2025 OMB FHIR ACH Monthly Measures Data Dictionary

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Overview

TOC - Monthly
FHIR DD Change Log
Details & Abbreviations
Condition-US Core
Coverage-R4
Device R4
Diagnostic Report-R4
Dx Rpt Lab-US Core
Dx Rpt-Report & Note - US Core
Encounter-US Core
Implantable Device-US Core
Lab Result Observation-US Core
Location-US Core
Medication-US Core
MedicationAdministration-R4
MedicationRequest-US Core
Observation-R4
Observation-Vital Signs R4
Patient-US Core
Procedure-US Core
Service Request-R4
Specimen-R4
Metadata

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Sheet 1: TOC - Monthly

Table of Contents - Resources & Profiles	Standard	ACH dQM
NHSN Protocol Subject Matter Expert (SME)		All
dQM Lead Back-up dQM Analyst		Kim Figueroa Lynn Perrine & Mary-Margaret Richter
Measure Submission Frequency		Monthly
Initial Population - CQL Definition		Patients of all ages with Inpt, ED, OBS, SS encounter type or with Inpt, ED, OBS, SS encounter class or with an Inpt, ED, OBS, SS location during MP.
Initial Population - Protocol Definition		All encounters for patients of any age in an ED, observation, or inpatient location or all encounters for patients of any age with an ED, observation, inpatient, or short stay status during the measurement period.
Condition - US Core	US Core v3.1.1	MS
Coverage	FHIR R4 v4.0.1	MS
Device R-4	FHIR R4 v4.0.1	MS
Diagnostic Report -R-4	FHIR R4 v.4.0.1	MS
Diagnostic Report (Lab) - US Core	US Core v3.1.1	MS
Diagnostic Report Profile for Report and Note Exchange	US Core v3.1.1	MS
Encounter-US Core	US Core v3.1.1	R
Implantable Device - US Core	US Core v3.1.1	MS
Laboratory Result Observation - US Core	US Core v3.1.1	MS
Location-US Core	US Core v3.1.1	R
Medication-US Core	US Core v3.1.1	MS
MedicationAdministration	FHIR R4 v4.0.1	MS
MedicationRequest-US Core	US Core v3.1.1	MS
Observation	FHIR R4 v4.0.1	MS In the ACH dQM, the CQL logic for the Observation Supplemental Data Element (SDE) is constrained to the following categories: lab, social history, vital signs, survey, imaging, and procedure
Observation-Vital Signs	FHIR R4 v4.0.1	MS
Patient - US Core	US Core v3.1.1	R
Procedure - US Core	US Core v3.1.1	MS
Service Request	FHIR R4 v4.0.1	MS
Specimen	FHIR R4 v4.0.1	MS
Comment:
* 3.1.0 Version cited in 21 st Centuries Cures Act https://www.federalregister.gov/documents/2020/05/01/2020-07419/21st-century-cures-act-interoperability-information-blocking-and-the-onc-health-it-certification
FHIR R4:
http://hl7.org/fhir/R4/downloads.html
Link to Change Log

