementations
                                                                                                                                                Comments

                                                                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                Control0..*
                                                                                                                                                TypeExtension
                                                                                                                                                Is Modifierfalse
                                                                                                                                                Summaryfalse
                                                                                                                                                Alternate Namesextensions, user content
                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                SlicingThis element introduces a set of slices on Observation.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                • value @ url
                                                                                                                                                • 362. Observation.category:laboratory.coding.system
                                                                                                                                                  Definition

                                                                                                                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                  ShortIdentity of the terminology system
                                                                                                                                                  Comments

                                                                                                                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                  Control1..1
                                                                                                                                                  Typeuri
                                                                                                                                                  Is Modifierfalse
                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                  Must Supporttrue
                                                                                                                                                  Summarytrue
                                                                                                                                                  Requirements

                                                                                                                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                  364. Observation.category:laboratory.coding.version
                                                                                                                                                  Definition

                                                                                                                                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                  ShortVersion of the system - if relevant
                                                                                                                                                  Comments

                                                                                                                                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                  Control0..1
                                                                                                                                                  Typestring
                                                                                                                                                  Is Modifierfalse
                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                  Must Supporttrue
                                                                                                                                                  Summarytrue
                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                  366. Observation.category:laboratory.coding.code
                                                                                                                                                  Definition

                                                                                                                                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                  ShortSymbol in syntax defined by the system
                                                                                                                                                  Control1..1
                                                                                                                                                  Typecode
                                                                                                                                                  Is Modifierfalse
                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                  Must Supporttrue
                                                                                                                                                  Summarytrue
                                                                                                                                                  Requirements

                                                                                                                                                  Need to refer to a particular code in the system.

                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                  368. Observation.category:laboratory.coding.display
                                                                                                                                                  Definition

                                                                                                                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                  ShortRepresentation defined by the system
                                                                                                                                                  Control1..1
                                                                                                                                                  Typestring
                                                                                                                                                  Is Modifierfalse
                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                  Must Supporttrue
                                                                                                                                                  Summarytrue
                                                                                                                                                  Requirements

                                                                                                                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                  370. Observation.category:laboratory.coding.userSelected
                                                                                                                                                  Definition

                                                                                                                                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                  ShortIf this coding was chosen directly by the user
                                                                                                                                                  Comments

                                                                                                                                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                  Control0..0
                                                                                                                                                  Typeboolean
                                                                                                                                                  Is Modifierfalse
                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                  Summarytrue
                                                                                                                                                  Requirements

                                                                                                                                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                  372. Observation.category:laboratory.text
                                                                                                                                                  Definition

                                                                                                                                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                                                                                  ShortPlain text representation of the concept
                                                                                                                                                  Comments

                                                                                                                                                  Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                  Control0..1
                                                                                                                                                  Typestring
                                                                                                                                                  Is Modifierfalse
                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                  Must Supporttrue
                                                                                                                                                  Summarytrue
                                                                                                                                                  Requirements

                                                                                                                                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                  374. Observation.category:studyType
                                                                                                                                                  Slice NamestudyType
                                                                                                                                                  Definition

                                                                                                                                                  Hier kann die fachspezifische Eingrenzung innerhalb der Laboratoriumsmedizin anhand entsprechender Kategorie-Codes angegeben werden. Beispiele für eine fachspezifische Eingrenzung sind: "Klinische Chemie", "Hämatologie", "Serologie", "Toxikologie", "Urindiagnostik", "Fertilitätsdiagnostik". Es besteht auch die Option, eine allgemeine Kategorie für "Labor" zu vergeben.

                                                                                                                                                  ShortBezeichnung für Fachbereich, unter dem Laboruntersuchungen gruppiert werden, Inhalt identisch zu Observation_Laboratory_Study_Group.category:studyType
                                                                                                                                                  Comments

                                                                                                                                                  In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                                                                                                                                                  Control0..1
                                                                                                                                                  BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                                                                                                                  (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                                                                                                                                                  Codes for high level observation categories.

                                                                                                                                                  TypeCodeableConcept
                                                                                                                                                  Is Modifierfalse
                                                                                                                                                  Must Supporttrue
                                                                                                                                                  Summaryfalse
                                                                                                                                                  Requirements

                                                                                                                                                  Used for filtering what observations are retrieved and displayed.

                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                  376. Observation.category:studyType.id
                                                                                                                                                  Definition

                                                                                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                  ShortUnique id for inter-element referencing
                                                                                                                                                  Control0..1
                                                                                                                                                  Typestring
                                                                                                                                                  Is Modifierfalse
                                                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                  Summaryfalse
                                                                                                                                                  378. Observation.category:studyType.extension
                                                                                                                                                  Definition

                                                                                                                                                  An Extension

                                                                                                                                                  ShortExtension
                                                                                                                                                  Control1..*
                                                                                                                                                  TypeExtension
                                                                                                                                                  Is Modifierfalse
                                                                                                                                                  Must Supporttrue
                                                                                                                                                  Summaryfalse
                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                  SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                                                                  • value @ url
                                                                                                                                                  • 380. Observation.category:studyType.extension:studyType
                                                                                                                                                    Slice NamestudyType
                                                                                                                                                    Definition

                                                                                                                                                    Diese Extension dient als Unterscheidungsmerkmal für den Diskriminator

                                                                                                                                                    ShortExtension
                                                                                                                                                    Control1..1
                                                                                                                                                    TypeExtension(KBV_EX_MIO_LAB_Diskriminator) (Extension Type: string)
                                                                                                                                                    Is Modifierfalse
                                                                                                                                                    Must Supporttrue
                                                                                                                                                    Summaryfalse
                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                    382. Observation.category:studyType.extension:studyType.id
                                                                                                                                                    Definition

                                                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                                                    Control0..1
                                                                                                                                                    Typestring
                                                                                                                                                    Is Modifierfalse
                                                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                    Summaryfalse
                                                                                                                                                    384. Observation.category:studyType.extension:studyType.extension
                                                                                                                                                    Definition

                                                                                                                                                    An Extension

                                                                                                                                                    ShortExtension
                                                                                                                                                    Control0..0
                                                                                                                                                    TypeExtension
                                                                                                                                                    Is Modifierfalse
                                                                                                                                                    Summaryfalse
                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                    SlicingThis element introduces a set of slices on Observation.category.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                    • value @ url
                                                                                                                                                    • 386. Observation.category:studyType.extension:studyType.url
                                                                                                                                                      Definition

                                                                                                                                                      Source of the definition for the extension code - a logical name or a URL.

                                                                                                                                                      Shortidentifies the meaning of the extension
                                                                                                                                                      Comments

                                                                                                                                                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                                                                      Control1..1
                                                                                                                                                      Typeuri
                                                                                                                                                      Is Modifierfalse
                                                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                      Summaryfalse
                                                                                                                                                      Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Diskriminator
                                                                                                                                                      388. Observation.category:studyType.extension:studyType.value[x]
                                                                                                                                                      Definition

                                                                                                                                                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                                                                      ShortValue of extension
                                                                                                                                                      Control1..1
                                                                                                                                                      Typestring
                                                                                                                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                      Is Modifierfalse
                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                      Must Supporttrue
                                                                                                                                                      Summaryfalse
                                                                                                                                                      Pattern ValuestudyType
                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                      390. Observation.category:studyType.coding
                                                                                                                                                      Definition

                                                                                                                                                      Benennung des labormedizinischen Bereiches als Code.

                                                                                                                                                      ShortCode defined by a terminology system
                                                                                                                                                      Comments

                                                                                                                                                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                      Control0..*
                                                                                                                                                      TypeCoding
                                                                                                                                                      Is Modifierfalse
                                                                                                                                                      Must Supporttrue
                                                                                                                                                      Summarytrue
                                                                                                                                                      Requirements

                                                                                                                                                      Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                      SlicingThis element introduces a set of slices on Observation.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                      • value @ $this
                                                                                                                                                      • 392. Observation.category:studyType.coding.id
                                                                                                                                                        Definition

                                                                                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                        ShortUnique id for inter-element referencing
                                                                                                                                                        Control0..1
                                                                                                                                                        Typestring
                                                                                                                                                        Is Modifierfalse
                                                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                        Summaryfalse
                                                                                                                                                        394. Observation.category:studyType.coding.extension
                                                                                                                                                        Definition

                                                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                        ShortAdditional content defined by implementations
                                                                                                                                                        Comments

                                                                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                        Control0..*
                                                                                                                                                        TypeExtension
                                                                                                                                                        Is Modifierfalse
                                                                                                                                                        Summaryfalse
                                                                                                                                                        Alternate Namesextensions, user content
                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                        SlicingThis element introduces a set of slices on Observation.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                        • value @ url
                                                                                                                                                        • 396. Observation.category:studyType.coding.system
                                                                                                                                                          Definition

                                                                                                                                                          The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                          ShortIdentity of the terminology system
                                                                                                                                                          Comments

                                                                                                                                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                          Control1..1
                                                                                                                                                          Typeuri
                                                                                                                                                          Is Modifierfalse
                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                          Summarytrue
                                                                                                                                                          Requirements

                                                                                                                                                          Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                          398. Observation.category:studyType.coding.version
                                                                                                                                                          Definition

                                                                                                                                                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                          ShortVersion of the system - if relevant
                                                                                                                                                          Comments

                                                                                                                                                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                          Control0..1
                                                                                                                                                          Typestring
                                                                                                                                                          Is Modifierfalse
                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                          Summarytrue
                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                          400. Observation.category:studyType.coding.code
                                                                                                                                                          Definition

                                                                                                                                                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                          ShortSymbol in syntax defined by the system
                                                                                                                                                          Control1..1
                                                                                                                                                          Typecode
                                                                                                                                                          Is Modifierfalse
                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                          Summarytrue
                                                                                                                                                          Requirements

                                                                                                                                                          Need to refer to a particular code in the system.

                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                          402. Observation.category:studyType.coding.display
                                                                                                                                                          Definition

                                                                                                                                                          A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                          ShortRepresentation defined by the system
                                                                                                                                                          Control1..1
                                                                                                                                                          Typestring
                                                                                                                                                          Is Modifierfalse
                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                          Summarytrue
                                                                                                                                                          Requirements

                                                                                                                                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                          404. Observation.category:studyType.coding.userSelected
                                                                                                                                                          Definition

                                                                                                                                                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                          ShortIf this coding was chosen directly by the user
                                                                                                                                                          Comments

                                                                                                                                                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                          Control0..1
                                                                                                                                                          Typeboolean
                                                                                                                                                          Is Modifierfalse
                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                          Summarytrue
                                                                                                                                                          Requirements

                                                                                                                                                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                          406. Observation.category:studyType.coding:loinc
                                                                                                                                                          Slice Nameloinc
                                                                                                                                                          Definition

                                                                                                                                                          LOINC®-Code für Fachbereich/Spezialgebiet der Labormedizin

                                                                                                                                                          ShortCode defined by a terminology system
                                                                                                                                                          Comments

                                                                                                                                                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                          Control0..1
                                                                                                                                                          BindingFor example codes, see KBV_VS_MIO_LAB_Laboratory_Specialties_LOINC (1.0.0-update)
                                                                                                                                                          (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Laboratory_Specialties_LOINC|1.0.0-update)
                                                                                                                                                          TypeCoding
                                                                                                                                                          Is Modifierfalse
                                                                                                                                                          Must Supporttrue
                                                                                                                                                          Summarytrue
                                                                                                                                                          Requirements

                                                                                                                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                          Pattern Value{
                                                                                                                                                            "system" : "http://loinc.org"
                                                                                                                                                          }
                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                          408. Observation.category:studyType.coding:loinc.id
                                                                                                                                                          Definition

                                                                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                          ShortUnique id for inter-element referencing
                                                                                                                                                          Control0..1
                                                                                                                                                          Typestring
                                                                                                                                                          Is Modifierfalse
                                                                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                          Summaryfalse
                                                                                                                                                          410. Observation.category:studyType.coding:loinc.extension
                                                                                                                                                          Definition

                                                                                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                          ShortAdditional content defined by implementations
                                                                                                                                                          Comments

                                                                                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                          Control0..*
                                                                                                                                                          TypeExtension
                                                                                                                                                          Is Modifierfalse
                                                                                                                                                          Summaryfalse
                                                                                                                                                          Alternate Namesextensions, user content
                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                          SlicingThis element introduces a set of slices on Observation.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                          • value @ url
                                                                                                                                                          • 412. Observation.category:studyType.coding:loinc.system
                                                                                                                                                            Definition

                                                                                                                                                            The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                            ShortIdentity of the terminology system
                                                                                                                                                            Comments

                                                                                                                                                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                            Control1..1
                                                                                                                                                            Typeuri
                                                                                                                                                            Is Modifierfalse
                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                            Must Supporttrue
                                                                                                                                                            Summarytrue
                                                                                                                                                            Requirements

                                                                                                                                                            Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                            414. Observation.category:studyType.coding:loinc.version
                                                                                                                                                            Definition

                                                                                                                                                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                            ShortVersion of the system - if relevant
                                                                                                                                                            Comments

                                                                                                                                                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                            Control1..1
                                                                                                                                                            Typestring
                                                                                                                                                            Is Modifierfalse
                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                            Must Supporttrue
                                                                                                                                                            Summarytrue
                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                            416. Observation.category:studyType.coding:loinc.code
                                                                                                                                                            Definition

                                                                                                                                                            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                            ShortSymbol in syntax defined by the system
                                                                                                                                                            Control1..1
                                                                                                                                                            Typecode
                                                                                                                                                            Is Modifierfalse
                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                            Must Supporttrue
                                                                                                                                                            Summarytrue
                                                                                                                                                            Requirements

                                                                                                                                                            Need to refer to a particular code in the system.

                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                            418. Observation.category:studyType.coding:loinc.display
                                                                                                                                                            Definition

                                                                                                                                                            A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                            ShortRepresentation defined by the system
                                                                                                                                                            Control1..1
                                                                                                                                                            Typestring
                                                                                                                                                            Is Modifierfalse
                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                            Must Supporttrue
                                                                                                                                                            Summarytrue
                                                                                                                                                            Requirements

                                                                                                                                                            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                            420. Observation.category:studyType.coding:loinc.userSelected
                                                                                                                                                            Definition

                                                                                                                                                            Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                            ShortIf this coding was chosen directly by the user
                                                                                                                                                            Comments

                                                                                                                                                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                            Control0..0
                                                                                                                                                            Typeboolean
                                                                                                                                                            Is Modifierfalse
                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                            Summarytrue
                                                                                                                                                            Requirements

                                                                                                                                                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                            422. Observation.category:studyType.text
                                                                                                                                                            Definition

                                                                                                                                                            Benennung des labormedizinischen Bereiches als Freitext.

                                                                                                                                                            ShortPlain text representation of the concept
                                                                                                                                                            Comments

                                                                                                                                                            Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                            Control0..1
                                                                                                                                                            Typestring
                                                                                                                                                            Is Modifierfalse
                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                            Must Supporttrue
                                                                                                                                                            Summarytrue
                                                                                                                                                            Requirements

                                                                                                                                                            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                            424. Observation.category:testProfile
                                                                                                                                                            Slice NametestProfile
                                                                                                                                                            Definition

                                                                                                                                                            Unter Test-Profil werden zusammengehörige Labortests oder eine Gruppe von Einzeluntersuchungen aus einem Verfahren zusammengefasst.

                                                                                                                                                            ShortBezeichnung für fachlich-medizinischen Bezug, unter dem Laboruntersuchungen gruppiert werden, Inhalt identisch zu Observation_Laboratory_Study_Group.category:testProfile
                                                                                                                                                            Comments

                                                                                                                                                            In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                                                                                                                                                            Control0..1
                                                                                                                                                            BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                                                                                                                            (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                                                                                                                                                            Codes for high level observation categories.

                                                                                                                                                            TypeCodeableConcept
                                                                                                                                                            Is Modifierfalse
                                                                                                                                                            Must Supporttrue
                                                                                                                                                            Summaryfalse
                                                                                                                                                            Requirements

                                                                                                                                                            Used for filtering what observations are retrieved and displayed.