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Sheet 2: FHIR DD Change Log

Date of Request	Data Element	Changed From	Changed To
4/4/2023	DiagnosticReport.id	NR	R[1..1]
4/4/2023	Observation.id	NR	R[1..1]
4/4/2023	Observation.subject	NR	R[1..1]
4/4/2023	Medication.ingredient.item[x]	NR	R[1..1]
4/4/2023	Encounter.identifier.system	NA	R[1..1]
4/13/2023	MedicationRequest.status	R [1..1] CQL is constrained to: 'completed'	R [1..1]
4/14/2023	NA	Entire Resource - R	Entire Resource – MS
4/14/2023	Encounter.location	R [0..*]	R [1..*]
4/14/2023	Encounter.location.location	NR	R [1..1]
4/18/2023	{Resource}.language	NR	NRT
4/18/2023	{Resource}.implicitRules	NR	NRT
4/18/2023	{Resource}.Identifier.period	MS[0..1] in Encounte Resource	NRT only in Technical column
4/18/2023	{Resource}.Identifier.assigner	NR	NRT
4/18/2023	Encounter.EpisodeOfCare	MS [0..1]	NRT only in Technical column
4/18/2023	Encounter.BasedOn	NR	NRT
4/18/2023	Encounter.serviceProvider	NR	NRT
4/18/2023	Encounter.appointment	NR	NRT
4/18/2023	Condition.recorder	NR	NRT
4/18/2023	Condition.asserter	NR	NRT
4/18/2023	Coverage.type	NR	NRT
4/18/2023	Coverage.dependent	NR	NRT
4/18/2023	Coverage.costToBeneficiary	NR	NRT
4/18/2023	Observation.category.extension	NR	NRT
4/18/2023	Medication.ingredient.isActive	NR	NRT
4/18/2023	MedicationRequest.statusReason	NR	NRT
4/18/2023	MedicationRequest.supportingInformation	NR	NRT
4/18/2023	MedicationRequest.performer	NR	NRT
4/18/2023	MedicationRequest.performerType	NR	NRT
4/18/2023	MedicationRequest.instantiatesCanonical	MS [0..1]	NRT only in Technical column
4/18/2023	MedicationRequest.instantiatesUri	NR	NRT
4/18/2023	MedicationRequest.basedOn	NR	NRT
4/18/2023	MedicationRequest.groupIdentifier	NR	NRT
4/18/2023	MedicationRequest.insurance	NR	NRT
4/18/2023	MedicationRequest.note	NR	NRT
4/18/2023	MedicationRequest.dosageInstruction.sequence	NR	NRT
4/18/2023	MedicationRequest.dosageInstruction.additionalInstruction	NR	NRT
4/18/2023	MedicationRequest.dosageInstruction.site	MS[0..1] for Hypo and CDI/HOB	NRT only in Technical column
4/18/2023	MedicationRequest.dosageInstruction.maxDosePerPeriod	NR	NRT
4/18/2023	MedicationRequest.dosageInstruction.maxDosePerAdministration	NR	NRT
4/18/2023	MedicationRequest.dosageInstruction.maxDosePerLifetime	NR	NRT
4/18/2023	MedicationRequest.substitution	NR	NRT
4/18/2023	MedicationRequest.dispenseRequest	NR	NRT
4/18/2023	MedicationRequest.priorPrescription	NR	NRT
4/18/2023	MedicationRequest.detectedIssue	NR	NRT
4/18/2023	MedicationRequest.eventHistory	NR	NRT
4/17/2023	Device.patient	NR	R [1..1]
4/18/2023	Observation.dateAbsentReason	NR	MS [0..1]
5/1/2023	MedicationRequest.statusReason	NR	NRT
5/1/2023	MedicationRequest.authoredOn	MS [0..*]	R [1..1]
5/1/2023	MedicationRequest.instantiatesCanonical	MS [0..*]	NRT
5/1/2023	MedicationRequest.courseOfTherapyType	MS [0..1]	NRT
5/1/2023	MedicationRequest.dosageInstruction	R [1..1]	MS [0..*]
5/1/2023	MedicationRequest.dosageInstruction.doseAndRate.id	NR	NRT
5/1/2023	MedicationRequest.dosageInstruction.doseAndRate.extension	NR	NRT
5/1/2023	MedicationRequest.dosageInstruction.doseAndRate.type	NR	MS [0..1]
5/1/2023	Medication.status	R [1..1]	NR
5/1/2023	Medication.ingredient.itemCodeableConcept	NR	MS [0..1]
5/1/2023	Medication.ingredient.itemReference	NR	MS [0..1]
5/2/2023	MedicationRequest.requester	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson|Device)	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile)
5/3/2023	Encounter.episodeOfCare	MS [0..1]	NRT
5/8/2023	MedicationRequest.dosageInstruction.doseAndRate.dose[x]	NR	MS [0..1]
5/8/2023	MedicationRequest.priority	NR	MS [0..1]
5/8/2023	MedicationRequest.reasonReference	NR	MS [0..*]
5/8/2023	MedicationRequest.instantiatesCanonical	NRT	MS [0..*]
5/8/2023	MedicationRequest.instantiatesUri	NRT	MS [0..*]
5/15/2023	Medication.ingredient.itemCodeableConcept Medication.ingredient.itemReference	MS [0..1]	Removed from table
5/15/2023	NA	NA	N/A
5/15/2023	Condition.onset.onsetDateTime Condition.onset.onsetAge Condition.onset.Period Condition.onset.Range Condition.onset.String	NR	Removed from table
5/15/2023	Condition.abatement.onsetDateTime Condition.abatement.onsetAge Condition.abatement.Period Condition.abatement.Range Condition.abatement.String	N/A	Removed from table
5/15/2023	Observation.encounter NR to MS	NR	MS [0..1]
5/15/2023	Observation.hasMember NR to MS	NR	MS [0..1]
5/16/2023	DiagnosticReport.effective.effectiveDateTime DiagnosticReport.effective.Period	NR	N/A
5/22/2023	Observation.category	NR	R [1..*]
6/4/2023	Encounter.episodeOfCare	MS [0..1]	NRT
6/5/2023	Procedure.subject	NR	R [1..1]
6/5/2023	Procedure.encounter	NR	MS [0..1]
6/5/2023	Procedure.location	NR	MS [0..1]
6/5/2023	Procedure.reasonCode	NR	MS [0..*]
6/6/2023	Observation.encounter	NR	MS [0..1]
6/6/2023	Observation.dataAbsentReason	NR	MS [0..1]
6/6/2023	Location	MS [0..*]	R [1..*]
6/6/2023	MedicationRequest.dosageInstruction.doseAndRate.type	NR	MS [0..1]
6/6/2023	MedicationRequest.dosageInstruction.doseAndRate.dose[x]	NR	MS [0..1]
6/6/2023	Specimen.type (not required for Hypo, but if necessary for alignment)	MS [0..1]	R [1..1]
6/6/2023	Medication.status	R [1..1]	NR
6/6/2023	Condition.encounter	MS [0..1]	MS [0..1]