                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                            426. Observation.category:testProfile.id
                                                                                                                                                            Definition

                                                                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                            ShortUnique id for inter-element referencing
                                                                                                                                                            Control0..1
                                                                                                                                                            Typestring
                                                                                                                                                            Is Modifierfalse
                                                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                            Summaryfalse
                                                                                                                                                            428. Observation.category:testProfile.extension
                                                                                                                                                            Definition

                                                                                                                                                            An Extension

                                                                                                                                                            ShortExtension
                                                                                                                                                            Control1..*
                                                                                                                                                            TypeExtension
                                                                                                                                                            Is Modifierfalse
                                                                                                                                                            Must Supporttrue
                                                                                                                                                            Summaryfalse
                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                            SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                                                                            • value @ url
                                                                                                                                                            • 430. Observation.category:testProfile.extension:testProfile
                                                                                                                                                              Slice NametestProfile
                                                                                                                                                              Definition

                                                                                                                                                              Diese Extension dient als Unterscheidungsmerkmal für den Diskriminator

                                                                                                                                                              ShortExtension
                                                                                                                                                              Control1..1
                                                                                                                                                              TypeExtension(KBV_EX_MIO_LAB_Diskriminator) (Extension Type: string)
                                                                                                                                                              Is Modifierfalse
                                                                                                                                                              Must Supporttrue
                                                                                                                                                              Summaryfalse
                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                              432. Observation.category:testProfile.extension:testProfile.id
                                                                                                                                                              Definition

                                                                                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                              ShortUnique id for inter-element referencing
                                                                                                                                                              Control0..1
                                                                                                                                                              Typestring
                                                                                                                                                              Is Modifierfalse
                                                                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                              Summaryfalse
                                                                                                                                                              434. Observation.category:testProfile.extension:testProfile.extension
                                                                                                                                                              Definition

                                                                                                                                                              An Extension

                                                                                                                                                              ShortExtension
                                                                                                                                                              Control0..0
                                                                                                                                                              TypeExtension
                                                                                                                                                              Is Modifierfalse
                                                                                                                                                              Summaryfalse
                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                              SlicingThis element introduces a set of slices on Observation.category.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                              • value @ url
                                                                                                                                                              • 436. Observation.category:testProfile.extension:testProfile.url
                                                                                                                                                                Definition

                                                                                                                                                                Source of the definition for the extension code - a logical name or a URL.

                                                                                                                                                                Shortidentifies the meaning of the extension
                                                                                                                                                                Comments

                                                                                                                                                                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                                                                                Control1..1
                                                                                                                                                                Typeuri
                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                Summaryfalse
                                                                                                                                                                Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Diskriminator
                                                                                                                                                                438. Observation.category:testProfile.extension:testProfile.value[x]
                                                                                                                                                                Definition

                                                                                                                                                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                                                                                ShortValue of extension
                                                                                                                                                                Control1..1
                                                                                                                                                                Typestring
                                                                                                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                Must Supporttrue
                                                                                                                                                                Summaryfalse
                                                                                                                                                                Pattern ValuetestProfile
                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                440. Observation.category:testProfile.coding
                                                                                                                                                                Definition

                                                                                                                                                                Benennung eines Test-Profils als Code.

                                                                                                                                                                ShortCode defined by a terminology system
                                                                                                                                                                Comments

                                                                                                                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                Control0..*
                                                                                                                                                                BindingFor example codes, see KBV_VS_MIO_LAB_Laboruntersuchungsgruppe (1.0.0-update)
                                                                                                                                                                (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Laboruntersuchungsgruppe|1.0.0-update)
                                                                                                                                                                TypeCoding
                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                Must Supporttrue
                                                                                                                                                                Summarytrue
                                                                                                                                                                Requirements

                                                                                                                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                SlicingThis element introduces a set of slices on Observation.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                • value @ $this
                                                                                                                                                                • 442. Observation.category:testProfile.coding.id
                                                                                                                                                                  Definition

                                                                                                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                  ShortUnique id for inter-element referencing
                                                                                                                                                                  Control0..1
                                                                                                                                                                  Typestring
                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                  Summaryfalse
                                                                                                                                                                  444. Observation.category:testProfile.coding.extension
                                                                                                                                                                  Definition

                                                                                                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                  ShortAdditional content defined by implementations
                                                                                                                                                                  Comments

                                                                                                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                  Control0..*
                                                                                                                                                                  TypeExtension
                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                  Summaryfalse
                                                                                                                                                                  Alternate Namesextensions, user content
                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                  SlicingThis element introduces a set of slices on Observation.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                  • value @ url
                                                                                                                                                                  • 446. Observation.category:testProfile.coding.system
                                                                                                                                                                    Definition

                                                                                                                                                                    The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                    ShortIdentity of the terminology system
                                                                                                                                                                    Comments

                                                                                                                                                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                    Control1..1
                                                                                                                                                                    Typeuri
                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                    Summarytrue
                                                                                                                                                                    Requirements

                                                                                                                                                                    Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                    448. Observation.category:testProfile.coding.version
                                                                                                                                                                    Definition

                                                                                                                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                    ShortVersion of the system - if relevant
                                                                                                                                                                    Comments

                                                                                                                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                    Control0..1
                                                                                                                                                                    Typestring
                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                    Summarytrue
                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                    450. Observation.category:testProfile.coding.code
                                                                                                                                                                    Definition

                                                                                                                                                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                    ShortSymbol in syntax defined by the system
                                                                                                                                                                    Control1..1
                                                                                                                                                                    Typecode
                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                    Summarytrue
                                                                                                                                                                    Requirements

                                                                                                                                                                    Need to refer to a particular code in the system.

                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                    452. Observation.category:testProfile.coding.display
                                                                                                                                                                    Definition

                                                                                                                                                                    A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                    ShortRepresentation defined by the system
                                                                                                                                                                    Control1..1
                                                                                                                                                                    Typestring
                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                    Summarytrue
                                                                                                                                                                    Requirements

                                                                                                                                                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                    454. Observation.category:testProfile.coding.userSelected
                                                                                                                                                                    Definition

                                                                                                                                                                    Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                    ShortIf this coding was chosen directly by the user
                                                                                                                                                                    Comments

                                                                                                                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                    Control0..0
                                                                                                                                                                    Typeboolean
                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                    Summarytrue
                                                                                                                                                                    Requirements

                                                                                                                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                    456. Observation.category:testProfile.text
                                                                                                                                                                    Definition

                                                                                                                                                                    Benennung des Test-Profils als Freitext.

                                                                                                                                                                    ShortPlain text representation of the concept
                                                                                                                                                                    Comments

                                                                                                                                                                    Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                                    Control0..1
                                                                                                                                                                    Typestring
                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                    Summarytrue
                                                                                                                                                                    Requirements

                                                                                                                                                                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                    458. Observation.code
                                                                                                                                                                    Definition

                                                                                                                                                                    Hier wird die konkrete einzelne Laboruntersuchung spezifiziert.

                                                                                                                                                                    ShortType of observation (code / type)
                                                                                                                                                                    Comments

                                                                                                                                                                    All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                                                                                                                                    Control1..1
                                                                                                                                                                    BindingFor example codes, see LOINCCodes
                                                                                                                                                                    (example to http://hl7.org/fhir/ValueSet/observation-codes|4.0.1)

                                                                                                                                                                    Codes identifying names of simple observations.

                                                                                                                                                                    TypeCodeableConcept
                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                    Summarytrue
                                                                                                                                                                    Requirements

                                                                                                                                                                    Knowing what kind of observation is being made is essential to understanding the observation.

                                                                                                                                                                    Alternate NamesName
                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                    460. Observation.code.id
                                                                                                                                                                    Definition

                                                                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                                                                    Control0..1
                                                                                                                                                                    Typestring
                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                    Summaryfalse
                                                                                                                                                                    462. Observation.code.extension
                                                                                                                                                                    Definition

                                                                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                    ShortAdditional content defined by implementations
                                                                                                                                                                    Comments

                                                                                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                    Control0..*
                                                                                                                                                                    TypeExtension
                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                    Summaryfalse
                                                                                                                                                                    Alternate Namesextensions, user content
                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                    SlicingThis element introduces a set of slices on Observation.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                    • value @ url
                                                                                                                                                                    • 464. Observation.code.extension:data-absent-reason
                                                                                                                                                                      Slice Namedata-absent-reason
                                                                                                                                                                      Definition

                                                                                                                                                                      Begründung für die Nicht-Vergabe eines LOINC®-Codes zur Laboruntersuchung

                                                                                                                                                                      ShortGrund für das Nichtvorhandensein eines LOINC®-Codes
                                                                                                                                                                      Control0..1
                                                                                                                                                                      TypeExtension(Data Absent Reason) (Extension Type: code)
                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                      Summaryfalse
                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                      466. Observation.code.extension:data-absent-reason.id
                                                                                                                                                                      Definition

                                                                                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                      ShortUnique id for inter-element referencing
                                                                                                                                                                      Control0..1
                                                                                                                                                                      Typestring
                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                      Summaryfalse
                                                                                                                                                                      468. Observation.code.extension:data-absent-reason.extension
                                                                                                                                                                      Definition

                                                                                                                                                                      An Extension

                                                                                                                                                                      ShortExtension
                                                                                                                                                                      Control0..0
                                                                                                                                                                      TypeExtension
                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                      Summaryfalse
                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                      SlicingThis element introduces a set of slices on Observation.code.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                      • value @ url
                                                                                                                                                                      • 470. Observation.code.extension:data-absent-reason.url
                                                                                                                                                                        Definition

                                                                                                                                                                        Source of the definition for the extension code - a logical name or a URL.

                                                                                                                                                                        Shortidentifies the meaning of the extension
                                                                                                                                                                        Comments

                                                                                                                                                                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                                                                                        Control1..1
                                                                                                                                                                        Typeuri
                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                        Summaryfalse
                                                                                                                                                                        Fixed Valuehttp://hl7.org/fhir/StructureDefinition/data-absent-reason
                                                                                                                                                                        472. Observation.code.extension:data-absent-reason.value[x]
                                                                                                                                                                        Definition

                                                                                                                                                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                                                                                        ShortValue of extension
                                                                                                                                                                        Control1..1
                                                                                                                                                                        BindingThe codes SHALL be taken from KBV_VS_MIO_LAB_Data_Absent_Reason (1.0.0-update)
                                                                                                                                                                        (required to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Data_Absent_Reason|1.0.0-update)
                                                                                                                                                                        Typecode
                                                                                                                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                        Must Supporttrue
                                                                                                                                                                        Summaryfalse
                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                        474. Observation.code.coding
                                                                                                                                                                        Definition

                                                                                                                                                                        In diesem Element wird ein LOINC®-Code für die Laboruntersuchung angegeben, inklusive Anzeigename (Display Name) sowie Name und Version des Codesystems.

                                                                                                                                                                        Die Angabe des LOINC®-Codes ist verbindlich. Falls dies nicht möglich ist, muss der Grund für das Nichtvorhandensein eines Codes (DataAbsentReason) angegeben werden.

                                                                                                                                                                        ShortCode defined by a terminology system
                                                                                                                                                                        Comments

                                                                                                                                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                        Control0..1
                                                                                                                                                                        TypeCoding
                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                        Must Supporttrue
                                                                                                                                                                        Summarytrue
                                                                                                                                                                        Requirements

                                                                                                                                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                        Pattern Value{
                                                                                                                                                                          "system" : "http://loinc.org"
                                                                                                                                                                        }
                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                        476. Observation.code.coding.id
                                                                                                                                                                        Definition

                                                                                                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                        ShortUnique id for inter-element referencing
                                                                                                                                                                        Control0..1
                                                                                                                                                                        Typestring
                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                        Summaryfalse
                                                                                                                                                                        478. Observation.code.coding.extension
                                                                                                                                                                        Definition

                                                                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                        ShortAdditional content defined by implementations
                                                                                                                                                                        Comments

                                                                                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                        Control0..*
                                                                                                                                                                        TypeExtension
                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                        Summaryfalse
                                                                                                                                                                        Alternate Namesextensions, user content
                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                        SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                        • value @ url
                                                                                                                                                                        • 480. Observation.code.coding.system
                                                                                                                                                                          Definition

                                                                                                                                                                          The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                          ShortIdentity of the terminology system
                                                                                                                                                                          Comments

                                                                                                                                                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                          Control1..1
                                                                                                                                                                          Typeuri
                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                          Summarytrue
                                                                                                                                                                          Requirements

                                                                                                                                                                          Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                          482. Observation.code.coding.version
                                                                                                                                                                          Definition

                                                                                                                                                                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                          ShortVersion of the system - if relevant
                                                                                                                                                                          Comments

                                                                                                                                                                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                          Control1..1
                                                                                                                                                                          Typestring
                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                          Summarytrue
                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                          484. Observation.code.coding.code
                                                                                                                                                                          Definition

                                                                                                                                                                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                          ShortSymbol in syntax defined by the system
                                                                                                                                                                          Control1..1
                                                                                                                                                                          Typecode
                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                          Summarytrue
                                                                                                                                                                          Requirements

                                                                                                                                                                          Need to refer to a particular code in the system.

                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                          486. Observation.code.coding.display
                                                                                                                                                                          Definition

                                                                                                                                                                          A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                          ShortRepresentation defined by the system
                                                                                                                                                                          Control1..1
                                                                                                                                                                          Typestring
                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                          Summarytrue
                                                                                                                                                                          Requirements

                                                                                                                                                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                          488. Observation.code.coding.userSelected
                                                                                                                                                                          Definition

                                                                                                                                                                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                          ShortIf this coding was chosen directly by the user
                                                                                                                                                                          Comments

                                                                                                                                                                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                          Control0..0
                                                                                                                                                                          Typeboolean
                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                          Summarytrue
                                                                                                                                                                          Requirements

                                                                                                                                                                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                          490. Observation.code.text
                                                                                                                                                                          Definition

                                                                                                                                                                          Die Freitext-Bezeichnung erlaubt es, in den verwendenden/verarbeitenden Systemen den Einrichtungs-spezifischen bzw. Verwender-spezifischen Bezeichner für eine Laboruntersuchung weiterhin zu verwenden.

                                                                                                                                                                          Für den Fall, dass anstelle des LOINC®-Codes ein Grund für das Nichtvorhandensein eines Codes (DataAbsentReason) vergeben wird, muss die Freitext-Bezeichnung befüllt sein.

                                                                                                                                                                          ShortVerwender-spezifische (vom Long Common Name des LOINC®-Codes ggf. abweichende) Bezeichnung für die Laboruntersuchung
                                                                                                                                                                          Comments

                                                                                                                                                                          Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                                          Control0..1
                                                                                                                                                                          Typestring
                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                          Summarytrue
                                                                                                                                                                          Requirements

                                                                                                                                                                          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                          492. Observation.subject
                                                                                                                                                                          Definition

                                                                                                                                                                          Hier wird die zu behandelnde Person referenziert.

                                                                                                                                                                          ShortZu behandelnde Person
                                                                                                                                                                          Comments

                                                                                                                                                                          One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

                                                                                                                                                                          Control1..1
                                                                                                                                                                          TypeReference(KBV_PR_MIO_LAB_Patient)
                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                          Summarytrue
                                                                                                                                                                          Requirements

                                                                                                                                                                          Observations have no value if you don't know who or what they're about.

                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                          494. Observation.subject.id
                                                                                                                                                                          Definition

                                                                                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                          ShortUnique id for inter-element referencing
                                                                                                                                                                          Control0..1
                                                                                                                                                                          Typestring
                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                          Summaryfalse
                                                                                                                                                                          496. Observation.subject.extension
                                                                                                                                                                          Definition

                                                                                                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                          ShortAdditional content defined by implementations
                                                                                                                                                                          Comments

                                                                                                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                          Control0..*
                                                                                                                                                                          TypeExtension
                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                          Summaryfalse
                                                                                                                                                                          Alternate Namesextensions, user content
                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                          SlicingThis element introduces a set of slices on Observation.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                          • value @ url
                                                                                                                                                                          • 498. Observation.subject.reference
                                                                                                                                                                            Definition

                                                                                                                                                                            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                                                                                                                            ShortLiteral reference, Relative, internal or absolute URL
                                                                                                                                                                            Comments

                                                                                                                                                                            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                                                                                                                            Control0..1
                                                                                                                                                                            This element is affected by the following invariants: ref-1
                                                                                                                                                                            Typestring
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                            Summarytrue
                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            500. Observation.subject.type
                                                                                                                                                                            Definition

                                                                                                                                                                            The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                                                                                                                            The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                                                                                                                            ShortType the reference refers to (e.g. "Patient")
                                                                                                                                                                            Comments

                                                                                                                                                                            This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                                                                                                                            Control0..1
                                                                                                                                                                            BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                                                                                                                            (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                                                                                                                            Aa resource (or, for logical models, the URI of the logical model).

                                                                                                                                                                            Typeuri
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                            Summarytrue
                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            502. Observation.subject.identifier
                                                                                                                                                                            Definition

                                                                                                                                                                            An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                                                                                                                            ShortLogical reference, when literal reference is not known
                                                                                                                                                                            Comments

                                                                                                                                                                            When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                                                                                                                            When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                                                                                                                            Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                                                                                                                            Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                                                                                                                            NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                                                                                                            Control1..1
                                                                                                                                                                            TypeIdentifier(Identifier-Profil für die 10-stellige Krankenversichertennummer)
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                            Summarytrue
                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            504. Observation.subject.display
                                                                                                                                                                            Definition

                                                                                                                                                                            Plain text narrative that identifies the resource in addition to the resource reference.