6/6/2023	Condition.onset[x]	MS [0..1]	MS [0..1]
6/6/2023	Condition.abatement[x]	MS [0..1]	MS [0..1]
6/6/2023	Condition.recordedDate	MS [0..1]	MS [0..1]
6/21/2023	Location resource designation in TOC	MS	R
6/28/2023	Medication.code
7/5/2023	TOC, dQM Measure Lead/Back-up Clinical Analyst Row	N/A	Updated
7/5/2023	Initial Population-CQL on TOC	all Inpt, ED, OBS + ADD	all Inpt (includes ED or OBS within 1 hour of Inpt) + ADD
7/10/2023	Specimen.subject	NR	MS [0..1]
7/10/2023	Specimen.collection	MS [0..1]	R [1..1]
7/10/2023	Specimen.collection.id	NR	NRT
7/10/2023	Specimen.collection.extension	NR	NRT
7/10/2023	Specimen.collection.modifierExtension	NR	NRT
7/31/2023	MedicationAdministration.context	NR	MS [0..1]
7/31/2023	MedicationAdministration.request	NR	MS [0..1]
7/31/2023	Condition.clinicalStatus	NA	added a note to FHIR Definition column G
7/31/2023	Condition.verificationStatus	NA	added a note to FHIR Definition column G
8/1/2023	Patient.contact.modifierExtension	[0..1]	NRT
8/1/2023	Patient.communication.modifierExtension	[0..1]	NRT
8/1/2023	Patient.identifier.period	NRT - in technical column	removed
8/1/2023	Specimen.processing.modifierExtension	NR	NRT
8/1/2023	Specimen.container.modifierExtension	NR	NRT
8/1/2023	Specimen.container.identifier	NR	NRT
8/1/2023	Specimen.text	NR	NRT
8/1/2023	Specimen.contained	NR	NRT
8/1/2023	Specimen.extension	NR	NRT
8/1/2023	Specimen.processing.id	NR	NRT
8/1/2023	Specimen.processing.extension	NR	NRT
8/1/2023	Specimen.container.id	NR	NRT
8/1/2023	Specimen.container.extension	NR	NRT
8/1/2023	N/A	Y or N	removed
8/1/2023	Specimen.meta	NR	NRT
8/1/2023	Specimen.modifierExtension	NR	NRT
8/1/2023	Specimen.collection.id	NR	NRT
8/1/2023	Specimen.collection.extension	NR	NRT
8/1/2023	Specimen.collection.modifierExtension	NR	NRT
8/1/2023	(Abbreviation Tab)	NA	NA
8/1/2023	Condition.meta	NR	NRT
8/1/2023	Condition.text	NR	NRT
8/1/2023	Condition.contained	NR	NRT
8/1/2023	Condition.extension	NR	NRT
8/1/2023	Condition.modifierExtension	NR	NRT
8/1/2023	Condition.identifier	NR	NRT
8/1/2023	Condition.stage.id	NR	NRT
8/1/2023	Condition.stage.extension	NR	NRT
8/1/2023	Condition.stage.modifierExtension	NR	NRT
8/1/2023	Condition.evidence.id	NR	NRT
8/1/2023	Condition.evidence.extension	NR	NRT
8/1/2023	Condition.evidence.modifierExtension	NR	NRT
8/1/2023	Coverage.meta	NR	NRT
8/1/2023	Coverage.text	NR	NRT
8/1/2023	Coverage.contained	NR	NRT
8/1/2023	Coverage.extension	NR	NRT
8/1/2023	Coverage.modifierExtension	NR	NRT
8/1/2023	Coverage.identifier	NR	NRT
8/1/2023	Coverage.class.id	NR	NRT
8/1/2023	Coverage.class.extension	NR	NRT
8/1/2023	Coverage.class.modifierExtension	NR	NRT
8/1/2023	DiagnosticReport.meta	NR	NRT
8/1/2023	DiagnosticReport.implicitRules	NR	NRT
8/1/2023	DiagnosticReport.language	NR	NRT
8/1/2023	DiagnosticReport.contained	NR	NRT
8/1/2023	DiagnosticReport.extension	NR	NRT
8/1/2023	DiagnosticReport.modifierExtension	NR	NRT
8/1/2023	DiagnosticReport.identifier	NR	NRT
8/1/2023	DiagnosticReport.category:LaboratorySlice.id	NR	NRT
8/1/2023	DiagnosticReport.category:LaboratorySlice.id.extension	NR	NRT
8/1/2023	DiagnosticReport.category:LaboratorySlice.coding.id	NR	NRT
8/1/2023	DiagnosticReport.media.id	NR	NRT
8/1/2023	DiagnosticReport.media.extension	NR	NRT
8/1/2023	DiagnosticReport.media.modifierExtension	NR	NRT
8/1/2023	DocumentReference.meta	NR	NRT
8/1/2023	DocumentReference.text	NR	NRT
8/1/2023	DocumentReference.contained	NR	NRT
8/1/2023	DocumentReference.extension	NR	NRT
8/1/2023	DocumentReference.modifierExtension	NR	NRT
8/1/2023	DocumentReference.masterIdentifier	NR	NRT
8/1/2023	DocumentReference.identifier	NR	NRT
8/1/2023	DocumentReference.relatesTo.id	NR	NRT
8/1/2023	DocumentReference.relatesTo.extension	NR	NRT
8/1/2023	DocumentReference.relatesTo.modifierExtension	NR	NRT
8/1/2023	DocumentReference.content.id	NR	NRT
8/1/2023	DocumentReference.content.extension	NR	NRT
8/1/2023	DocumentReference.content.modifierExtension	NR	NRT
8/1/2023	DocumentReference.content.attachment.id	NR	NRT
8/1/2023	DocumentReference.content.attachment.extension	NR	NRT
8/1/2023	DocumentReference.content.attachment.language	NR	NRT
8/1/2023	DocumentReference.context.id	NR	NRT
8/1/2023	DocumentReference.context.extension	NR	NRT
8/1/2023	DocumentReference.context.modifierExtension	NR	NRT
8/1/2023	Encounter.meta	NR	NRT
8/1/2023	Encounter.text	NR	NRT
8/1/2023	Encounter.contained	NR	NRT
8/1/2023	Encounter.extension	NR	NRT
8/1/2023	Encounter.modifierExtension	NR	NRT
8/1/2023	Encounter.identifier.id	NR	NRT
8/1/2023	Encounter.identifier.extension	NR	NRT
8/1/2023	Encounter.statusHistory.id	NR	NRT
8/1/2023	Encounter.statusHistory.extension	NR	NRT
8/1/2023	Encounter.statusHistory.modifierExtension	NR	NRT
8/1/2023	Encounter.classHistory.id	NR	NRT
8/1/2023	Encounter.classHistory.extension	NR	NRT
8/1/2023	Encounter.classHistory.modifierExtension	NR	NRT
8/1/2023	Encounter.participant.id	NR	NRT
8/1/2023	Encounter.participant.extension	NR	NRT
8/1/2023	Encounter.participant.modifierExtension	NR	NRT
8/1/2023	Encounter.diagnosis.id	NR	NRT
8/1/2023	Encounter.diagnosis.extension	NR	NRT
8/1/2023	Encounter.diagnosis.modifierExtension	NR	NRT
8/1/2023	Encounter.diagnosis.condition	NR	NRT
8/1/2023	Encounter.hospitalization.id	NR	NRT