                                                                                                                                                                            ShortText alternative for the resource
                                                                                                                                                                            Comments

                                                                                                                                                                            This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                                                                                                                            Control0..1
                                                                                                                                                                            Typestring
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                            Summarytrue
                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            506. Observation.focus
                                                                                                                                                                            Definition

                                                                                                                                                                            The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.

                                                                                                                                                                            ShortWhat the observation is about, when it is not about the subject of record
                                                                                                                                                                            Comments

                                                                                                                                                                            Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.

                                                                                                                                                                            Control0..0
                                                                                                                                                                            TypeReference(Resource)
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Summarytrue
                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            508. Observation.encounter
                                                                                                                                                                            Definition

                                                                                                                                                                            The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.

                                                                                                                                                                            ShortHealthcare event during which this observation is made
                                                                                                                                                                            Comments

                                                                                                                                                                            This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

                                                                                                                                                                            Control0..0
                                                                                                                                                                            TypeReference(Encounter)
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Summarytrue
                                                                                                                                                                            Requirements

                                                                                                                                                                            For some observations it may be important to know the link between an observation and a particular encounter.

                                                                                                                                                                            Alternate NamesContext
                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            510. Observation.effective[x]
                                                                                                                                                                            Definition

                                                                                                                                                                            Der Klinische Bezugszeitpunkt ist wichtig, um die Laboruntersuchung im Zeitverlauf einordnen zu können.

                                                                                                                                                                            Die Redundanz ist beabsichtigt. Es geht darum, einen Zeitpunkt ermitteln zu können, der für Studien-Statistiken als vergleichsrelevant eingestuft wird. Da im klinischen Alltag nicht sicher gestellt ist, dass grundsätzlich und immer der Zeitpunkt der Materialentnahme auch dokumentiert wird, wurde dieser Algorithmus festgelegt, um die Dokumentation eines statistischen relevanten Zeitpunktes zu garantieren:

                                                                                                                                                                            • WENN der Entnahmezeitpunkt des Probenmaterials angeben ist, so gilt der Entnahmezeitpunkt;
                                                                                                                                                                            • WENN der Sammelzeitraum-bis angegeben ist, so gilt der bis-Zeitpunkt;
                                                                                                                                                                            • SONST gilt (hilfsweise) der Laboreingangszeitpunkt: Zeitpunkt des Eingangs der Probe im Labor.
                                                                                                                                                                            ShortKlinischer Bezugszeitpunkt
                                                                                                                                                                            Comments

                                                                                                                                                                            At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

                                                                                                                                                                            Control1..1
                                                                                                                                                                            TypedateTime
                                                                                                                                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                            Summarytrue
                                                                                                                                                                            Requirements

                                                                                                                                                                            Knowing when an observation was deemed true is important to its relevance as well as determining trends.

                                                                                                                                                                            Alternate NamesOccurrence
                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            date-1: Datetime must be at least day, month and year. (($this as dateTime).toString().length() >= 10)
                                                                                                                                                                            512. Observation.issued
                                                                                                                                                                            Definition

                                                                                                                                                                            Zeitstempel oder Zeitangabe zur Dokumentation der einzelnen Laboruntersuchung.

                                                                                                                                                                            ShortDokumentationszeitpunkt
                                                                                                                                                                            Comments

                                                                                                                                                                            For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.

                                                                                                                                                                            Control1..1
                                                                                                                                                                            Typeinstant
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                            Summarytrue
                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            514. Observation.performer
                                                                                                                                                                            Definition

                                                                                                                                                                            Hier wird das durchführende Labor in Bezug auf die einzelne Laboruntersuchung benannt.

                                                                                                                                                                            Zur Beachtung: im Laborgesamtbefund wird das durchführende Labor (als DiagnosticReport.performer) dokumentiert. Für selbst erbrachte Laborleistungen muss aus Gründen der EU-Kompatibilität auch immer zur Einzeluntersuchung das durchführende Labor (Observation.performer) dokumentiert werden, dieses kann aus dem Laborgesamtbefund abgeleitet werden.

                                                                                                                                                                            Wenn das auftragnehmende Labor die einzelne Laboruntersuchung nicht in Eigenleistung erbringt sondern an ein Speziallabor weiterleitet, sogenannte Fremdleistung, muss hier das durchführende sekundäre Labor als durchführendes Labor dokumentiert werden.

                                                                                                                                                                            ShortWho is responsible for the observation
                                                                                                                                                                            Control1..*
                                                                                                                                                                            TypeReference(KBV_PR_MIO_LAB_Practitioner, KBV_PR_MIO_LAB_PractitionerRole, KBV_PR_MIO_LAB_Organization)
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                            Must Support TypesNo must-support rules about the choice of types/profiles
                                                                                                                                                                            Summarytrue
                                                                                                                                                                            Requirements

                                                                                                                                                                            May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.

                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            516. Observation.performer.id
                                                                                                                                                                            Definition

                                                                                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                            ShortUnique id for inter-element referencing
                                                                                                                                                                            Control0..1
                                                                                                                                                                            Typestring
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                            Summaryfalse
                                                                                                                                                                            518. Observation.performer.extension
                                                                                                                                                                            Definition

                                                                                                                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                            ShortAdditional content defined by implementations
                                                                                                                                                                            Comments

                                                                                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                            Control0..*
                                                                                                                                                                            TypeExtension
                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                            Summaryfalse
                                                                                                                                                                            Alternate Namesextensions, user content
                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                            SlicingThis element introduces a set of slices on Observation.performer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                            • value @ url
                                                                                                                                                                            • 520. Observation.performer.reference
                                                                                                                                                                              Definition

                                                                                                                                                                              A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                                                                                                                              ShortLiteral reference, Relative, internal or absolute URL
                                                                                                                                                                              Comments

                                                                                                                                                                              Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                                                                                                                              Control1..1
                                                                                                                                                                              This element is affected by the following invariants: ref-1
                                                                                                                                                                              Typestring
                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                              Summarytrue
                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                              522. Observation.performer.type
                                                                                                                                                                              Definition

                                                                                                                                                                              The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                                                                                                                              The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                                                                                                                              ShortType the reference refers to (e.g. "Patient")
                                                                                                                                                                              Comments

                                                                                                                                                                              This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                                                                                                                              Control0..1
                                                                                                                                                                              BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                                                                                                                              (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                                                                                                                              Aa resource (or, for logical models, the URI of the logical model).

                                                                                                                                                                              Typeuri
                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                              Summarytrue
                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                              524. Observation.performer.identifier
                                                                                                                                                                              Definition

                                                                                                                                                                              An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                                                                                                                              ShortLogical reference, when literal reference is not known
                                                                                                                                                                              Comments

                                                                                                                                                                              When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                                                                                                                              When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                                                                                                                              Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                                                                                                                              Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                                                                                                                              NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                                                                                                              Control0..1
                                                                                                                                                                              TypeIdentifier
                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                              Summarytrue
                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                              526. Observation.performer.display
                                                                                                                                                                              Definition

                                                                                                                                                                              Plain text narrative that identifies the resource in addition to the resource reference.

                                                                                                                                                                              ShortText alternative for the resource
                                                                                                                                                                              Comments

                                                                                                                                                                              This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                                                                                                                              Control0..1
                                                                                                                                                                              Typestring
                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                              Summarytrue
                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                              528. Observation.value[x]
                                                                                                                                                                              Definition

                                                                                                                                                                              Messergebnisse können quantitativ oder qualitativ sein.

                                                                                                                                                                              ShortActual result
                                                                                                                                                                              Comments

                                                                                                                                                                              An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                                                                                              Control0..1
                                                                                                                                                                              This element is affected by the following invariants: obs-7
                                                                                                                                                                              TypeChoice of: Quantity, CodeableConcept, string, Range, Ratio
                                                                                                                                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                              Must Support TypesNo must-support rules about the choice of types/profiles
                                                                                                                                                                              Summarytrue
                                                                                                                                                                              Requirements

                                                                                                                                                                              An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                              SlicingThis element introduces a set of slices on Observation.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                                                                                              • type @ $this
                                                                                                                                                                              • 530. Observation.value[x]:valueQuantity
                                                                                                                                                                                Slice NamevalueQuantity
                                                                                                                                                                                Definition

                                                                                                                                                                                Hier wird der Ergebniswert als Quantität angegeben.

                                                                                                                                                                                ShortActual result
                                                                                                                                                                                Comments

                                                                                                                                                                                An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                                                                                                Control0..1
                                                                                                                                                                                This element is affected by the following invariants: obs-7
                                                                                                                                                                                TypeQuantity
                                                                                                                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                Summarytrue
                                                                                                                                                                                Requirements

                                                                                                                                                                                An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                                                                                                Pattern Value{
                                                                                                                                                                                  "system" : "http://unitsofmeasure.org"
                                                                                                                                                                                }
                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                532. Observation.value[x]:valueQuantity.id
                                                                                                                                                                                Definition

                                                                                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                                                                                Control0..1
                                                                                                                                                                                Typestring
                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                534. Observation.value[x]:valueQuantity.extension
                                                                                                                                                                                Definition

                                                                                                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                ShortAdditional content defined by implementations
                                                                                                                                                                                Comments

                                                                                                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                Control0..*
                                                                                                                                                                                TypeExtension
                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                Alternate Namesextensions, user content
                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                SlicingThis element introduces a set of slices on Observation.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                • value @ url
                                                                                                                                                                                • 536. Observation.value[x]:valueQuantity.value
                                                                                                                                                                                  Definition

                                                                                                                                                                                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                                                                                                  ShortNumerical value (with implicit precision)
                                                                                                                                                                                  Comments

                                                                                                                                                                                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                                                                                  Control1..1
                                                                                                                                                                                  Typedecimal
                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                  Requirements

                                                                                                                                                                                  Precision is handled implicitly in almost all cases of measurement.

                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                  538. Observation.value[x]:valueQuantity.comparator
                                                                                                                                                                                  Definition

                                                                                                                                                                                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                                                                                                                                                  Short< | <= | >= | > - how to understand the value
                                                                                                                                                                                  Control0..1
                                                                                                                                                                                  BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                                                                                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                                                                                  How the Quantity should be understood and represented.

                                                                                                                                                                                  Typecode
                                                                                                                                                                                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                  Requirements

                                                                                                                                                                                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                                                                                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                  540. Observation.value[x]:valueQuantity.unit
                                                                                                                                                                                  Definition

                                                                                                                                                                                  A human-readable form of the unit.

                                                                                                                                                                                  ShortUnit representation
                                                                                                                                                                                  Control1..1
                                                                                                                                                                                  Typestring
                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                  Requirements

                                                                                                                                                                                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                  542. Observation.value[x]:valueQuantity.system
                                                                                                                                                                                  Definition

                                                                                                                                                                                  The identification of the system that provides the coded form of the unit.

                                                                                                                                                                                  ShortSystem that defines coded unit form
                                                                                                                                                                                  Control1..1
                                                                                                                                                                                  This element is affected by the following invariants: qty-3
                                                                                                                                                                                  Typeuri
                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                  Requirements

                                                                                                                                                                                  Need to know the system that defines the coded form of the unit.

                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                  544. Observation.value[x]:valueQuantity.code
                                                                                                                                                                                  Definition

                                                                                                                                                                                  A computer processable form of the unit in some unit representation system.

                                                                                                                                                                                  ShortCoded form of the unit
                                                                                                                                                                                  Comments

                                                                                                                                                                                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                                                                                  Control1..1
                                                                                                                                                                                  Typecode
                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                  Requirements

                                                                                                                                                                                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                  546. Observation.value[x]:valueCodeableConcept
                                                                                                                                                                                  Slice NamevalueCodeableConcept
                                                                                                                                                                                  Definition

                                                                                                                                                                                  Qualitative Messergebnisse sind - je nach Messgröße oder Skalierung:

                                                                                                                                                                                  Ordinal, d.h. numerische, in der Regel ganzzahlige Ordnungswerte, die den Vergleich (z. B. kleiner als, größer als) ermöglichen oder zur Vergabe einer Punktebewertung ("Benotung") herangezogen werden, beispielsweise eine Schmerzskala (z.B. von 1 bis 10)

                                                                                                                                                                                  Nominal, d.h. Festwerte ohne Rangordnung, beispielsweise in der Mikrobiologie: Krankheitserreger (z.B. Escherichia Coli; Staphylococcus aureus als Bezeichner oder als Code.) oder Angabe zum Nachweis (z.B. vorhanden / nicht vorhanden).

                                                                                                                                                                                  ShortQualitatives Messergebnis (z.B. nominal oder ordinal)
                                                                                                                                                                                  Comments

                                                                                                                                                                                  An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                                                                                                  Control0..1
                                                                                                                                                                                  This element is affected by the following invariants: obs-7
                                                                                                                                                                                  TypeCodeableConcept
                                                                                                                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                  Requirements

                                                                                                                                                                                  An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                  548. Observation.value[x]:valueCodeableConcept.id
                                                                                                                                                                                  Definition

                                                                                                                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                  ShortUnique id for inter-element referencing
                                                                                                                                                                                  Control0..1
                                                                                                                                                                                  Typestring
                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                  550. Observation.value[x]:valueCodeableConcept.extension
                                                                                                                                                                                  Definition

                                                                                                                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                  ShortAdditional content defined by implementations
                                                                                                                                                                                  Comments

                                                                                                                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                  Control0..*
                                                                                                                                                                                  TypeExtension
                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                  Alternate Namesextensions, user content
                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                  SlicingThis element introduces a set of slices on Observation.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                  • value @ url
                                                                                                                                                                                  • 552. Observation.value[x]:valueCodeableConcept.coding
                                                                                                                                                                                    Definition

                                                                                                                                                                                    Qualitatives Messergebnis in codierter Form.

                                                                                                                                                                                    ShortCode defined by a terminology system
                                                                                                                                                                                    Comments

                                                                                                                                                                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                    Control0..*
                                                                                                                                                                                    TypeCoding
                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                    Requirements

                                                                                                                                                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                    SlicingThis element introduces a set of slices on Observation.value[x].coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                    • value @ $this
                                                                                                                                                                                    • 554. Observation.value[x]:valueCodeableConcept.coding.id
                                                                                                                                                                                      Definition

                                                                                                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                      ShortUnique id for inter-element referencing
                                                                                                                                                                                      Control0..1
                                                                                                                                                                                      Typestring
                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                      556. Observation.value[x]:valueCodeableConcept.coding.extension
                                                                                                                                                                                      Definition

                                                                                                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                      ShortAdditional content defined by implementations
                                                                                                                                                                                      Comments

                                                                                                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                      Control0..*
                                                                                                                                                                                      TypeExtension
                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                      Alternate Namesextensions, user content
                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                      SlicingThis element introduces a set of slices on Observation.value[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                      • value @ url
                                                                                                                                                                                      • 558. Observation.value[x]:valueCodeableConcept.coding.system
                                                                                                                                                                                        Definition

                                                                                                                                                                                        The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                        ShortIdentity of the terminology system
                                                                                                                                                                                        Comments

                                                                                                                                                                                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                        Control1..1
                                                                                                                                                                                        Typeuri
                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                        Summarytrue
                                                                                                                                                                                        Requirements

                                                                                                                                                                                        Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                        560. Observation.value[x]:valueCodeableConcept.coding.version
                                                                                                                                                                                        Definition

                                                                                                                                                                                        The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                        ShortVersion of the system - if relevant
                                                                                                                                                                                        Comments

                                                                                                                                                                                        Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                        NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                        Control0..1
                                                                                                                                                                                        Typestring
                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                        Summarytrue
                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                        562. Observation.value[x]:valueCodeableConcept.coding.code
                                                                                                                                                                                        Definition

                                                                                                                                                                                        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                        ShortSymbol in syntax defined by the system
                                                                                                                                                                                        Control1..1
                                                                                                                                                                                        Typecode
                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                        Summarytrue
                                                                                                                                                                                        Requirements

                                                                                                                                                                                        Need to refer to a particular code in the system.