8/1/2023	Encounter.hospitalization.extension	NR	NRT
8/1/2023	Encounter.hospitalization.modifierExtension	NR	NRT
8/1/2023	Encounter.location.id	NR	NRT
8/1/2023	Encounter.location.extension	NR	NRT
8/1/2023	Encounter.location.modifierExtension	NR	NRT
8/1/2023	Immunization.meta	NR	NRT
8/1/2023	Immunization.implicitRules	NR	NRT
8/1/2023	Immunization.language	NR	NRT
8/1/2023	Immunization.text	NR	NRT
8/1/2023	Immunization.contained	NR	NRT
8/1/2023	Immunization.extension	NR	NRT
8/1/2023	Immunization.modifierExtension	NR	NRT
8/1/2023	Immunization.performer.id	NR	NRT
8/1/2023	Immunization.performer.extension	NR	NRT
8/1/2023	Immunization.performer.modifierExtension	NR	NRT
8/1/2023	Immunization.education.id	NR	NRT
8/1/2023	Immunization.education.extension	NR	NRT
8/1/2023	Immunization.education.modifierExtension	NR	NRT
8/1/2023	Immunization.reaction.id	NR	NRT
8/1/2023	Immunization.reaction.extension	NR	NRT
8/1/2023	Immunization.reaction.modifierExtension	NR	NRT
8/1/2023	Immunization.protocolApplied.id	NR	NRT
8/1/2023	Immunization.protocolApplied.extension	NR	NRT
8/1/2023	Immunization.protocolApplied.modifierExtension	NR	NRT
8/1/2023	Device.meta	NR	NRT
8/1/2023	Device.implicitRules	NR	NRT
8/1/2023	Device.language	NR	NRT
8/1/2023	Device.text	NR	NRT
8/1/2023	Device.contained	NR	NRT
8/1/2023	Device.extension	NR	NRT
8/1/2023	Device.modifierExtension	NR	NRT
8/1/2023	Device.identifier	NR	NRT
8/1/2023	Device.deviceName.id	NR	NRT
8/1/2023	Device.deviceName.extension	NR	NRT
8/1/2023	Device.deviceName.modifierExtension	NR	NRT
8/1/2023	Device.specialization.id	NR	NRT
8/1/2023	Device.specialization.extension	NR	NRT
8/1/2023	Device.specialization.modifierExtension	NR	NRT
8/1/2023	Device.version.id	NR	NRT
8/1/2023	Device.version.extension	NR	NRT
8/1/2023	Device.version.modifierExtension	NR	NRT
8/1/2023	Device.property.id	NR	NRT
8/1/2023	Device.property.extension	NR	NRT
8/1/2023	Device.property.modifierExtension	NR	NRT
8/1/2023	Observation.meta	NR	NRT
8/1/2023	Observation.text	NR	NRT
8/1/2023	Observation.contained	NR	NRT
8/1/2023	Observation.extension	NR	NRT
8/1/2023	Observation.modifierExtension	NR	NRT
8/1/2023	Observation.identifier	NR	NRT
8/1/2023	Observation.category.id	NR	NRT
8/1/2023	Observation.referenceRange.id	NR	NRT
8/1/2023	Observation.referenceRange.extension	NR	NRT
8/1/2023	Observation.referenceRange.modifierExtension	NR	NRT
8/1/2023	Observation.component.id	NR	NRT
8/1/2023	Observation.component.extension	NR	NRT
8/1/2023	Observation.component.modifierExtension	NR	NRT
8/1/2023	Location.meta	NR	NRT
8/1/2023	Location.text	NR	NRT
8/1/2023	Location.contained	NR	NRT
8/1/2023	Location.extension	NR	NRT
8/1/2023	Location.modifierExtension	NR	NRT
8/1/2023	Location.address.id	NR	NRT
8/1/2023	Location.address.extension	NR	NRT
8/1/2023	Location.position.id	NR	NRT
8/1/2023	Location.position.extension	NR	NRT
8/1/2023	Location.position.modifierExtension	NR	NRT
8/1/2023	Location.hoursOfOperation.id	NR	NRT
8/1/2023	Location.hoursOfOperation.extension	NR	NRT
8/1/2023	Location.hoursOfOperation.modifierExtension	NR	NRT
8/1/2023	Medication.meta	NR	NRT
8/1/2023	Medication.text	NR	NRT
8/1/2023	Medication.contained	NR	NRT
8/1/2023	Medication.extension	NR	NRT
8/1/2023	Medication.modifierExtension	NR	NRT
8/1/2023	Medication.identifier	NR	NRT
8/1/2023	Medication.ingredient.id	NR	NRT
8/1/2023	Medication.ingredient.extension	NR	NRT
8/1/2023	Medication.ingredient.modifierExtension	NR	NRT
8/1/2023	Medication.batch.id	NR	NRT
8/1/2023	Medication.batch.extension	NR	NRT
8/1/2023	Medication.batch.modifierExtension	NR	NRT
8/1/2023	MedicationAdministration.meta	NR	NRT
8/1/2023	MedicationAdministration.text	NR	NRT
8/1/2023	MedicationAdministration.contained	NR	NRT
8/1/2023	MedicationAdministration.extension	NR	NRT
8/1/2023	MedicationAdministration.modifierExtension	NR	NRT
8/1/2023	MedicationAdministration.identifier	NR	NRT
8/1/2023	MedicationAdministration.performer.id	NR	NRT
8/1/2023	MedicationAdministration.performer.extension	NR	NRT
8/1/2023	MedicationAdministration.performer.modifierExtension	NR	NRT
8/1/2023	MedicationAdministration.dosage.id	NR	NRT
8/1/2023	MedicationAdministration.dosage.extension	NR	NRT
8/1/2023	MedicationAdministration.dosage.modifierExtension	NR	NRT
8/1/2023	MedicationRequest.meta	NR	NRT
8/1/2023	MedicationRequest.text	NR	NRT
8/1/2023	MedicationRequest.contained	NR	NRT
8/1/2023	MedicationRequest.extension	NR	NRT
8/1/2023	MedicationRequest.modifierExtension	NR	NRT
8/1/2023	MedicationRequest.identifier	NR	NRT
8/1/2023	MedicationRequest.dosageInstruction.id	NR	NRT
8/1/2023	MedicationRequest.dosageInstruction.extension	NR	NRT
8/1/2023	MedicationRequest.dosageInstruction.modifierExtension	NR	NRT
8/1/2023	MedicationRequest.substitution.id	NR	NRT
8/1/2023	MedicationRequest.substitution.extension	NR	NRT
8/1/2023	MedicationRequest.substitution.modifierExtension	NR	NRT
8/1/2023	Observation.meta	NR	NRT
8/1/2023	Observation.implicitRules	NR	NRT
8/1/2023	Observation.language	NR	NRT
8/1/2023	Observation.text	NR	NRT
8/1/2023	Observation.contained	NR	NRT
8/1/2023	Observation.extension	NR	NRT
8/1/2023	Observation.modifierExtension	NR	NRT
8/1/2023	Observation.identifier	NR	NRT
8/1/2023	Observation.referenceRange.id	NR	NRT