                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                        564. Observation.value[x]:valueCodeableConcept.coding.display
                                                                                                                                                                                        Definition

                                                                                                                                                                                        A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                        ShortRepresentation defined by the system
                                                                                                                                                                                        Control1..1
                                                                                                                                                                                        Typestring
                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                        Summarytrue
                                                                                                                                                                                        Requirements

                                                                                                                                                                                        Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                        566. Observation.value[x]:valueCodeableConcept.coding.userSelected
                                                                                                                                                                                        Definition

                                                                                                                                                                                        Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                        ShortIf this coding was chosen directly by the user
                                                                                                                                                                                        Comments

                                                                                                                                                                                        Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                        Control0..1
                                                                                                                                                                                        Typeboolean
                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                        Summarytrue
                                                                                                                                                                                        Requirements

                                                                                                                                                                                        This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                        568. Observation.value[x]:valueCodeableConcept.coding:snomed
                                                                                                                                                                                        Slice Namesnomed
                                                                                                                                                                                        Definition

                                                                                                                                                                                        Darstellung des qualitativen Messergebnisses als SNOMED CT®-Code.

                                                                                                                                                                                        ShortCode defined by a terminology system
                                                                                                                                                                                        Comments

                                                                                                                                                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                        Control0..1
                                                                                                                                                                                        BindingFor example codes, see KBV_VS_MIO_LAB_Observation_Laboratory_Study_Value_SNOMED_CT (1.0.0-update)
                                                                                                                                                                                        (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Observation_Laboratory_Study_Value_SNOMED_CT|1.0.0-update)
                                                                                                                                                                                        TypeCoding
                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                        Must Supporttrue
                                                                                                                                                                                        Summarytrue
                                                                                                                                                                                        Requirements

                                                                                                                                                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                        Pattern Value{
                                                                                                                                                                                          "system" : "http://snomed.info/sct"
                                                                                                                                                                                        }
                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                        570. Observation.value[x]:valueCodeableConcept.coding:snomed.id
                                                                                                                                                                                        Definition

                                                                                                                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                        ShortUnique id for inter-element referencing
                                                                                                                                                                                        Control0..1
                                                                                                                                                                                        Typestring
                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                        572. Observation.value[x]:valueCodeableConcept.coding:snomed.extension
                                                                                                                                                                                        Definition

                                                                                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                        ShortAdditional content defined by implementations
                                                                                                                                                                                        Comments

                                                                                                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                        Control0..*
                                                                                                                                                                                        TypeExtension
                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                        Alternate Namesextensions, user content
                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                        SlicingThis element introduces a set of slices on Observation.value[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                        • value @ url
                                                                                                                                                                                        • 574. Observation.value[x]:valueCodeableConcept.coding:snomed.system
                                                                                                                                                                                          Definition

                                                                                                                                                                                          The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                          ShortIdentity of the terminology system
                                                                                                                                                                                          Comments

                                                                                                                                                                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                          Control1..1
                                                                                                                                                                                          Typeuri
                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                          Requirements

                                                                                                                                                                                          Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                          576. Observation.value[x]:valueCodeableConcept.coding:snomed.version
                                                                                                                                                                                          Definition

                                                                                                                                                                                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                          ShortVersion of the system - if relevant
                                                                                                                                                                                          Comments

                                                                                                                                                                                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                          Control1..1
                                                                                                                                                                                          Typestring
                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                          578. Observation.value[x]:valueCodeableConcept.coding:snomed.code
                                                                                                                                                                                          Definition

                                                                                                                                                                                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                          ShortSymbol in syntax defined by the system
                                                                                                                                                                                          Control1..1
                                                                                                                                                                                          Typecode
                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                          Requirements

                                                                                                                                                                                          Need to refer to a particular code in the system.

                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                          580. Observation.value[x]:valueCodeableConcept.coding:snomed.display
                                                                                                                                                                                          Definition

                                                                                                                                                                                          A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                          ShortRepresentation defined by the system
                                                                                                                                                                                          Control1..1
                                                                                                                                                                                          Typestring
                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                          Requirements

                                                                                                                                                                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                          582. Observation.value[x]:valueCodeableConcept.coding:snomed.userSelected
                                                                                                                                                                                          Definition

                                                                                                                                                                                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                          ShortIf this coding was chosen directly by the user
                                                                                                                                                                                          Comments

                                                                                                                                                                                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                          Control0..0
                                                                                                                                                                                          Typeboolean
                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                          Requirements

                                                                                                                                                                                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                          584. Observation.value[x]:valueCodeableConcept.text
                                                                                                                                                                                          Definition

                                                                                                                                                                                          Qualitatives Messergebnis als Freitext.

                                                                                                                                                                                          ShortPlain text representation of the concept
                                                                                                                                                                                          Comments

                                                                                                                                                                                          Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                                                          Control0..1
                                                                                                                                                                                          Typestring
                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                          Requirements

                                                                                                                                                                                          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                          586. Observation.value[x]:valueRatio
                                                                                                                                                                                          Slice NamevalueRatio
                                                                                                                                                                                          Definition

                                                                                                                                                                                          Eine bisher gebräuchliche Ergebnisdarstellung von Antikörper-Bestimmungen ist der Verdünnungstiter, bei welchem die Antikörper noch nachweisbar sind. Umgangssprachlich häufig nur als "Titer" bezeichnet. Die Titerangabe setzt sich aus zwei ins Verhältnis gesetzten Quantitäten (Zähler, Nenner) zusammen. Wenn zur Ergebnisdarstellung ein Komparator benötigt wird, dann gelten die mathematischen Regeln, beispielsweise ist 1:32 ein kleinerer Wert als 1:16.

                                                                                                                                                                                          ShortActual result
                                                                                                                                                                                          Comments

                                                                                                                                                                                          An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                                                                                                          Control0..1
                                                                                                                                                                                          This element is affected by the following invariants: obs-7
                                                                                                                                                                                          TypeRatio
                                                                                                                                                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                          Requirements

                                                                                                                                                                                          An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                          588. Observation.value[x]:valueRatio.id
                                                                                                                                                                                          Definition

                                                                                                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                          ShortUnique id for inter-element referencing
                                                                                                                                                                                          Control0..1
                                                                                                                                                                                          Typestring
                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                          590. Observation.value[x]:valueRatio.extension
                                                                                                                                                                                          Definition

                                                                                                                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                          ShortAdditional content defined by implementations
                                                                                                                                                                                          Comments

                                                                                                                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                          Control0..*
                                                                                                                                                                                          TypeExtension
                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                          Alternate Namesextensions, user content
                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                          SlicingThis element introduces a set of slices on Observation.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                          • value @ url
                                                                                                                                                                                          • 592. Observation.value[x]:valueRatio.numerator
                                                                                                                                                                                            Definition

                                                                                                                                                                                            Hier wird der Zähler zum Ergebniswert Ratio angegeben.

                                                                                                                                                                                            ShortNumerator value
                                                                                                                                                                                            Control1..1
                                                                                                                                                                                            TypeQuantity
                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                            Pattern Value{
                                                                                                                                                                                              "system" : "http://unitsofmeasure.org"
                                                                                                                                                                                            }
                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                            594. Observation.value[x]:valueRatio.numerator.id
                                                                                                                                                                                            Definition

                                                                                                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                            ShortUnique id for inter-element referencing
                                                                                                                                                                                            Control0..1
                                                                                                                                                                                            Typestring
                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                            Summaryfalse
                                                                                                                                                                                            596. Observation.value[x]:valueRatio.numerator.extension
                                                                                                                                                                                            Definition

                                                                                                                                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                            ShortAdditional content defined by implementations
                                                                                                                                                                                            Comments

                                                                                                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                            Control0..*
                                                                                                                                                                                            TypeExtension
                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                            Summaryfalse
                                                                                                                                                                                            Alternate Namesextensions, user content
                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                            SlicingThis element introduces a set of slices on Observation.value[x].numerator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                            • value @ url
                                                                                                                                                                                            • 598. Observation.value[x]:valueRatio.numerator.value
                                                                                                                                                                                              Definition

                                                                                                                                                                                              The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                                                                                                              ShortNumerical value (with implicit precision)
                                                                                                                                                                                              Comments

                                                                                                                                                                                              The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                                                                                              Control1..1
                                                                                                                                                                                              Typedecimal
                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                              Requirements

                                                                                                                                                                                              Precision is handled implicitly in almost all cases of measurement.

                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                              600. Observation.value[x]:valueRatio.numerator.comparator
                                                                                                                                                                                              Definition

                                                                                                                                                                                              How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                                                                                                                                                              Short< | <= | >= | > - how to understand the value
                                                                                                                                                                                              Control0..1
                                                                                                                                                                                              BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                                                                                              (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                                                                                              How the Quantity should be understood and represented.

                                                                                                                                                                                              Typecode
                                                                                                                                                                                              Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                              Requirements

                                                                                                                                                                                              Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                                                                                              Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                              602. Observation.value[x]:valueRatio.numerator.unit
                                                                                                                                                                                              Definition

                                                                                                                                                                                              A human-readable form of the unit.

                                                                                                                                                                                              ShortUnit representation
                                                                                                                                                                                              Control1..1
                                                                                                                                                                                              Typestring
                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                              Requirements

                                                                                                                                                                                              There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                              604. Observation.value[x]:valueRatio.numerator.system
                                                                                                                                                                                              Definition

                                                                                                                                                                                              The identification of the system that provides the coded form of the unit.

                                                                                                                                                                                              ShortSystem that defines coded unit form
                                                                                                                                                                                              Control1..1
                                                                                                                                                                                              This element is affected by the following invariants: qty-3
                                                                                                                                                                                              Typeuri
                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                              Requirements

                                                                                                                                                                                              Need to know the system that defines the coded form of the unit.

                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                              606. Observation.value[x]:valueRatio.numerator.code
                                                                                                                                                                                              Definition

                                                                                                                                                                                              A computer processable form of the unit in some unit representation system.

                                                                                                                                                                                              ShortCoded form of the unit
                                                                                                                                                                                              Comments

                                                                                                                                                                                              The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                                                                                              Control1..1
                                                                                                                                                                                              Typecode
                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                              Requirements

                                                                                                                                                                                              Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                              608. Observation.value[x]:valueRatio.denominator
                                                                                                                                                                                              Definition

                                                                                                                                                                                              Hier wird der Nenner zum Ergebniswert Ratio angegeben.

                                                                                                                                                                                              ShortDenominator value
                                                                                                                                                                                              Control1..1
                                                                                                                                                                                              TypeQuantity
                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                              Pattern Value{
                                                                                                                                                                                                "system" : "http://unitsofmeasure.org"
                                                                                                                                                                                              }
                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                              610. Observation.value[x]:valueRatio.denominator.id
                                                                                                                                                                                              Definition

                                                                                                                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                              ShortUnique id for inter-element referencing
                                                                                                                                                                                              Control0..1
                                                                                                                                                                                              Typestring
                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                              Summaryfalse
                                                                                                                                                                                              612. Observation.value[x]:valueRatio.denominator.extension
                                                                                                                                                                                              Definition

                                                                                                                                                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                              ShortAdditional content defined by implementations
                                                                                                                                                                                              Comments

                                                                                                                                                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                              Control0..*
                                                                                                                                                                                              TypeExtension
                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                              Summaryfalse
                                                                                                                                                                                              Alternate Namesextensions, user content
                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                              SlicingThis element introduces a set of slices on Observation.value[x].denominator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                              • value @ url
                                                                                                                                                                                              • 614. Observation.value[x]:valueRatio.denominator.value
                                                                                                                                                                                                Definition

                                                                                                                                                                                                The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                                                                                                                ShortNumerical value (with implicit precision)
                                                                                                                                                                                                Comments

                                                                                                                                                                                                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                Typedecimal
                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                Requirements

                                                                                                                                                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                616. Observation.value[x]:valueRatio.denominator.comparator
                                                                                                                                                                                                Definition

                                                                                                                                                                                                How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                                                                                                                                                                Short< | <= | >= | > - how to understand the value
                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                                                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                                                                                                How the Quantity should be understood and represented.

                                                                                                                                                                                                Typecode
                                                                                                                                                                                                Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                Requirements

                                                                                                                                                                                                Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                                                                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                618. Observation.value[x]:valueRatio.denominator.unit
                                                                                                                                                                                                Definition

                                                                                                                                                                                                A human-readable form of the unit.

                                                                                                                                                                                                ShortUnit representation
                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                Typestring
                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                Requirements

                                                                                                                                                                                                There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                620. Observation.value[x]:valueRatio.denominator.system
                                                                                                                                                                                                Definition

                                                                                                                                                                                                The identification of the system that provides the coded form of the unit.

                                                                                                                                                                                                ShortSystem that defines coded unit form
                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                This element is affected by the following invariants: qty-3
                                                                                                                                                                                                Typeuri
                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                Requirements

                                                                                                                                                                                                Need to know the system that defines the coded form of the unit.

                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                622. Observation.value[x]:valueRatio.denominator.code
                                                                                                                                                                                                Definition

                                                                                                                                                                                                A computer processable form of the unit in some unit representation system.

                                                                                                                                                                                                ShortCoded form of the unit
                                                                                                                                                                                                Comments

                                                                                                                                                                                                The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                Typecode
                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                Requirements

                                                                                                                                                                                                Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                624. Observation.value[x]:valueRange
                                                                                                                                                                                                Slice NamevalueRange
                                                                                                                                                                                                Definition

                                                                                                                                                                                                Für Messergebnisse, die nicht als genau ein Wert, sondern als ein Wertebereich/Werteintervall angegeben werden.

                                                                                                                                                                                                ShortActual result
                                                                                                                                                                                                Comments

                                                                                                                                                                                                An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                This element is affected by the following invariants: obs-7
                                                                                                                                                                                                TypeRange
                                                                                                                                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                Requirements

                                                                                                                                                                                                An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                626. Observation.value[x]:valueRange.id
                                                                                                                                                                                                Definition

                                                                                                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                Typestring
                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                628. Observation.value[x]:valueRange.extension
                                                                                                                                                                                                Definition

                                                                                                                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                ShortAdditional content defined by implementations
                                                                                                                                                                                                Comments

                                                                                                                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                Control0..*
                                                                                                                                                                                                TypeExtension
                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                Alternate Namesextensions, user content
                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                SlicingThis element introduces a set of slices on Observation.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                • value @ url
                                                                                                                                                                                                • 630. Observation.value[x]:valueRange.low
                                                                                                                                                                                                  Definition

                                                                                                                                                                                                  Untere Grenze eines Ergebnisbereiches, Ergebnisintervalls. Die Einheiten von Obergrenze und Untergrenze müssen identisch sein.

                                                                                                                                                                                                  ShortLow limit
                                                                                                                                                                                                  Comments

                                                                                                                                                                                                  If the low element is missing, the low boundary is not known.

                                                                                                                                                                                                  Control1..1
                                                                                                                                                                                                  TypeQuantity(SimpleQuantity)
                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                                  Pattern Value{
                                                                                                                                                                                                    "system" : "http://unitsofmeasure.org"
                                                                                                                                                                                                  }
                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                  632. Observation.value[x]:valueRange.low.id
                                                                                                                                                                                                  Definition

                                                                                                                                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                  ShortUnique id for inter-element referencing
                                                                                                                                                                                                  Control0..1
                                                                                                                                                                                                  Typestring
                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                  634. Observation.value[x]:valueRange.low.extension
                                                                                                                                                                                                  Definition

                                                                                                                                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                  ShortAdditional content defined by implementations
                                                                                                                                                                                                  Comments

                                                                                                                                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                  Control0..*
                                                                                                                                                                                                  TypeExtension
                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                  Alternate Namesextensions, user content
                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                  SlicingThis element introduces a set of slices on Observation.value[x].low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                  • value @ url
                                                                                                                                                                                                  • 636. Observation.value[x]:valueRange.low.value
                                                                                                                                                                                                    Definition

                                                                                                                                                                                                    The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                                                                                                                    ShortNumerical value (with implicit precision)
                                                                                                                                                                                                    Comments

                                                                                                                                                                                                    The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                    Typedecimal
                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                    Precision is handled implicitly in almost all cases of measurement.

                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                    638. Observation.value[x]:valueRange.low.comparator
                                                                                                                                                                                                    Definition

                                                                                                                                                                                                    Not allowed to be used in this context

                                                                                                                                                                                                    Short< | <= | >= | > - how to understand the value
                                                                                                                                                                                                    Control0..0
                                                                                                                                                                                                    BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                                                                                                    (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                                                                                                    How the Quantity should be understood and represented.

                                                                                                                                                                                                    Typecode
                                                                                                                                                                                                    Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                    Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                                                                                                    Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                    640. Observation.value[x]:valueRange.low.unit
                                                                                                                                                                                                    Definition

                                                                                                                                                                                                    A human-readable form of the unit.

                                                                                                                                                                                                    ShortUnit representation
                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                    There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                    642. Observation.value[x]:valueRange.low.system
                                                                                                                                                                                                    Definition

                                                                                                                                                                                                    The identification of the system that provides the coded form of the unit.

                                                                                                                                                                                                    ShortSystem that defines coded unit form
                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                    This element is affected by the following invariants: qty-3
                                                                                                                                                                                                    Typeuri
                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                    Need to know the system that defines the coded form of the unit.