8/1/2023	Observation.referenceRange.extension	NR	NRT
8/1/2023	Observation.referenceRange.modifierExtension	NR	NRT
8/1/2023	Observation.component.id	NR	NRT
8/1/2023	Observation.component.extension	NR	NRT
8/1/2023	Observation.component.modifierExtension	NR	NRT
8/1/2023	Procedure.meta	NR	NRT
8/1/2023	Procedure.implicitRules	NR	NRT
8/1/2023	Procedure.language	NR	NRT
8/1/2023	Procedure.text	NR	NRT
8/1/2023	Procedure.contained	NR	NRT
8/1/2023	Procedure.extension	NR	NRT
8/1/2023	Procedure.modifierExtension	NR	NRT
8/1/2023	Procedure.identifier	NR	NRT
8/1/2023	Procedure.performer.id	NR	NRT
8/1/2023	Procedure.performer.extension	NR	NRT
8/1/2023	Procedure.performer.modifierExtension	NR	NRT
8/1/2023	Procedure.focalDevice.id	NR	NRT
8/1/2023	Procedure.focalDevice.extension	NR	NRT
8/1/2023	Procedure.focalDevice.modifierExtension	NR	NRT
8/1/2023	ServiceRequest.meta	NR	NRT
8/1/2023	ServiceRequest.text	NR	NRT
8/1/2023	ServiceRequest.contained	NR	NRT
8/1/2023	ServiceRequest.extension	NR	NRT
8/1/2023	ServiceRequest.modifierExtension	NR	NRT
8/1/2023	ServiceRequest.identifier	NR	NRT
8/2/2023	Patient.meta	NR	NRT
8/2/2023	Patient.implicitRules	NR	NRT
8/2/2023	Patient.language	NR	NRT
8/2/2023	Patient.text	NR	NRT
8/2/2023	Patient.contained	NR	NRT
8/2/2023	Patient.modifierExtension	NR	NRT
8/2/2023	Patient.telecom.id	NR	NRT
8/2/2023	Patient.telecom.extension	NR	NRT
8/4/2023	Observation.code	R [1..1]	R [1..1] The following constraint is written into the CQL: "Blood Glucose Laboratory and Point of Care Tests" http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1190.38
8/7/2023	MedicationRequest.dosageInstruction.site	NRT	blank
8/7/2023	Encounter.diagnosis.condition	NRT	R [1..1]
8/7/2023	Encounter.diagnosis.condition	NRT	(left blank)
8/8/2023	Device R4 Resource	N/A	N/A
8/9/2023	Diagnostic Report Profile for Report and Note Exchange	N/A	N/A
8/17/2023	MedicationRequest.dosageInstruction.text	MS [0..1]	MS [0..1]
8/18/2023	MedicationRequest.statusReason	NRT	MS[0..1]
9/6/2023	NA	NA	NA
10/2/2023	All data element aligment analysis	NA	NA
10/2/2023	All data element aligment analysis	NA	NA
10/3/2023	NHSN IG - Cross Measure, Monthly Column	NA	NA
10/4/2023`	Added an "ACH dQM" column with requirements
1010/2023	Medication and Medication Request Resources in ACH dQM
10/18/2023	Medication.status	NR	MS[0..*]
10/18/2023	Specimen.status	NR	MS[0..1]
10/20/2023	Observation - Vital Signs Resource/Profile	NA	NA
10/25/2023	Observation.component.code	MS [1..1]	R [1..1]
10/30/2023	Encounter.status	R [1..1] The following constraints are written into the CQL: 'in-progress', 'finished', 'triaged'	R [1..1] The following constraints are written into the CQL: 'in-progress', 'finished', 'triaged', 'onleave', 'entered-in-error'
10/31/2023	Encounter.status	R [1..1] The following constraints are written into the CQL: 'in-progress', 'finished', 'triaged', 'entered-in-error'	R [1..1] The following constraints are written into the CQL: 'in-progress', 'finished', 'triaged', 'onleave', 'entered-in-error'
11/1/2023	Observation.specimen (in Lab Result Observation -US Core)	MS [0..*]	MS [0..1]
11/7/2023	Patient.extension (gender identity)	MS [0..1]	MS [0..*]
11/8/2023	Observation-Vital Signs R4 Observation.referenceRange	NR	MS [0..*]
11/8/2023	Observation-Vital Signs R4 Observation.component.referenceRange	NR	MS[0..*]
11/8/2023	Observation-R4 Observation.referenceRange	NR	MS [0..*]
11/8/2023	Observation-R4 Observation.component.referenceRange	NR	MS [0..1]
11/9/2023	Observation-Vital Signs R4 Observation.referenceRange.age	NR	MS [0..1]
11/9/2023	Observation-R4 Observation.referenceRange.age	NR	MS [0..1]
11/9/2023	Observation-R4 Observation.referenceRange.low	NR	MS [0..1]
11/9/2023	Observation-Vital Signs R4 Observation.referenceRange.low	NR	MS [0..1]
11/9/2023	Observation-R4 Observation.referenceRange.high	NR	MS [0..1]
11/9/2023	Observation-Vital Signs R4 Observation.referenceRange.high	NR	MS [0..1]
11/9/2023	Observation-R4 Observation.component.referenceRange.low	NR	MS [0..1]
11/9/2023	Observation-Vital Signs R4 Observation.component.referenceRange.low	NR	MS [0..1]
11/9/2023	Observation-R4 Observation.component.referenceRange.high	NR	MS [0..1]
11/9/2023	Observation-Vital Signs R4 Observation.component.referenceRange.high	NR	MS [0..1]
11/13/2023	DiagnosticReport.imagingStudy DiagnosticReport.media DiagnosticReport.presentedForm	NR	NRT
11/21/2023	Encounter.type	http://hl7.org/fhir/us/core/ValueSet/us-core-encounter-type	https://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-encounter-type.html
11/21/2023	Encounter.diagnosis.use	http://hl7.org/fhir/ValueSet/diagnosis-role	https://hl7.org/fhir/R4/valueset-diagnosis-role.html
11/21/2023	Encounter.hospitalization.admitSource	http://hl7.org/fhir/ValueSet/encounter-admit-source	https://hl7.org/fhir/R4/valueset-encounter-admit-source.html
11/21/2023	Encounter.location.status	http://hl7.org/fhir/ValueSet/encounter-location-status	https://hl7.org/fhir/R4/valueset-encounter-location-status.html
11/21/2023	Device.status	http://hl7.org/fhir/ValueSet/device-status|4.0.1	https://hl7.org/fhir/R4/valueset-device-status.html
11/21/2023	Device.deviceName.type	http://hl7.org/fhir/ValueSet/device-nametype|4.0.1	https://hl7.org/fhir/R4/valueset-device-nametype.html
11/21/2023	Observation.category	http://hl7.org/fhir/ValueSet/observation-category	https://hl7.org/fhir/R4/valueset-observation-category.html
11/21/2023	Observation.interpretation	http://hl7.org/fhir/ValueSet/observation-interpretation	https://hl7.org/fhir/R4/valueset-observation-interpretation.html
11/21/2023	Observation.component.interpretation	http://hl7.org/fhir/ValueSet/observation-interpretation	https://hl7.org/fhir/R4/valueset-observation-interpretation.html
11/30/2023	MedicationRequest-US Core	R	MS
12/6/2023	DiagnosticReport.status	R[1..]	R[1..1]
12/13/2023	Implantable Device (US Core) Device.owner	N/A	N/A
12/13/2023	Implantable Device (UsCore) Device.contact	N/A	N/A
12/13/2023	Implantable Device (UsCore) Device.location	N/A	N/A
12/13/2023	Implantable Device (UsCore) Device.url	N/A	N/A
12/13/2023	Implantable Device (UsCore) Device.note	N/A	N/A
12/13/2023	Implantable Device (UsCore) Device.safety	N/A	N/A
12/13/2023	Implantable Device (UsCore) Device.parent	N/A	N/A
12/13/2023	Observation Vital Signs (R4) Observation.component.referenceRange.low	N/A	N/A
12/13/2023	Observation Vital Signs (R4) Observation.component.referenceRange.high	N/A	N/A
12/13/2023	Observation Vital Signs (R4) Observation.component.referenceRange.type	N/A	N/A
12/13/2023	Observation Vital Signs (R4) Observation.component.referenceRange.appliesTo	N/A	N/A
12/13/2023	Observation Vital Signs (R4) Observation.component.referenceRange.age	N/A	N/A
12/13/2023	Observation Vital Signs (R4) Observation.component. referenceRange.text	N/A	N/A
1/2/2024	Observation.component.id	R [1..1]	NRT
1/2/2024	Observation.component.extension	MS [0..1]	NRT
1/2/2024	Observation.component.modifierExtension	MS [0..*]	NRT
1/2/2024	Observation.component.dataAbsentReason	MS [0..*]	NR
1/2/2024	Observation.value[x]	MS [0..1] (could have a null if lab result/status is not yet finalized)	MS [0..1]
1/2/2024	Observation.note	MS [0..1]	NR
1/2/2024	Condition.onset[x]	MS [0..1]	MS [0..1]
1/2/2024	Condition.abatement[x]	MS [0..1]	MS [0..1]
1/2/2024	Condition.recordedDate	MS [0..1]	MS [0..1]
1/2/2024	Location.alias	MS [0..*]	MS [0..*]
1/2/2024	Medication	MS [0..*]	MS [0..*]
1/2/2024	Medication.form	MS [0..1]	MS [0..1]
1/2/2024	Medication.amount	MS [0..1]	MS [0..1]
1/2/2024	Medication.ingredient	MS [0..*]	MS [0..*]
1/2/2024	Encounter.statusHistory		NR
1/4/2024	Observation.encounter (Lab Result Observation)	MS [0..1]	MS [0..1]
1/4/2024	DiagnosticReport.specimen	MS [0..*]	MS [0..*]
1/4/2024	Location.partOf	MS [0..1]	MS [0..1]
1/4/2024	MedicationAdministration	MS [0..*]	MS [0..*]
1/4/2024	MedicationAdministration.statusReason	MS [0..*]	MS [0..*]
1/4/2024	MedicationAdministration.category	MS [0..*]	MS [0..*]
1/4/2024	MedicationAdministration.reasonCode	MS [0..*]	MS [0..*]
1/4/2024	MedicationAdministration.reasonReference	MS [0..*]	MS [0..*]
1/4/2024	MedicationRequest.dosageInstruction.method	MS [0..1]	MS [0..1]
1/4/2024	MedicationRequest.dosageInstruction.doseAndRate	MS [0..*]	MS [0..*]
1/4/2024	MedicationRequest.dosageInstruction.doseAndRate.type	MS [0..1]	MS [0..1]
1/4/2024	MedicationRequest.dosageInstruction.doseAndRate.dose[x]	MS [0..1]	MS [0..1]
1/4/2024	MedicationRequest.dosageInstruction.doseAndRate.rate[x]	MS [0..1]	MS [0..1]
1/4/2024	Procedure	MS [0..*]	MS [0..*]
1/4/2024	Procedure.encounter	MS[0..1]	MS [0..1]
1/4/2024	Procedure.location	MS [0..1]	MS [0..1]
1/4/2024	ServiceRequest	MS [0..*]	MS [0..*]
1/4/2024	ServiceRequest.category	MS [0..*]	MS [0..*]
1/4/2024	ServiceRequest.priority	MS [0..1]	MS [0…1]
1/4/2024	ServiceRequest.doNotPerform	MS [0..1]	MS [0..1]
1/4/2024	ServiceRequest.code	MS [0..1]	MS [0..1]
1/4/2024	ServiceRequest.encounter	MS [0..1]	MS [0..1]
1/4/2024	ServiceRequest.occurrence[x]	MS [0..1]	MS [0..1]
1/4/2024	ServiceRequest.asNeeded[x]	MS [0..1]	MS [0..1]
1/4/2024	ServiceRequest.reasonReference	MS [0..*]	MS [0..*]
1/4/2024	ServiceRequest.specimen	MS [0..*]	MS [0..*]
1/16/2024	DiagnosticReport.imagingStudy	NR	NRT
1/16/2024	DiagnosticReport.media	NR	NRT
1/16/2024	DiagnosticReport.presentedForm	NR	NRT
1/24/2024	Diagnostic Report Report and Note DiagnosticReport.text	NR	NRT
1/24/2024	Diagnostic Report- Lab DiagnosticReport.text	NR	NRT
1/24/2024	Location.identifier	NR	NRT
1/29/2024	location.managingOrg	MS	NR
1/29/2024	patient.managingOrganization	MS	NR
1/30/2024	DiagnosticReport.media.link	NR	NRT
1/30/2024	DiagnosticReport.media.comment	NR	NRT
1/30/2024	MedicationRequest.substitution.allowed[x]	NR	NRT
1/30/2024	MedicationRequest.substitution.reason	NR	NRT
2/9/2024	DiagnosticReport.presentedForm	NR	NRT
2/15/2023	Implantable Device Device.deviceName	MS [0..1*]	MS [0..*]
2/15/2024	Updates to binding strengths for ACH	NA	NA
3/1/2024	Encounter.participant	NR	NRT
3/1/2024	Encounter.participant.id	NR	NRT
3/1/2024	Encounter.participant.extension	NR	NRT
3/1/2024	Encounter.participant.modifierExtension	NR	NRT
3/1/2024	Encounter.participant.type	NR	NRT
3/1/2024	Encounter.participant.period	NR	NRT
3/1/2024	Encounter.participant.individual	NR	NRT
3/7/2024	Service Request resource	N	MS
4/2/2024	Diagnostic Report - R4 (Tab and TOC)	none	added
6/12/2024	MedicationRequest.requester	R[1..1]	NR