                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                    644. Observation.value[x]:valueRange.low.code
                                                                                                                                                                                                    Definition

                                                                                                                                                                                                    A computer processable form of the unit in some unit representation system.

                                                                                                                                                                                                    ShortCoded form of the unit
                                                                                                                                                                                                    Comments

                                                                                                                                                                                                    The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                    Typecode
                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                    Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                    646. Observation.value[x]:valueRange.high
                                                                                                                                                                                                    Definition

                                                                                                                                                                                                    Obere Grenze eines Ergebnisbereiches, Ergebnisintervalls. Die Einheiten von Obergrenze und Untergrenze müssen identisch sein.

                                                                                                                                                                                                    ShortHigh limit
                                                                                                                                                                                                    Comments

                                                                                                                                                                                                    If the high element is missing, the high boundary is not known.

                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                    TypeQuantity(SimpleQuantity)
                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                    Pattern Value{
                                                                                                                                                                                                      "system" : "http://unitsofmeasure.org"
                                                                                                                                                                                                    }
                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                    648. Observation.value[x]:valueRange.high.id
                                                                                                                                                                                                    Definition

                                                                                                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                                                                                                    Control0..1
                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                    650. Observation.value[x]:valueRange.high.extension
                                                                                                                                                                                                    Definition

                                                                                                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                    ShortAdditional content defined by implementations
                                                                                                                                                                                                    Comments

                                                                                                                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                    Control0..*
                                                                                                                                                                                                    TypeExtension
                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                    Alternate Namesextensions, user content
                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                    SlicingThis element introduces a set of slices on Observation.value[x].high.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                    • value @ url
                                                                                                                                                                                                    • 652. Observation.value[x]:valueRange.high.value
                                                                                                                                                                                                      Definition

                                                                                                                                                                                                      The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                                                                                                                                                      ShortNumerical value (with implicit precision)
                                                                                                                                                                                                      Comments

                                                                                                                                                                                                      The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                      Typedecimal
                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                      Precision is handled implicitly in almost all cases of measurement.

                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                      654. Observation.value[x]:valueRange.high.comparator
                                                                                                                                                                                                      Definition

                                                                                                                                                                                                      Not allowed to be used in this context

                                                                                                                                                                                                      Short< | <= | >= | > - how to understand the value
                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                      BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                                                                                                      (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                                                                                                      How the Quantity should be understood and represented.

                                                                                                                                                                                                      Typecode
                                                                                                                                                                                                      Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                      Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                                                                                                      Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                      656. Observation.value[x]:valueRange.high.unit
                                                                                                                                                                                                      Definition

                                                                                                                                                                                                      A human-readable form of the unit.

                                                                                                                                                                                                      ShortUnit representation
                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                      There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                      658. Observation.value[x]:valueRange.high.system
                                                                                                                                                                                                      Definition

                                                                                                                                                                                                      The identification of the system that provides the coded form of the unit.

                                                                                                                                                                                                      ShortSystem that defines coded unit form
                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                      This element is affected by the following invariants: qty-3
                                                                                                                                                                                                      Typeuri
                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                      Need to know the system that defines the coded form of the unit.

                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                      660. Observation.value[x]:valueRange.high.code
                                                                                                                                                                                                      Definition

                                                                                                                                                                                                      A computer processable form of the unit in some unit representation system.

                                                                                                                                                                                                      ShortCoded form of the unit
                                                                                                                                                                                                      Comments

                                                                                                                                                                                                      The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                      Typecode
                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                      Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                      662. Observation.value[x]:valueString
                                                                                                                                                                                                      Slice NamevalueString
                                                                                                                                                                                                      Definition

                                                                                                                                                                                                      Textergebnis als Freitext. Dieses Feld ist für Beobachtungen vorgesehen, bei denen für das Resultat keine numerischen oder codierten Werte benötigt werden. Beispiele sind qualitative Beschreibungen oder freitextliche Kommentare.

                                                                                                                                                                                                      ShortErgebnis uncodiert in Textform
                                                                                                                                                                                                      Comments

                                                                                                                                                                                                      An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                                                                                                                      Control0..1
                                                                                                                                                                                                      This element is affected by the following invariants: obs-7
                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                      An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                      664. Observation.dataAbsentReason
                                                                                                                                                                                                      Definition

                                                                                                                                                                                                      Begründung für die Nicht-Verfügbarkeit eines Messergebnisses. Die Angabe eines Messergebnisses ist gefordert ("required"). Wenn kein Messergebnis zur Verfügung steht, wird in der FHIR®-Struktur ein "dataAbsentReason" angegeben. Der Inhalt dieser Begründung soll der System-anwendenden Person angezeigt werden

                                                                                                                                                                                                      ShortWhy the result is missing
                                                                                                                                                                                                      Comments

                                                                                                                                                                                                      Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".

                                                                                                                                                                                                      The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

                                                                                                                                                                                                      Control0..1
                                                                                                                                                                                                      This element is affected by the following invariants: obs-6
                                                                                                                                                                                                      BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                                                                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1)

                                                                                                                                                                                                      Codes specifying why the result (Observation.value[x]) is missing.

                                                                                                                                                                                                      TypeCodeableConcept
                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                      For many results it is necessary to handle exceptional values in measurements.

                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                      666. Observation.dataAbsentReason.id
                                                                                                                                                                                                      Definition

                                                                                                                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                      ShortUnique id for inter-element referencing
                                                                                                                                                                                                      Control0..1
                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                      668. Observation.dataAbsentReason.extension
                                                                                                                                                                                                      Definition

                                                                                                                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                      ShortAdditional content defined by implementations
                                                                                                                                                                                                      Comments

                                                                                                                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                      Control0..*
                                                                                                                                                                                                      TypeExtension
                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                      Alternate Namesextensions, user content
                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                      SlicingThis element introduces a set of slices on Observation.dataAbsentReason.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                      • value @ url
                                                                                                                                                                                                      • 670. Observation.dataAbsentReason.coding
                                                                                                                                                                                                        Definition

                                                                                                                                                                                                        A reference to a code defined by a terminology system.

                                                                                                                                                                                                        ShortCode defined by a terminology system
                                                                                                                                                                                                        Comments

                                                                                                                                                                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                                        Control1..1
                                                                                                                                                                                                        TypeCoding
                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                        Must Supporttrue
                                                                                                                                                                                                        Summarytrue
                                                                                                                                                                                                        Requirements

                                                                                                                                                                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                        672. Observation.dataAbsentReason.coding.id
                                                                                                                                                                                                        Definition

                                                                                                                                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                        ShortUnique id for inter-element referencing
                                                                                                                                                                                                        Control0..1
                                                                                                                                                                                                        Typestring
                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                                        674. Observation.dataAbsentReason.coding.extension
                                                                                                                                                                                                        Definition

                                                                                                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                        ShortAdditional content defined by implementations
                                                                                                                                                                                                        Comments

                                                                                                                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                        Control0..*
                                                                                                                                                                                                        TypeExtension
                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                                        Alternate Namesextensions, user content
                                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                        SlicingThis element introduces a set of slices on Observation.dataAbsentReason.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                        • value @ url
                                                                                                                                                                                                        • 676. Observation.dataAbsentReason.coding.system
                                                                                                                                                                                                          Definition

                                                                                                                                                                                                          The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                                          ShortIdentity of the terminology system
                                                                                                                                                                                                          Comments

                                                                                                                                                                                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                          Typeuri
                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                          Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                          678. Observation.dataAbsentReason.coding.version
                                                                                                                                                                                                          Definition

                                                                                                                                                                                                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                                          ShortVersion of the system - if relevant
                                                                                                                                                                                                          Comments

                                                                                                                                                                                                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                                          Control0..1
                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                          680. Observation.dataAbsentReason.coding.code
                                                                                                                                                                                                          Definition

                                                                                                                                                                                                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                                          ShortSymbol in syntax defined by the system
                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                          Typecode
                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                          Need to refer to a particular code in the system.

                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                          682. Observation.dataAbsentReason.coding.display
                                                                                                                                                                                                          Definition

                                                                                                                                                                                                          A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                                          ShortRepresentation defined by the system
                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                          684. Observation.dataAbsentReason.coding.userSelected
                                                                                                                                                                                                          Definition

                                                                                                                                                                                                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                                          ShortIf this coding was chosen directly by the user
                                                                                                                                                                                                          Comments

                                                                                                                                                                                                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                                          Control0..0
                                                                                                                                                                                                          Typeboolean
                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                          686. Observation.dataAbsentReason.text
                                                                                                                                                                                                          Definition

                                                                                                                                                                                                          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                                                                                                                                          ShortPlain text representation of the concept
                                                                                                                                                                                                          Comments

                                                                                                                                                                                                          Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                                                                          Control0..0
                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                          688. Observation.interpretation
                                                                                                                                                                                                          Definition

                                                                                                                                                                                                          Medizinisch relevante Bewertung zur einzelnen Laboruntersuchung. Die Interpretation kann als Code und/oder Text vorliegen. Die Angabe einer Interpretation ist optional, bei nicht vorhandener Klassifikation wird hier nichts übermittelt. Empfehlung: eine dokumentierte Interpretation sollte mindestens einen Interpretationscode enthalten.

                                                                                                                                                                                                          ShortMedizinische Interpretation des einzelnen Laborergebnisses
                                                                                                                                                                                                          Comments

                                                                                                                                                                                                          Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                                                                                                                                                                                                          Control0..*
                                                                                                                                                                                                          BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodes
                                                                                                                                                                                                          (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation|4.0.1)

                                                                                                                                                                                                          Codes identifying interpretations of observations.

                                                                                                                                                                                                          TypeCodeableConcept
                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                          For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                                                                                                                                                          Alternate NamesAbnormal Flag
                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                          690. Observation.interpretation.id
                                                                                                                                                                                                          Definition

                                                                                                                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                          ShortUnique id for inter-element referencing
                                                                                                                                                                                                          Control0..1
                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                                          692. Observation.interpretation.extension
                                                                                                                                                                                                          Definition

                                                                                                                                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                          ShortAdditional content defined by implementations
                                                                                                                                                                                                          Comments

                                                                                                                                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                          Control0..*
                                                                                                                                                                                                          TypeExtension
                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                                          Alternate Namesextensions, user content
                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                          SlicingThis element introduces a set of slices on Observation.interpretation.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                          • value @ url
                                                                                                                                                                                                          • 694. Observation.interpretation.coding
                                                                                                                                                                                                            Definition

                                                                                                                                                                                                            Hier kann die Interpretation als codierte Information angegeben werden.

                                                                                                                                                                                                            ShortCode defined by a terminology system
                                                                                                                                                                                                            Comments

                                                                                                                                                                                                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                                            Control0..*
                                                                                                                                                                                                            TypeCoding
                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                            Requirements

                                                                                                                                                                                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                            SlicingThis element introduces a set of slices on Observation.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                            • value @ $this
                                                                                                                                                                                                            • 696. Observation.interpretation.coding.id
                                                                                                                                                                                                              Definition

                                                                                                                                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                              ShortUnique id for inter-element referencing
                                                                                                                                                                                                              Control0..1
                                                                                                                                                                                                              Typestring
                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                              Summaryfalse
                                                                                                                                                                                                              698. Observation.interpretation.coding.extension
                                                                                                                                                                                                              Definition

                                                                                                                                                                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                              ShortAdditional content defined by implementations
                                                                                                                                                                                                              Comments

                                                                                                                                                                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                              Control0..*
                                                                                                                                                                                                              TypeExtension
                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                              Summaryfalse
                                                                                                                                                                                                              Alternate Namesextensions, user content
                                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                              SlicingThis element introduces a set of slices on Observation.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                              • value @ url
                                                                                                                                                                                                              • 700. Observation.interpretation.coding.system
                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                                                ShortIdentity of the terminology system
                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                                Typeuri
                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                702. Observation.interpretation.coding.version
                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                                                ShortVersion of the system - if relevant
                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                                Typestring
                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                704. Observation.interpretation.coding.code
                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                                                ShortSymbol in syntax defined by the system
                                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                                Typecode
                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                Need to refer to a particular code in the system.

                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                706. Observation.interpretation.coding.display
                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                                                ShortRepresentation defined by the system
                                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                                Typestring
                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                708. Observation.interpretation.coding.userSelected
                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                                                ShortIf this coding was chosen directly by the user
                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                                Typeboolean
                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                710. Observation.interpretation.coding:hl7Interpretation
                                                                                                                                                                                                                Slice Namehl7Interpretation
                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                Für die codierte Interpretation wird eine Auswahl von Interpretationscodes als Option angeboten. Die Nutzung der hinterlegten Codes ist abhängig vom Kontext.

                                                                                                                                                                                                                ShortCode defined by a terminology system
                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                                BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodes
                                                                                                                                                                                                                (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)
                                                                                                                                                                                                                TypeCoding
                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                                                Pattern Value{
                                                                                                                                                                                                                  "system" : "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
                                                                                                                                                                                                                }
                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                712. Observation.interpretation.coding:hl7Interpretation.id
                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                                Typestring
                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                                714. Observation.interpretation.coding:hl7Interpretation.extension
                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                ShortAdditional content defined by implementations
                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                Control0..*
                                                                                                                                                                                                                TypeExtension
                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                                Alternate Namesextensions, user content
                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                SlicingThis element introduces a set of slices on Observation.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                • value @ url
                                                                                                                                                                                                                • 716. Observation.interpretation.coding:hl7Interpretation.system
                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                                                  ShortIdentity of the terminology system
                                                                                                                                                                                                                  Comments

                                                                                                                                                                                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                                                  Control1..1
                                                                                                                                                                                                                  Typeuri
                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                                                  Requirements

                                                                                                                                                                                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                  718. Observation.interpretation.coding:hl7Interpretation.version
                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                                                  ShortVersion of the system - if relevant
                                                                                                                                                                                                                  Comments

                                                                                                                                                                                                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                                                  Control0..1
                                                                                                                                                                                                                  Typestring
                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                  720. Observation.interpretation.coding:hl7Interpretation.code
                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                                                  ShortSymbol in syntax defined by the system
                                                                                                                                                                                                                  Control1..1
                                                                                                                                                                                                                  Typecode
                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                                                  Requirements

                                                                                                                                                                                                                  Need to refer to a particular code in the system.

                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                  722. Observation.interpretation.coding:hl7Interpretation.display
                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                                                  ShortRepresentation defined by the system
                                                                                                                                                                                                                  Control1..1
                                                                                                                                                                                                                  Typestring
                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                                                  Requirements

                                                                                                                                                                                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                  724. Observation.interpretation.coding:hl7Interpretation.userSelected
                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                                                  ShortIf this coding was chosen directly by the user
                                                                                                                                                                                                                  Comments

                                                                                                                                                                                                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                                                  Control0..0
                                                                                                                                                                                                                  Typeboolean
                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                                                  Requirements

                                                                                                                                                                                                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                  726. Observation.interpretation.coding:snomed
                                                                                                                                                                                                                  Slice Namesnomed
                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                  Hier kann ein Code aus SNOMED-CT® angegeben werden.

                                                                                                                                                                                                                  ShortCode defined by a terminology system
                                                                                                                                                                                                                  Comments

                                                                                                                                                                                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                                                  Control0..1
                                                                                                                                                                                                                  TypeCoding
                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                                                  Requirements

                                                                                                                                                                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                                                  Pattern Value{
                                                                                                                                                                                                                    "system" : "http://snomed.info/sct"
                                                                                                                                                                                                                  }
                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                  728. Observation.interpretation.coding:snomed.id
                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                  ShortUnique id for inter-element referencing
                                                                                                                                                                                                                  Control0..1
                                                                                                                                                                                                                  Typestring
                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                                  730. Observation.interpretation.coding:snomed.extension
                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                  ShortAdditional content defined by implementations
                                                                                                                                                                                                                  Comments

                                                                                                                                                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                  Control0..*
                                                                                                                                                                                                                  TypeExtension
                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                                  Alternate Namesextensions, user content
                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                  SlicingThis element introduces a set of slices on Observation.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                  • value @ url
                                                                                                                                                                                                                  • 732. Observation.interpretation.coding:snomed.system
                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                    The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                                                    ShortIdentity of the terminology system
                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                                    Typeuri
                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                    Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                    734. Observation.interpretation.coding:snomed.version
                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                                                    ShortVersion of the system - if relevant
                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                    736. Observation.interpretation.coding:snomed.code
                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                                                    ShortSymbol in syntax defined by the system
                                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                                    Typecode
                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                    Need to refer to a particular code in the system.

                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                    738. Observation.interpretation.coding:snomed.display
                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                    A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                                                    ShortRepresentation defined by the system
                                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                    740. Observation.interpretation.coding:snomed.userSelected
                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                    Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                                                    ShortIf this coding was chosen directly by the user
                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                                                    Control0..0
                                                                                                                                                                                                                    Typeboolean
                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                    742. Observation.interpretation.text
                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                    Hier kann eine medizinisch relevante Bewertung als Freitext eingegeben werden. Unter Eigenschaften sind mögliche Werte gelistet, die in dieses Feld hineinpassen könnten, beispielsweise ein Textfeld  aus dem LDT zur Interpretation des Ergebnisses.

                                                                                                                                                                                                                    ShortPlain text representation of the concept
                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                    Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                                                                                    Control0..1
                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                    744. Observation.note
                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                    Die ergänzenden Angaben beziehen sich genau auf diese Einzeluntersuchung. Neben dem Element (Interpretation) ist dieses Feld für weitere, über die rein medizinische Interpretation hinausgehende Kommentierungen gedacht.

                                                                                                                                                                                                                    ShortComments about the observation
                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                    May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

                                                                                                                                                                                                                    Control0..*
                                                                                                                                                                                                                    TypeAnnotation
                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                    Need to be able to provide free text additional information.

                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                    746. Observation.note.id
                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                                                                                                                    Control0..1
                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                                    748. Observation.note.extension
                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                    ShortAdditional content defined by implementations
                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                    Control0..*
                                                                                                                                                                                                                    TypeExtension
                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                                    Alternate Namesextensions, user content
                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                    SlicingThis element introduces a set of slices on Observation.note.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                    • value @ url
                                                                                                                                                                                                                    • 750. Observation.note.author[x]
                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                      The individual responsible for making the annotation.

                                                                                                                                                                                                                      ShortIndividual responsible for the annotation
                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                      Organization is used when there's no need for specific attribution as to who made the comment.

                                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                                      TypeChoice of: Reference(Practitioner, Patient, RelatedPerson, Organization), string
                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                      752. Observation.note.time
                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                      Indicates when this particular annotation was made.

                                                                                                                                                                                                                      ShortWhen the annotation was made
                                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                                      TypedateTime
                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                      754. Observation.note.text
                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                      The text of the annotation in markdown format.

                                                                                                                                                                                                                      ShortThe annotation - text content (as markdown)
                                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                                      Typemarkdown
                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                      756. Observation.bodySite
                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                      Indicates the site on the subject's body where the observation was made (i.e. the target site).

                                                                                                                                                                                                                      ShortObserved body part
                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                      Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.

                                                                                                                                                                                                                      If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.

                                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                                      BindingFor example codes, see SNOMEDCTBodyStructures
                                                                                                                                                                                                                      (example to http://hl7.org/fhir/ValueSet/body-site|4.0.1)

                                                                                                                                                                                                                      Codes describing anatomical locations. May include laterality.

                                                                                                                                                                                                                      TypeCodeableConcept
                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                      758. Observation.method
                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                      Der LOINC®-Code impliziert über die LOINC®-Achse METHOD bereits eine Untersuchungsmethode, unter der Voraussetzung, dass der Part METHOD einen Wert beinhaltet. Die "Untersuchungsmethode, ergänzende Spezifizierung" kann in Bezug auf die LOINC®-spezifizierte Laboruntersuchung ergänzt werden, falls der Wert für die LOINC®-Achse METHOD nicht ausreichend spezifisch ist oder gar nicht vorhanden ist.

                                                                                                                                                                                                                      Ein Beispiel: die Laboruntersuchung (Observation_Laboratory_Study.code) ist mit dem LOINC®-Code 26453-1 "Erythrocytes [#/volume] in Blood" ohne Angabe zur Methode codiert. Als ergänzende Spezifizieruung wird für die Untersuchungsmethode (Observation_Laboratory_Study.method) der SNOMED CT®-Code 702659008 |Automated count| zugeordnet.

                                                                                                                                                                                                                      ShortUntersuchungsmethode, ergänzende Spezifizierung (z.B. postkoordinierend)
                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                      Only used if not implicit in code for Observation.code.

                                                                                                                                                                                                                      Control0..1
                                                                                                                                                                                                                      BindingFor example codes, see ObservationMethods
                                                                                                                                                                                                                      (example to http://hl7.org/fhir/ValueSet/observation-methods|4.0.1)

                                                                                                                                                                                                                      Methods for simple observations.

                                                                                                                                                                                                                      TypeCodeableConcept
                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                                      In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                      760. Observation.method.id
                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                      ShortUnique id for inter-element referencing
                                                                                                                                                                                                                      Control0..1
                                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                                      762. Observation.method.extension
                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                      ShortAdditional content defined by implementations
                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                      Control0..*
                                                                                                                                                                                                                      TypeExtension
                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                                      Alternate Namesextensions, user content
                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                      SlicingThis element introduces a set of slices on Observation.method.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                      • value @ url
                                                                                                                                                                                                                      • 764. Observation.method.coding
                                                                                                                                                                                                                        Definition

                                                                                                                                                                                                                        Hier kann die Untersuchungsmethode als codierte Information angegeben werden.

                                                                                                                                                                                                                        ShortCode defined by a terminology system
                                                                                                                                                                                                                        Comments

                                                                                                                                                                                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                                                        Control0..*
                                                                                                                                                                                                                        BindingFor example codes, see Untersuchungsmethode SNOMED CT®
                                                                                                                                                                                                                        (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_Observation_Methods)
                                                                                                                                                                                                                        TypeCoding
                                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                                        Must Supporttrue
                                                                                                                                                                                                                        Summarytrue
                                                                                                                                                                                                                        Requirements

                                                                                                                                                                                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                        766. Observation.method.coding.id
                                                                                                                                                                                                                        Definition

                                                                                                                                                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                        ShortUnique id for inter-element referencing
                                                                                                                                                                                                                        Control0..1
                                                                                                                                                                                                                        Typestring
                                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                                                        768. Observation.method.coding.extension
                                                                                                                                                                                                                        Definition

                                                                                                                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                        ShortAdditional content defined by implementations
                                                                                                                                                                                                                        Comments

                                                                                                                                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                        Control0..*
                                                                                                                                                                                                                        TypeExtension
                                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                                                        Alternate Namesextensions, user content
                                                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                        SlicingThis element introduces a set of slices on Observation.method.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                        • value @ url
                                                                                                                                                                                                                        • 770. Observation.method.coding.system
                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                          The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                                                          ShortIdentity of the terminology system
                                                                                                                                                                                                                          Comments

                                                                                                                                                                                                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                                          Typeuri
                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                          Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                          772. Observation.method.coding.version
                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                                                          ShortVersion of the system - if relevant
                                                                                                                                                                                                                          Comments

                                                                                                                                                                                                                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                                                          Control0..1
                                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                          774. Observation.method.coding.code
                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                                                          ShortSymbol in syntax defined by the system
                                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                                          Typecode
                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                          Need to refer to a particular code in the system.

                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                          776. Observation.method.coding.display
                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                          A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                                                          ShortRepresentation defined by the system
                                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                          778. Observation.method.coding.userSelected
                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                                                          ShortIf this coding was chosen directly by the user
                                                                                                                                                                                                                          Comments

                                                                                                                                                                                                                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                                                          Control0..0
                                                                                                                                                                                                                          Typeboolean
                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                          780. Observation.method.text
                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                          Hier kann eine Freitext-Bezeichnung der Untersuchungsmethode notiert werden. Mögliche Verwendung:

                                                                                                                                                                                                                          • als Freitextergänzung, wenn die Methode durch die Spezifikation Laboruntersuchung (LOINC® Code: METHOD) nicht ausreichend spezifisch codiert werden kann
                                                                                                                                                                                                                          • ersatzweise, wenn zur Untersuchungsmethode auch kein passender SNOMED CT®-Code zugeordnet werden kann
                                                                                                                                                                                                                          • als ergänzender, dem SNOMED CT®-Code entsprechender Freitext
                                                                                                                                                                                                                          ShortPlain text representation of the concept
                                                                                                                                                                                                                          Comments

                                                                                                                                                                                                                          Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                                                                                          Control0..1
                                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                          782. Observation.specimen
                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                          Eine Laboruntersuchung kann auf einer Primärprobe oder einer weiter verarbeiteten Probe (Sekundärprobe) basieren. Die Zuordnung einer Sekundärprobe zu einer Laboruntersuchung ist dann empfehlenswert, wenn durch die Probenvorbereitung im Labor eine relevante Veränderung des Untersuchungsmaterials erfolgt (z.B. Abtrennung Plasma).

                                                                                                                                                                                                                          Ein Beispiel für die Unterscheidung zwischen Primärprobe und Sekundärprobe: als Primärprobe erreicht eine Probenart = Vollblut das Labor. Durch Zentrifugieren im Labor entsteht eine Sekundärprobe mit Probenart = Serum. Die zu analysierende Substanz wird im Serum gemessen.

                                                                                                                                                                                                                          ShortSpecimen used for this observation
                                                                                                                                                                                                                          Comments

                                                                                                                                                                                                                          Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

                                                                                                                                                                                                                          Control0..1
                                                                                                                                                                                                                          TypeReference(KBV_PR_MIO_LAB_Specimen)
                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                          784. Observation.specimen.id
                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                          ShortUnique id for inter-element referencing
                                                                                                                                                                                                                          Control0..1
                                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                                                          786. Observation.specimen.extension
                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                          ShortAdditional content defined by implementations
                                                                                                                                                                                                                          Comments

                                                                                                                                                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                          Control0..*
                                                                                                                                                                                                                          TypeExtension
                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                                                          Alternate Namesextensions, user content
                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                          SlicingThis element introduces a set of slices on Observation.specimen.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                          • value @ url
                                                                                                                                                                                                                          • 788. Observation.specimen.reference
                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                                                                                                                                                                            ShortLiteral reference, Relative, internal or absolute URL
                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                                                                                                                                                                            Control1..1
                                                                                                                                                                                                                            This element is affected by the following invariants: ref-1
                                                                                                                                                                                                                            Typestring
                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                            790. Observation.specimen.type
                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                            The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                                                                                                                                                                            The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                                                                                                                                                                            ShortType the reference refers to (e.g. "Patient")
                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                            This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                                                                                                                                                                            Control0..0
                                                                                                                                                                                                                            BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                                                                                                                                                                            (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                                                                                                                                                                            Aa resource (or, for logical models, the URI of the logical model).

                                                                                                                                                                                                                            Typeuri
                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                            792. Observation.specimen.identifier
                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                            An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                                                                                                                                                                            ShortLogical reference, when literal reference is not known
                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                            When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                                                                                                                                                                            When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                                                                                                                                                                            Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                                                                                                                                                                            Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                                                                                                                                                                            NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                                                                                                                                                            Control0..0
                                                                                                                                                                                                                            TypeIdentifier
                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                            794. Observation.specimen.display
                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                            Plain text narrative that identifies the resource in addition to the resource reference.

                                                                                                                                                                                                                            ShortText alternative for the resource
                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                            This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                                                                                                                                                                            Control0..0
                                                                                                                                                                                                                            Typestring
                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                            796. Observation.device
                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                            Hier wird das Gerät bzw. Medizinprodukt referenziert, mit dem die Laboruntersuchung durchgeführt wird.

                                                                                                                                                                                                                            ShortLaboranalysegerät
                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                            Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

                                                                                                                                                                                                                            Control0..1
                                                                                                                                                                                                                            TypeReference(KBV_PR_MIO_LAB_Device_Laboratory_Analyzer)
                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                                                                            Summaryfalse
                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                            798. Observation.device.id
                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                            ShortUnique id for inter-element referencing
                                                                                                                                                                                                                            Control0..1
                                                                                                                                                                                                                            Typestring
                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                            Summaryfalse
                                                                                                                                                                                                                            800. Observation.device.extension
                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                            ShortAdditional content defined by implementations
                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                            Control0..*
                                                                                                                                                                                                                            TypeExtension
                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                            Summaryfalse
                                                                                                                                                                                                                            Alternate Namesextensions, user content
                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                            SlicingThis element introduces a set of slices on Observation.device.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                            • value @ url
                                                                                                                                                                                                                            • 802. Observation.device.reference
                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                              A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                                                                                                                                                                              ShortLiteral reference, Relative, internal or absolute URL
                                                                                                                                                                                                                              Comments

                                                                                                                                                                                                                              Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                                                                                                                                                                              Control1..1
                                                                                                                                                                                                                              This element is affected by the following invariants: ref-1
                                                                                                                                                                                                                              Typestring
                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                              804. Observation.device.type
                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                              The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                                                                                                                                                                              The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                                                                                                                                                                              ShortType the reference refers to (e.g. "Patient")
                                                                                                                                                                                                                              Comments

                                                                                                                                                                                                                              This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                                                                                                                                                                              Control0..0
                                                                                                                                                                                                                              BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                                                                                                                                                                              (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                                                                                                                                                                              Aa resource (or, for logical models, the URI of the logical model).

                                                                                                                                                                                                                              Typeuri
                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                              806. Observation.device.identifier
                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                              An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                                                                                                                                                                              ShortLogical reference, when literal reference is not known
                                                                                                                                                                                                                              Comments

                                                                                                                                                                                                                              When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                                                                                                                                                                              When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                                                                                                                                                                              Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                                                                                                                                                                              Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                                                                                                                                                                              NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                                                                                                                                                              Control0..0
                                                                                                                                                                                                                              TypeIdentifier
                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                              808. Observation.device.display
                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                              Plain text narrative that identifies the resource in addition to the resource reference.

                                                                                                                                                                                                                              ShortText alternative for the resource
                                                                                                                                                                                                                              Comments

                                                                                                                                                                                                                              This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                                                                                                                                                                              Control0..0
                                                                                                                                                                                                                              Typestring
                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                              810. Observation.referenceRange
                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                              Richtgrenzen oder Bewertungsgrenzen zu einer Laboruntersuchung

                                                                                                                                                                                                                              • werden herangezogen für die Beurteilung und Einordnung von Messergebnissen
                                                                                                                                                                                                                              • sind laborärztliche Entscheidungsgrenzen (mit ggf. juristischer Relevanz)
                                                                                                                                                                                                                              • sind ärztliche Entscheidungshilfen im klinischen Allta

                                                                                                                                                                                                                              Disclaimer: FHIR® definiert aktuell nur inklusive Richtgrenzen. Für die Praxistauglichkeit besteht aber die Anforderung, auch exklusive Richtgrenzen abbilden zu können. Diese Thematik wurde schon bei HL7® FHIR® platziert, es gibt aber noch keine abschließende Festlegung dazu. Im Informationsmodell sind beide Optionen bereits dargestellt, um diese Anforderung sichtbar zu machen.

                                                                                                                                                                                                                              ShortProvides guide for interpretation
                                                                                                                                                                                                                              Comments

                                                                                                                                                                                                                              Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                                                                                                                                                                                              Control0..*
                                                                                                                                                                                                                              TypeBackboneElement
                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                                                              Summaryfalse
                                                                                                                                                                                                                              Requirements

                                                                                                                                                                                                                              Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                                                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                              obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                                                                                                                                                                                                                              812. Observation.referenceRange.id
                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                              ShortUnique id for inter-element referencing
                                                                                                                                                                                                                              Control0..1
                                                                                                                                                                                                                              Typestring
                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                              Summaryfalse
                                                                                                                                                                                                                              814. Observation.referenceRange.extension
                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                              An Extension

                                                                                                                                                                                                                              ShortExtension
                                                                                                                                                                                                                              Control0..*
                                                                                                                                                                                                                              TypeExtension
                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                                                              Summaryfalse
                                                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                              SlicingThis element introduces a set of slices on Observation.referenceRange.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                              • value @ url
                                                                                                                                                                                                                              • 816. Observation.referenceRange.extension:sourceReferenceRange
                                                                                                                                                                                                                                Slice NamesourceReferenceRange
                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                Mögliche Angaben als Quelle für Richtgrenzen können sein:

                                                                                                                                                                                                                                • Internationaler Standard
                                                                                                                                                                                                                                • Nationaler Standard
                                                                                                                                                                                                                                • Literatur
                                                                                                                                                                                                                                • Gerätehersteller
                                                                                                                                                                                                                                • Beipackzettel
                                                                                                                                                                                                                                • Labor-intern
                                                                                                                                                                                                                                • nicht angegeben

                                                                                                                                                                                                                                Zusätzlich zur Freitextangabe einer LDT-Information ist in FHIR® auch die Codierung möglich (optional).