---

Sheet 3: Details & Abbreviations

Details	Monthly FHIR Master Data Dictionary
Version of Document:	2.2
Date of Document	7/16/2024
Draft Purpose	This FHIR Master Data Dictionary documents the NHSN specific measure requirements to inform the development of the CDC NHSN dQM IG for monthly measures.
Authors	dQM Leads, FHIR Analysts, Protocol Leads
Scope	All monthly NHSN Measures
Abbreviation	Name	Details	Comments
MS	Must Support	If available, it will be queried by NHSNLink for measure calculation or risk adjustment.	Must be designated as MS or R if wanted in the Silver table.
R	Required	Required to be queried by NHSNLink for the NHSN Application to determine initial population.	Must be designated as MS or R if wanted in the Silver table.
NR	Not Required	Queried by NHSNLink but not required to calculate the measures.	Elements designated as NR will go into the Bronze table but will not progress to Silver.
NRT	Not Required by Technical Team	Not queried by NHSNLink and determined by the technical team as not needed.	NRT elements will not be included in the bundle.
AI	Action Item	In the change log tab, the dQM leads will indicate if an update requires an action item.	If an AI is identified, a Jira ticket is typically assigned to a responsible party.
CQL	Clinical Quality Language	CQL is machine-readable and structured on the FHIR data model. The NHSN dQM CQL defines the following items: • The initial population eligible for the measure • Line-level data required to calculate measure metrics • Additional line-level data for stratification, risk adjustment, social determinants of health, and patient matching	FHIR bundle validation will occur against the CDC NHSN dQM IG, version 3.1.1 of US Core Profiles, and version 4.0.1 of FHIR R4.
Key for use of colors, fonts, and tabs
Red Font	Cardinality differs from FHIR R4 or US Core standards or conformance is more constrained against FHIR R4 or US Core profiles.
Bold Font	In the FHIR Resource tabs, it indicates the parent data elements.
Teal Tab	FHIR R4 v.4.0.1 Profiles *Disclaimer: If URL links are directed to a different version of this standard, please email the dQM project manager to correct the hyperlink.
Maroon Tab	US Core v.3.1.1 Profiles *Disclaimer: If URL links are directed to a different version of this standard, please email the dQM project manager to correct the hyperlink.
NHSN Technical Guidance provided by Mamadou Bass Toure
Mark all {Resource}.{dataElement}.identifiers as NRT.
Mark all {Resource}.contained as NRT.
Mark all {Resource}.meta as NRT.
Mark all {Resource}.text as NRT.

---

Sheet 4: Condition-US Core

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FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description	FHIR Binding Value Set	ACH dQM
Condition	0	*		Condition	Detailed information about conditions, problems or diagnoses us-core-1: A code in Condition.category SHOULD be from US Core Condition Category Codes value set.					MS [0.*]
Condition.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R [1..1]
Condition.meta	0	1		Meta	Metadata about the resource	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.				NRT
Condition.implicitRules	0	1		uri	A set of rules under which this content was created	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.				NRT
Condition.language	0	1		code	Language of the resource content	The base language in which the resource is written.	preferred	Common Languages.	http://hl7.org/fhir/R4/valueset-languages.html	NRT
Condition.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.				NRT
Condition.contained	0	*		Resource	Contained, inline Resources	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.				NRT
Condition.extension	0	*		Extension	Additional content defined by implementations	An Extension				NRT
Condition.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).				NRT
Condition.identifier	0	*		Identifier	External Ids for this condition	Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.				NRT
Condition.clinicalStatus	0	1	Y	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved	The clinical status of the condition. NOTE (7/31/2023): This is an invariant. When clinicalStatus is not present (empty), then a verificationStatus of "entered in error " is required. This will not be captured in FHIR validation.	required	ConditionClinicalStatusCodes	http://hl7.org/fhir/R4/ValueSet/condition-clinical	MS [0..1]
Condition.verificationStatus	0	1	Y	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error	The verification status to support the clinical status of the condition. NOTE (7/31/2023): This is an invariant. When clinicalStatus is not present (empty), then a verificationStatus of "entered in error " is required. This will not be captured in FHIR validation.	required	ConditionVerificationStatus	http://hl7.org/fhir/R4/ValueSet/condition-ver-status	MS [0.1]
Condition.category	1	*	Y	CodeableConcept	problem-list-item | encounter-diagnosis | health-concern	A category assigned to the condition.	extensible	US Core Condition Category Codes	http://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-condition-category.html	R [1..*]
Condition.severity	0	1		CodeableConcept	Subjective severity of condition	A subjective assessment of the severity of the condition as evaluated by the clinician.	preferred	Condition/DagnosisSeverity	http://hl7.org/fhir/R4/ValueSet/condition-severity	NR
Condition.code	1	1	Y	CodeableConcept	Identification of the condition, problem or diagnosis	Identification of the condition, problem or diagnosis.	extensible	US Core Condition Code	https://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-condition-code.html	R [1..1]
Condition.bodySite	0	*		CodeableConcept	Anatomical location, if relevant	The anatomical location where this condition manifests itself.	example	SNOMEDCTBodyStructures	https://hl7.org/fhir/R4/valueset-body-site.html	NR
Condition.subject	1	1	Y	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)	Who has the condition?	Indicates the patient or group who the condition record is associated with.				R [1..1]
Condition.encounter	0	1		Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)	Encounter created as part of	The Encounter during which this Condition was created or to which the creation of this record is tightly associated.				MS [0.1]
Condition.onset[x]	0	1		dateTime Age Period Range String	Estimated or actual date, date-time, or age	Estimated or actual date or date-time the condition began, in the opinion of the clinician.				MS [0..1]
Condition.abatement[x]	0	1		dateTime Age Period Range String	When in resolution/remission	The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.				MS [0..1]
Condition.recordedDate	0	1		dateTime	Date record was first recorded	The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.				MS [0..1]
Condition.recorder	0	1		Reference(Practitioner|PractitionerRole|Patient|RelatedPerson)	Who recorded the condition	Individual who recorded the record and takes responsibility for its content.				NRT
Condition.asserter	0	1		Reference(Practitioner|PractitionerRole|Patient|RelatedPerson)	Person who asserts this condition	Individual who is making the condition statement.				NRT
Condition.stage	0	*		BackboneElement	Stage/grade, usually assessed formally	Clinical stage or grade of a condition. May include formal severity assessments.				NR
Condition.stage.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Condition.stage.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Condition.stage.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Condition.stage.summary	0	1		CodeableConcept	Simple summary (disease specific)	A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.	example	ConditionStage	https://hl7.org/fhir/R4/valueset-condition-stage.html	NR
Condition.stage.assessment	0	*		Reference(ClinicalImpression|DiagnosticReport|Observation)	Formal record of assessment	Reference to a formal record of the evidence on which the staging assessment is based.				NR
Condition.stage.type	0	1		CodeableConcept	Kind of staging	The kind of staging, such as pathological or clinical staging.	example	ConditionStageType	https://hl7.org/fhir/R4/valueset-condition-stage-type.html	NR
Condition.evidence	0	*		BackboneElement	Supporting evidence	Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.				NR
Condition.evidence.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Condition.evidence.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Condition.evidence.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Condition.evidence.code	0	*		CodeableConcept	Manifestation/symptom	A manifestation or symptom that led to the recording of this condition.	example	ManifestationAndSymptomCodes	https://hl7.org/fhir/R4/valueset-manifestation-or-symptom.html	NR
Condition.evidence.detail	0	*		Reference(Resource)	Supporting information found elsewhere	Links to other relevant information, including pathology reports.				NR
Condition.note	0	*		Annotation	Additional information about the Condition	Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.				NR