                                                                                                                                                                                                                                ShortQuelle der Richtgrenzen
                                                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                                                This element is affected by the following invariants: ele-1
                                                                                                                                                                                                                                TypeExtension(KBV_EX_MIO_LAB_Source_Reference_Range) (Extension Type: CodeableConcept)
                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                818. Observation.referenceRange.extension:sourceReferenceRange.id
                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                                                Typestring
                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                                                820. Observation.referenceRange.extension:sourceReferenceRange.extension
                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                An Extension

                                                                                                                                                                                                                                ShortExtension
                                                                                                                                                                                                                                Control0..0
                                                                                                                                                                                                                                TypeExtension
                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                SlicingThis element introduces a set of slices on Observation.referenceRange.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                • value @ url
                                                                                                                                                                                                                                • 822. Observation.referenceRange.extension:sourceReferenceRange.url
                                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                                  Source of the definition for the extension code - a logical name or a URL.

                                                                                                                                                                                                                                  Shortidentifies the meaning of the extension
                                                                                                                                                                                                                                  Comments

                                                                                                                                                                                                                                  The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                                                                                                                                                  Control1..1
                                                                                                                                                                                                                                  Typeuri
                                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                                                  Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_Source_Reference_Range
                                                                                                                                                                                                                                  824. Observation.referenceRange.extension:sourceReferenceRange.value[x]
                                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                                                                                                                                                  ShortValue of extension
                                                                                                                                                                                                                                  Control1..1
                                                                                                                                                                                                                                  TypeCodeableConcept
                                                                                                                                                                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                  826. Observation.referenceRange.extension:sourceReferenceRange.value[x].id
                                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                  ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                  Control0..1
                                                                                                                                                                                                                                  Typestring
                                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                                                  828. Observation.referenceRange.extension:sourceReferenceRange.value[x].extension
                                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                                  ShortAdditional content defined by implementations
                                                                                                                                                                                                                                  Comments

                                                                                                                                                                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                  Control0..*
                                                                                                                                                                                                                                  TypeExtension
                                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                                                  Alternate Namesextensions, user content
                                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                  SlicingThis element introduces a set of slices on Observation.referenceRange.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                  • value @ url
                                                                                                                                                                                                                                  • 830. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding
                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                    A reference to a code defined by a terminology system.

                                                                                                                                                                                                                                    ShortCode defined by a terminology system
                                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                                                                    Control0..*
                                                                                                                                                                                                                                    TypeCoding
                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                    832. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.id
                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                    Control0..1
                                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                                                    834. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.extension
                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                                    ShortAdditional content defined by implementations
                                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                    Control0..*
                                                                                                                                                                                                                                    TypeExtension
                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                                                    Alternate Namesextensions, user content
                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                    SlicingThis element introduces a set of slices on Observation.referenceRange.extension.value[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                    • value @ url
                                                                                                                                                                                                                                    • 836. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.system
                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                      The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                                                                      ShortIdentity of the terminology system
                                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                                                      Typeuri
                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                                                      Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                      838. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.version
                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                      The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                                                                      ShortVersion of the system - if relevant
                                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                                      Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                                                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                                                                      Control0..1
                                                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                      840. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.code
                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                                                                      ShortSymbol in syntax defined by the system
                                                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                                                      Typecode
                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                                                      Need to refer to a particular code in the system.

                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                      842. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.display
                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                      A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                                                                      ShortRepresentation defined by the system
                                                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                      844. Observation.referenceRange.extension:sourceReferenceRange.value[x].coding.userSelected
                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                      Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                                                                      ShortIf this coding was chosen directly by the user
                                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                                      Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                                                      Typeboolean
                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                                                      This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                      846. Observation.referenceRange.extension:sourceReferenceRange.value[x].text
                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                                                                                                                                                                      ShortPlain text representation of the concept
                                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                                      Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                      848. Observation.referenceRange.extension:noLinearReferenceRange
                                                                                                                                                                                                                                      Slice NamenoLinearReferenceRange
                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                      Kennzeichnung, dass das numerische Ergebnis aus einem NICHT-LINEAREN Wertebereich stammt. Beispiele hierfür sind ganzzahlige Scores oder Titer-Reihen. Umgangssprachlich wird auch von sog. "semiquantitativen" Ergebnissen gesprochen. Seit LOINC® Version 2.76 ist das anhand des LOINC®-Codes offiziell definiert und ablesbar mit Scale = "SemiQn". Das Kennzeichen ist optional und wird vom messenden Labor gesetzt.

                                                                                                                                                                                                                                      ShortKennzeichen Nicht-linearer Referenzbereich
                                                                                                                                                                                                                                      Control0..1
                                                                                                                                                                                                                                      This element is affected by the following invariants: ele-1
                                                                                                                                                                                                                                      TypeExtension(KBV_EX_MIO_LAB_No_Linear_Reference_Range) (Extension Type: boolean)
                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                      850. Observation.referenceRange.extension:noLinearReferenceRange.id
                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                      ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                      Control0..1
                                                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                                                      852. Observation.referenceRange.extension:noLinearReferenceRange.extension
                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                      An Extension

                                                                                                                                                                                                                                      ShortExtension
                                                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                                                      TypeExtension
                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                      Summaryfalse
                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                      SlicingThis element introduces a set of slices on Observation.referenceRange.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                      • value @ url
                                                                                                                                                                                                                                      • 854. Observation.referenceRange.extension:noLinearReferenceRange.url
                                                                                                                                                                                                                                        Definition

                                                                                                                                                                                                                                        Source of the definition for the extension code - a logical name or a URL.

                                                                                                                                                                                                                                        Shortidentifies the meaning of the extension
                                                                                                                                                                                                                                        Comments

                                                                                                                                                                                                                                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                                                                                                                                                                        Control1..1
                                                                                                                                                                                                                                        Typeuri
                                                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                                                                        Fixed Valuehttps://fhir.kbv.de/StructureDefinition/KBV_EX_MIO_LAB_No_Linear_Reference_Range
                                                                                                                                                                                                                                        856. Observation.referenceRange.extension:noLinearReferenceRange.value[x]
                                                                                                                                                                                                                                        Definition

                                                                                                                                                                                                                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                                                                                                                                                        ShortValue of extension
                                                                                                                                                                                                                                        Control1..1
                                                                                                                                                                                                                                        Typeboolean
                                                                                                                                                                                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                        Must Supporttrue
                                                                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                        858. Observation.referenceRange.modifierExtension
                                                                                                                                                                                                                                        Definition

                                                                                                                                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                                                                                                                                                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                                                                                                                                                                        ShortExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                        Comments

                                                                                                                                                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                        Control0..*
                                                                                                                                                                                                                                        TypeExtension
                                                                                                                                                                                                                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                                                                                                                                                                        Summarytrue
                                                                                                                                                                                                                                        Requirements

                                                                                                                                                                                                                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                                                                                                                                                                        Alternate Namesextensions, user content, modifiers
                                                                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                        860. Observation.referenceRange.low
                                                                                                                                                                                                                                        Definition

                                                                                                                                                                                                                                        Die untere Richtgrenze ist eine quantitative Grenze. Datentyp und Einheit entsprechen denen beim quantitativen Messergebnis. Unter Eigenschaften sind mögliche Werte gelistet, die in dieses Feld hineinpassen könnten, beispielsweise ein Grenzwert aus dem LDT. Bei diesen Beispielen aus dem LDT gilt es zu beachten, dass die Grenzwerte nur für eine Richtgrenze vom Typ "normal" gelten.

                                                                                                                                                                                                                                        Disclaimer: FHIR® definiert aktuell nur inklusive Richtgrenzen. Für die Praxistauglichkeit besteht aber die Anforderung, auch exklusive Richtgrenzen abbilden zu können. Diese Thematik wurde schon bei HL7® FHIR® platziert, es gibt aber noch keine abschließende Festlegung dazu. Im Informationsmodell sind beide Optionen bereits dargestellt, um diese Anforderung sichtbar zu machen.

                                                                                                                                                                                                                                        ShortLow Range, if relevant
                                                                                                                                                                                                                                        Control0..1
                                                                                                                                                                                                                                        This element is affected by the following invariants: obs-3
                                                                                                                                                                                                                                        TypeQuantity(SimpleQuantity)
                                                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                                                        Must Supporttrue
                                                                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                                                                        Pattern Value{
                                                                                                                                                                                                                                          "system" : "http://unitsofmeasure.org"
                                                                                                                                                                                                                                        }
                                                                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                        862. Observation.referenceRange.low.id
                                                                                                                                                                                                                                        Definition

                                                                                                                                                                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                        ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                        Control0..1
                                                                                                                                                                                                                                        Typestring
                                                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                                                                        864. Observation.referenceRange.low.extension
                                                                                                                                                                                                                                        Definition

                                                                                                                                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                                        ShortAdditional content defined by implementations
                                                                                                                                                                                                                                        Comments

                                                                                                                                                                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                        Control0..*
                                                                                                                                                                                                                                        TypeExtension
                                                                                                                                                                                                                                        Is Modifierfalse
                                                                                                                                                                                                                                        Summaryfalse
                                                                                                                                                                                                                                        Alternate Namesextensions, user content
                                                                                                                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                        SlicingThis element introduces a set of slices on Observation.referenceRange.low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                        • value @ url
                                                                                                                                                                                                                                        • 866. Observation.referenceRange.low.value
                                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                                          Numerischer Wert für eine gemessene Größe, eine Zahl mit optionalen Dezimalstellen.

                                                                                                                                                                                                                                          ShortNumerical value (with implicit precision)
                                                                                                                                                                                                                                          Comments

                                                                                                                                                                                                                                          The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                                                          Typedecimal
                                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                                          Precision is handled implicitly in almost all cases of measurement.

                                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                          868. Observation.referenceRange.low.comparator
                                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                                          Not allowed to be used in this context

                                                                                                                                                                                                                                          Short< | <= | >= | > - how to understand the value
                                                                                                                                                                                                                                          Control0..0
                                                                                                                                                                                                                                          BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                                                                                                                                          (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                                                                                                                                          How the Quantity should be understood and represented.

                                                                                                                                                                                                                                          Typecode
                                                                                                                                                                                                                                          Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                                          Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                                                                                                                                          Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                          870. Observation.referenceRange.low.unit
                                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                                          Die Einheit leitet sich aus der Messgröße (gemessene Eigenschaft und Mengenmaß) ab. Ein Beispiel: Wenn die Messgröße "Massekonzentration pro Volumen" ist, kommen als Einheiten mg/dl oder g/dl in Frage. Nur UCUM-Einheiten sind zulässig.

                                                                                                                                                                                                                                          Nicht immer werden Richtgrenzen mit Einheiten angegeben. Ein typisches Bespiel hierfür: zum Immunitätsnachweis aus einer Probe werden Verdünnungsreihen von 1:2, 1:4, 1:8, 1:16, 1:32 usw. hergestellt. Die Verdünnungen gibt man auf Zellkulturen, die dann mit einem Virus infiziert werden. Die höchste Verdünnungsstufe, bei der noch eine Infektion der Zellen vollständig verhindert wird, also noch ausreichend Antikörper vorhanden sind, wird als Titer angegeben. Dieser Titer wird ohne Einheiten angeben.

                                                                                                                                                                                                                                          ShortUnit representation
                                                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                                          There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                          872. Observation.referenceRange.low.system
                                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                                          The identification of the system that provides the coded form of the unit.

                                                                                                                                                                                                                                          ShortSystem that defines coded unit form
                                                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                                                          This element is affected by the following invariants: qty-3
                                                                                                                                                                                                                                          Typeuri
                                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                                          Need to know the system that defines the coded form of the unit.

                                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                          874. Observation.referenceRange.low.code
                                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                                          A computer processable form of the unit in some unit representation system.

                                                                                                                                                                                                                                          ShortCoded form of the unit
                                                                                                                                                                                                                                          Comments

                                                                                                                                                                                                                                          The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                                                                                                                                          Control1..1
                                                                                                                                                                                                                                          Typecode
                                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                                          Summarytrue
                                                                                                                                                                                                                                          Requirements

                                                                                                                                                                                                                                          Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                          876. Observation.referenceRange.high
                                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                                          Die obere Richtgrenze ist eine quantitative Grenze. Datentyp und Einheit entsprechen denen beim quantitativen Messergebnis. Unter Eigenschaften sind mögliche Werte gelistet, die in dieses Feld hineinpassen könnten, beispielsweise ein Grenzwert aus dem LDT. Bei diesen Beispielen aus dem LDT gilt es zu beachten, dass die Grenzwerte nur für eine Richtgrenze vom Typ "normal" gelten.

                                                                                                                                                                                                                                          Disclaimer: FHIR® definiert aktuell nur inklusive Richtgrenzen. Für die Praxistauglichkeit besteht aber die Anforderung, auch exklusive Richtgrenzen abbilden zu können. Diese Thematik wurde schon bei HL7® FHIR® platziert, es gibt aber noch keine abschließende Festlegung dazu. Im Informationsmodell sind beide Optionen bereits dargestellt, um diese Anforderung sichtbar zu machen.

                                                                                                                                                                                                                                          ShortHigh Range, if relevant
                                                                                                                                                                                                                                          Control0..1
                                                                                                                                                                                                                                          This element is affected by the following invariants: obs-3
                                                                                                                                                                                                                                          TypeQuantity(SimpleQuantity)
                                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                                          Must Supporttrue
                                                                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                                                                          Pattern Value{
                                                                                                                                                                                                                                            "system" : "http://unitsofmeasure.org"
                                                                                                                                                                                                                                          }
                                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                          878. Observation.referenceRange.high.id
                                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                          ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                          Control0..1
                                                                                                                                                                                                                                          Typestring
                                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                                                                          880. Observation.referenceRange.high.extension
                                                                                                                                                                                                                                          Definition

                                                                                                                                                                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                                          ShortAdditional content defined by implementations
                                                                                                                                                                                                                                          Comments

                                                                                                                                                                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                          Control0..*
                                                                                                                                                                                                                                          TypeExtension
                                                                                                                                                                                                                                          Is Modifierfalse
                                                                                                                                                                                                                                          Summaryfalse
                                                                                                                                                                                                                                          Alternate Namesextensions, user content
                                                                                                                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                          SlicingThis element introduces a set of slices on Observation.referenceRange.high.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                          • value @ url
                                                                                                                                                                                                                                          • 882. Observation.referenceRange.high.value
                                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                                            Numerischer Wert für eine gemessene Größe, eine Zahl mit optionalen Dezimalstellen.

                                                                                                                                                                                                                                            ShortNumerical value (with implicit precision)
                                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                                            The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                                                                                                                                            Control1..1
                                                                                                                                                                                                                                            Typedecimal
                                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                                                            Requirements

                                                                                                                                                                                                                                            Precision is handled implicitly in almost all cases of measurement.

                                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                            884. Observation.referenceRange.high.comparator
                                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                                            Not allowed to be used in this context

                                                                                                                                                                                                                                            Short< | <= | >= | > - how to understand the value
                                                                                                                                                                                                                                            Control0..0
                                                                                                                                                                                                                                            BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                                                                                                                                            (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                                                                                                                                            How the Quantity should be understood and represented.

                                                                                                                                                                                                                                            Typecode
                                                                                                                                                                                                                                            Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                                                            Requirements

                                                                                                                                                                                                                                            Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                                                                                                                                            Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                            886. Observation.referenceRange.high.unit
                                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                                            Die Einheit leitet sich aus der Messgröße (gemessene Eigenschaft und Mengenmaß) ab. Ein Beispiel: Wenn die Messgröße "Massekonzentration pro Volumen" ist, kommen als Einheiten mg/dl oder g/dl in Frage. Nur UCUM-Einheiten sind zulässig.

                                                                                                                                                                                                                                            Nicht immer werden Richtgrenzen mit Einheiten angegeben. Ein typisches Bespiel hierfür: zum Immunitätsnachweis aus einer Probe werden Verdünnungsreihen von 1:2, 1:4, 1:8, 1:16, 1:32 usw. hergestellt. Die Verdünnungen gibt man auf Zellkulturen, die dann mit einem Virus infiziert werden. Die höchste Verdünnungsstufe, bei der noch eine Infektion der Zellen vollständig verhindert wird, also noch ausreichend Antikörper vorhanden sind, wird als Titer angegeben. Dieser Titer wird ohne Einheiten angeben.

                                                                                                                                                                                                                                            ShortUnit representation
                                                                                                                                                                                                                                            Control1..1
                                                                                                                                                                                                                                            Typestring
                                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                                                            Requirements

                                                                                                                                                                                                                                            There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                            888. Observation.referenceRange.high.system
                                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                                            The identification of the system that provides the coded form of the unit.

                                                                                                                                                                                                                                            ShortSystem that defines coded unit form
                                                                                                                                                                                                                                            Control1..1
                                                                                                                                                                                                                                            This element is affected by the following invariants: qty-3
                                                                                                                                                                                                                                            Typeuri
                                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                                                            Requirements

                                                                                                                                                                                                                                            Need to know the system that defines the coded form of the unit.

                                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                            890. Observation.referenceRange.high.code
                                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                                            A computer processable form of the unit in some unit representation system.

                                                                                                                                                                                                                                            ShortCoded form of the unit
                                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                                            The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                                                                                                                                            Control1..1
                                                                                                                                                                                                                                            Typecode
                                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                                                                                            Summarytrue
                                                                                                                                                                                                                                            Requirements

                                                                                                                                                                                                                                            Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                            892. Observation.referenceRange.type
                                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                                            Die Typisierung von Richtgrenzen bezieht sich auf die Indikation einer Laboruntersuchung. Beispiele sind:

                                                                                                                                                                                                                                            • Referenzbereich, zur Feststellung oder Ausschluss von Erkrankungen
                                                                                                                                                                                                                                            • Therapeutischer Bereich, zur Einstellung einer medikamentösen Therapie
                                                                                                                                                                                                                                            • Zielbereich, zur Kontrolle medizinischer Maßnahmen
                                                                                                                                                                                                                                            • Perzentilen (z. B. circannuale 2,5-97,5, als 95% eines gesunden Kollektivs)
                                                                                                                                                                                                                                            • Erwartungsbereiche aufgrund endokrinologischer Konstitution
                                                                                                                                                                                                                                            ShortReference range qualifier
                                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                                            This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.

                                                                                                                                                                                                                                            Control1..1
                                                                                                                                                                                                                                            BindingThe codes SHOULD be taken from ObservationReferenceRangeMeaningCodes
                                                                                                                                                                                                                                            (preferred to http://hl7.org/fhir/ValueSet/referencerange-meaning|4.0.1)

                                                                                                                                                                                                                                            Code for the meaning of a reference range.

                                                                                                                                                                                                                                            TypeCodeableConcept
                                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                                            Must Supporttrue
                                                                                                                                                                                                                                            Summaryfalse
                                                                                                                                                                                                                                            Requirements

                                                                                                                                                                                                                                            Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.

                                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                            894. Observation.referenceRange.type.id
                                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                            ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                            Control0..1
                                                                                                                                                                                                                                            Typestring
                                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                            Summaryfalse
                                                                                                                                                                                                                                            896. Observation.referenceRange.type.extension
                                                                                                                                                                                                                                            Definition

                                                                                                                                                                                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                                            ShortAdditional content defined by implementations
                                                                                                                                                                                                                                            Comments

                                                                                                                                                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                            Control0..*
                                                                                                                                                                                                                                            TypeExtension
                                                                                                                                                                                                                                            Is Modifierfalse
                                                                                                                                                                                                                                            Summaryfalse
                                                                                                                                                                                                                                            Alternate Namesextensions, user content
                                                                                                                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                            SlicingThis element introduces a set of slices on Observation.referenceRange.type.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                            • value @ url
                                                                                                                                                                                                                                            • 898. Observation.referenceRange.type.coding
                                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                                              Hier wird der Richtgrenzen-Typ in codierter Form angegeben.

                                                                                                                                                                                                                                              Für die codierte Richtgrenzen-Typisierung wird eine Auswahl von HL7®-Codes als (bevorzugte) Option angeboten. Die Nutzung der hinterlegten Codes ist abhängig vom Kontext.

                                                                                                                                                                                                                                              ShortCode defined by a terminology system
                                                                                                                                                                                                                                              Comments

                                                                                                                                                                                                                                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                                                                              Control0..*
                                                                                                                                                                                                                                              TypeCoding
                                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                                              Must Supporttrue
                                                                                                                                                                                                                                              Summarytrue
                                                                                                                                                                                                                                              Requirements

                                                                                                                                                                                                                                              Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                              900. Observation.referenceRange.type.coding.id
                                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                              ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                              Control0..1
                                                                                                                                                                                                                                              Typestring
                                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                              Summaryfalse
                                                                                                                                                                                                                                              902. Observation.referenceRange.type.coding.extension
                                                                                                                                                                                                                                              Definition

                                                                                                                                                                                                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                                              ShortAdditional content defined by implementations
                                                                                                                                                                                                                                              Comments

                                                                                                                                                                                                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                              Control0..*
                                                                                                                                                                                                                                              TypeExtension
                                                                                                                                                                                                                                              Is Modifierfalse
                                                                                                                                                                                                                                              Summaryfalse
                                                                                                                                                                                                                                              Alternate Namesextensions, user content
                                                                                                                                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                              SlicingThis element introduces a set of slices on Observation.referenceRange.type.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                              • value @ url
                                                                                                                                                                                                                                              • 904. Observation.referenceRange.type.coding.system
                                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                                The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                                                                                ShortIdentity of the terminology system
                                                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                                                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                                                                Typeuri
                                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                                                Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                906. Observation.referenceRange.type.coding.version
                                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                                The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                                                                                ShortVersion of the system - if relevant
                                                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                                                Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                                                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                                                                Typestring
                                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                908. Observation.referenceRange.type.coding.code
                                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                                                                                ShortSymbol in syntax defined by the system
                                                                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                                                                Typecode
                                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                                                Need to refer to a particular code in the system.

                                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                910. Observation.referenceRange.type.coding.display
                                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                                A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                                                                                ShortRepresentation defined by the system
                                                                                                                                                                                                                                                Control1..1
                                                                                                                                                                                                                                                Typestring
                                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                                                Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                912. Observation.referenceRange.type.coding.userSelected
                                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                                Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                                                                                ShortIf this coding was chosen directly by the user
                                                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                                                Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                                                                                Control0..0
                                                                                                                                                                                                                                                Typeboolean
                                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                                                This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                914. Observation.referenceRange.type.text
                                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                                Hier wird der Richtgrenzen-Typ als Freitext eingegeben.

                                                                                                                                                                                                                                                ShortPlain text representation of the concept
                                                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                                                Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                                                                Typestring
                                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                                                                Summarytrue
                                                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                                                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                916. Observation.referenceRange.appliesTo
                                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                                Die Ermittlung von "Normwerten" basiert üblicherweise auf 95% eines gesunden Erwachsenen-Kollektivs. Normwerte sind Grenzwerte, die sich auf ein „Normalkollektiv“ beziehen. Als Normalkollektiv wird definiert: „gesunde“ PatientInnen ohne erhöhtes Risiko. Es kann spezifische Richtgrenzen für andere Kollektive geben. Mögliche Unterscheidungen sind:

                                                                                                                                                                                                                                                • nach Alter
                                                                                                                                                                                                                                                • nach klinisch-relevantem Geschlecht (divers, männlich, weiblich)
                                                                                                                                                                                                                                                • nach Konstitution/Merkmal
                                                                                                                                                                                                                                                • nach körperlichem Zustand

                                                                                                                                                                                                                                                Beispielsweise:

                                                                                                                                                                                                                                                • Biologisch weiblich (female-typical)
                                                                                                                                                                                                                                                • Biologisch männlich (male-typical)
                                                                                                                                                                                                                                                • Weiblich, postmenopausal
                                                                                                                                                                                                                                                • Erwachsene, männlich, 30-50 Jahre
                                                                                                                                                                                                                                                • Raucher
                                                                                                                                                                                                                                                • Kind (Beginn des 4. bis zum vollendeten 12. Lebensjahr)

                                                                                                                                                                                                                                                Bei den Angaben zum Kollektiv können mehrere Angaben kombiniert aufgeführt werden. Zusätzlich zur Freitextangabe einer LDT-Information ist in FHIR® auch die Codierung möglich (optional).

                                                                                                                                                                                                                                                ShortReference range population
                                                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                                                This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.

                                                                                                                                                                                                                                                Control0..*
                                                                                                                                                                                                                                                BindingFor example codes, see ObservationReferenceRangeAppliesToCodes
                                                                                                                                                                                                                                                (example to http://hl7.org/fhir/ValueSet/referencerange-appliesto|4.0.1)

                                                                                                                                                                                                                                                Codes identifying the population the reference range applies to.

                                                                                                                                                                                                                                                TypeCodeableConcept
                                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                                Must Supporttrue
                                                                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                                                                Requirements

                                                                                                                                                                                                                                                Need to be able to identify the target population for proper interpretation.

                                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                918. Observation.referenceRange.appliesTo.id
                                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                                Control0..1
                                                                                                                                                                                                                                                Typestring
                                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                                                                920. Observation.referenceRange.appliesTo.extension
                                                                                                                                                                                                                                                Definition

                                                                                                                                                                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                                                ShortAdditional content defined by implementations
                                                                                                                                                                                                                                                Comments

                                                                                                                                                                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                                Control0..*
                                                                                                                                                                                                                                                TypeExtension
                                                                                                                                                                                                                                                Is Modifierfalse
                                                                                                                                                                                                                                                Summaryfalse
                                                                                                                                                                                                                                                Alternate Namesextensions, user content
                                                                                                                                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                                SlicingThis element introduces a set of slices on Observation.referenceRange.appliesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                                • value @ url
                                                                                                                                                                                                                                                • 922. Observation.referenceRange.appliesTo.coding
                                                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                                                  Hier kann der "Kollektiv-Bezug" als codierte Information angegeben werden.

                                                                                                                                                                                                                                                  Dieses ValueSet mit HL7®-Codes für den Kollektivbezug enthält (eHDSI-konform) bislang nur geschlechtsspezifische Bezüge. Viele weitere, mögliche Kollektivbezüge sind noch nicht standardisiert terminologisch abgebildet.

                                                                                                                                                                                                                                                  ShortCode defined by a terminology system
                                                                                                                                                                                                                                                  Comments

                                                                                                                                                                                                                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                                                                                                                                  Control0..*
                                                                                                                                                                                                                                                  BindingFor example codes, see KBV_VS_MIO_LAB_EHDSIReferenceRangeAppliesTo (1.0.0-update)
                                                                                                                                                                                                                                                  (example to https://fhir.kbv.de/ValueSet/KBV_VS_MIO_LAB_EHDSIReferenceRangeAppliesTo|1.0.0-update)
                                                                                                                                                                                                                                                  TypeCoding
                                                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                                                  Must Supporttrue
                                                                                                                                                                                                                                                  Summarytrue
                                                                                                                                                                                                                                                  Requirements

                                                                                                                                                                                                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                  924. Observation.referenceRange.appliesTo.coding.id
                                                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                                  ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                                  Control0..1
                                                                                                                                                                                                                                                  Typestring
                                                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                                                                  926. Observation.referenceRange.appliesTo.coding.extension
                                                                                                                                                                                                                                                  Definition

                                                                                                                                                                                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                                                  ShortAdditional content defined by implementations
                                                                                                                                                                                                                                                  Comments

                                                                                                                                                                                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                                  Control0..*
                                                                                                                                                                                                                                                  TypeExtension
                                                                                                                                                                                                                                                  Is Modifierfalse
                                                                                                                                                                                                                                                  Summaryfalse
                                                                                                                                                                                                                                                  Alternate Namesextensions, user content
                                                                                                                                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                                  SlicingThis element introduces a set of slices on Observation.referenceRange.appliesTo.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                                  • value @ url
                                                                                                                                                                                                                                                  • 928. Observation.referenceRange.appliesTo.coding.system
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                                                                                                                                    ShortIdentity of the terminology system
                                                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                                                                    Typeuri
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                                                    Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    930. Observation.referenceRange.appliesTo.coding.version
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                                                                                                                                    ShortVersion of the system - if relevant
                                                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                                                                                                                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                                                                                                                                    Control0..1
                                                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    932. Observation.referenceRange.appliesTo.coding.code
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                                                                                                                                                    ShortSymbol in syntax defined by the system
                                                                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                                                                    Typecode
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                                                    Need to refer to a particular code in the system.

                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    934. Observation.referenceRange.appliesTo.coding.display
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                                                                                                                                    ShortRepresentation defined by the system
                                                                                                                                                                                                                                                    Control1..1
                                                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    936. Observation.referenceRange.appliesTo.coding.userSelected
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                                                                                                                                    ShortIf this coding was chosen directly by the user
                                                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                                                                                                                                    Control0..0
                                                                                                                                                                                                                                                    Typeboolean
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    938. Observation.referenceRange.appliesTo.text
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    Freitextangabe zum Kollektiv-Bezug der Richtgrenzen

                                                                                                                                                                                                                                                    ShortPlain text representation of the concept
                                                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                                                    Very often the text is the same as a displayName of one of the codings.

                                                                                                                                                                                                                                                    Control0..1
                                                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                                                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    940. Observation.referenceRange.age
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.

                                                                                                                                                                                                                                                    ShortApplicable age range, if relevant
                                                                                                                                                                                                                                                    Control0..0
                                                                                                                                                                                                                                                    TypeRange
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                                                                    Requirements

                                                                                                                                                                                                                                                    Some analytes vary greatly over age.

                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    942. Observation.referenceRange.text
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    Textbasierter Referenzbereich, der verwendet werden kann, wenn ein quantitativer Bereich nicht geeignet ist.

                                                                                                                                                                                                                                                    ShortText based reference range in an observation
                                                                                                                                                                                                                                                    Control0..1
                                                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    944. Observation.hasMember
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.

                                                                                                                                                                                                                                                    ShortRelated resource that belongs to the Observation group
                                                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                                                    When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

                                                                                                                                                                                                                                                    Control0..0
                                                                                                                                                                                                                                                    TypeReference(Observation, QuestionnaireResponse, MolecularSequence)
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    946. Observation.derivedFrom
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    Laboruntersuchungen, die als Berechnung erstellt werden, können auf Laboruntersuchungen beruhen, die hier referenziert werden. Hierbei ist zu beachten, dass die Angabe solch referenzierter Messunge(en) nicht zwingend vollständig ist.

                                                                                                                                                                                                                                                    ShortRelated measurements the observation is made from
                                                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                                                    All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below.

                                                                                                                                                                                                                                                    Control0..*
                                                                                                                                                                                                                                                    TypeReference(KBV_PR_MIO_LAB_Observation_Laboratory_Study)
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Must Supporttrue
                                                                                                                                                                                                                                                    Summarytrue
                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    948. Observation.derivedFrom.id
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                                                                                                                                                    Control0..1
                                                                                                                                                                                                                                                    Typestring
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                                                                    950. Observation.derivedFrom.extension
                                                                                                                                                                                                                                                    Definition

                                                                                                                                                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                                                                                                                                    ShortAdditional content defined by implementations
                                                                                                                                                                                                                                                    Comments

                                                                                                                                                                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                                                                                                                                    Control0..*
                                                                                                                                                                                                                                                    TypeExtension
                                                                                                                                                                                                                                                    Is Modifierfalse
                                                                                                                                                                                                                                                    Summaryfalse
                                                                                                                                                                                                                                                    Alternate Namesextensions, user content
                                                                                                                                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                                                                                                                                    SlicingThis element introduces a set of slices on Observation.derivedFrom.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                                                                                                                                    • value @ url
                                                                                                                                                                                                                                                    • 952. Observation.derivedFrom.reference
                                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                                      A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                                                                                                                                                                                                      ShortLiteral reference, Relative, internal or absolute URL
                                                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                                                      Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                                                                                                                                                                                                      Control1..1
                                                                                                                                                                                                                                                      This element is affected by the following invariants: ref-1
                                                                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                      Must Supporttrue
                                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                      954. Observation.derivedFrom.type
                                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                                      The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                                                                                                                                                                                                      The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                                                                                                                                                                                                      ShortType the reference refers to (e.g. "Patient")
                                                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                                                      This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                                                                      BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                                                                                                                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                                                                                                                                                                                                      Aa resource (or, for logical models, the URI of the logical model).

                                                                                                                                                                                                                                                      Typeuri
                                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                      956. Observation.derivedFrom.identifier
                                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                                      An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                                                                                                                                                                                                      ShortLogical reference, when literal reference is not known
                                                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                                                      When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                                                                                                                                                                                                      When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                                                                                                                                                                                                      Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                                                                                                                                                                                                      Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                                                                                                                                                                                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                                                                      TypeIdentifier
                                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                      958. Observation.derivedFrom.display
                                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                                      Plain text narrative that identifies the resource in addition to the resource reference.

                                                                                                                                                                                                                                                      ShortText alternative for the resource
                                                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                                                      This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                                                                      Typestring
                                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                                                                                                                                      960. Observation.component
                                                                                                                                                                                                                                                      Definition

                                                                                                                                                                                                                                                      Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                                                                                                                                                                                                                                      ShortComponent results
                                                                                                                                                                                                                                                      Comments

                                                                                                                                                                                                                                                      For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                                                                                                                                                                                                                      Control0..0
                                                                                                                                                                                                                                                      TypeBackboneElement
                                                                                                                                                                                                                                                      Is Modifierfalse
                                                                                                                                                                                                                                                      Summarytrue
                                                                                                                                                                                                                                                      Requirements

                                                                                                                                                                                                                                                      Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                                                                                                                                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))