---

Sheet 5: Coverage-R4

Back to TOC
FHIR Path	Min	Max	Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description	Binding Value Set	ACH dQM
Coverage			DomainResource	Insurance or medical plan or a payment agreement Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension	Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.				MS [0..*]
Coverage.id	0	1	id	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R[1..1]
Coverage.meta	0	1	Meta	Metadata about the resource	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.				NRT
Coverage.implicitRules	0	1	uri	A set of rules under which this content was created	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.				NRT
Coverage.language	0	1	code	Language of the resource content	The base language in which the resource is written.	preferred	IETF language tag	https://hl7.org/fhir/valueset-languages.html	NRT
Coverage.text	0	1	Narrative	Text summary of the resource, for human interpretation	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.				NRT
Coverage.contained	0	*	Resource	Contained, inline Resources	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.				NRT
Coverage.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Coverage.modifierExtension	0	*	Extension	Extensions that cannot be ignored	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).				NRT
Coverage.identifier	0	*	Identifier	Business Identifier for the coverage	A unique identifier assigned to this coverage.				NRT
Coverage.status	1	1	code	active | cancelled | draft | entered-in-error	The status of the resource instance.	required	FinancialResourceStatusCodes	https://hl7.org/fhir/R4/valueset-fm-status.html	R[1..1]
Coverage.type	0	1	CodeableConcept	Coverage category such as medical or accident	The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.	extensible	CoverageTypeAndSelf-PayCodes	https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion	MS [0..1]
Coverage.policyHolder	0	1	Reference(Patient|RelatedPerson|Organization)	Owner of the policy	The party who 'owns' the insurance policy.				MS [0..1]
Coverage.subscriber	0	1	Reference(Patient|RelatedPerson)	Subscriber to the policy	The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.				MS [0..1]
Coverage.subscriberId	0	1	string	ID assigned to the subscriber	The insurer assigned ID for the Subscriber.				MS [0..1]
Coverage.beneficiary	1	1	Reference(Patient)	Plan beneficiary	The party who benefits from the insurance coverage; the patient when products and/or services are provided.				R[1..1]
Coverage.dependent	0	1	string	Dependent number	A unique identifier for a dependent under the coverage.				MS [0..1]
Coverage.relationship	0	1	CodeableConcept	Beneficiary relationship to the subscriber	The relationship of beneficiary (patient) to the subscriber.	extensible	SubscriberRelationshipCodes	https://hl7.org/fhir/R4/valueset-subscriber-relationship.html	MS [0..1]
Coverage.period	0	1	Period	Coverage start and end dates	Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.				MS [0..1]
Coverage.payor	1	*	Reference(Organization|Patient|RelatedPerson)	Issuer of the policy	The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.				R[1..*]
Coverage.class	0	*	BackboneElement	Additional coverage classifications	A suite of underwriter specific classifiers.				NR
Coverage.class.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Coverage.class.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Coverage.class.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Coverage.class.type	1	1	CodeableConcept	Type of class such as 'group' or 'plan'	The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.	extensible	CoverageClassCodes	https://hl7.org/fhir/R4/valueset-coverage-class.html	NRT
Coverage.class.value	1	1	string	Value associated with the type	The alphanumeric string value associated with the insurer issued label.				NR
Coverage.class.name	0	1	string	Human readable description of the type and value	A short description for the class.				NR
Coverage.order	0	1	positiveInt	Relative order of the coverage	The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.				NR
Coverage.network	0	1	string	Insurer network	The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.				NR
Coverage.costToBeneficiary	0	*	BackboneElement	Patient payments for services/products	A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.				NRT
Coverage.costToBeneficiary.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Coverage.costToBeneficiary.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Coverage.costToBeneficiary.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Coverage.costToBeneficiary.type	0	1	CodeableConcept	Cost category	The category of patient centric costs associated with treatment.	extensible	CoverageCopayTypeCodes	https://hl7.org/fhir/R4/valueset-coverage-copay-type.html	NRT
Coverage.costToBeneficiary.value[x] valueQuantity valueMoney	1	1	SimpleQuantity Money	The amount or percentage due from the beneficiary	The amount due from the patient for the cost category.				NRT
Coverage.costToBeneficiary.exception	0	*	BackboneElement	Exceptions for patient payments	A suite of codes indicating exceptions or reductions to patient costs and their effective periods.				NRT
Coverage.costToBeneficiary.exception.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Coverage.costToBeneficiary.exception.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Coverage.costToBeneficiary.exception.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Coverage.costToBeneficiary.exception.type	1	1	CodeableConcept	Exception category	The code for the specific exception.	example	ExampleCoverageFinancialExceptionCodes	https://hl7.org/fhir/R4/valueset-coverage-financial-exception.html	NRT
Coverage.costToBeneficiary.exception.period	0	1	Period	The effective period of the exception	The timeframe during when the exception is in force.				NRT
Coverage.subrogation	0	1	boolean	Reimbursement to insurer	When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.				NR
Coverage.contract	0	*	Reference(Contract)	Contract details	The policy(s) which constitute this insurance coverage.				NR

---

Sheet 6: Device R4

Back to TOC
Path	Min	Max	Data Type(s)	FHIR Short Description	FHIR Definition	Comments	Binding Strength	Binding Description	FHIR Binding Value Set	ACH dQM
Device	0	*		Item used in healthcare	A type of a manufactured item that is used in the provision of healthcare without being substantially changed through that activity. The device may be a medical or non-medical device.					MS[0..*]
Device.id	0	1	id	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.	Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.				R[1..1]
Device.meta	0	1	Meta	Metadata about the resource	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.					NRT
Device.implicitRules	0	1	uri	A set of rules under which this content was created	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.	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 its narrative along with other profiles, value sets, etc.				NRT
Device.language	0	1	code	Language of the resource content	The base language in which the resource is written.	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).	required	IETF language tag for a human language	https://hl7.org/fhir/valueset-all-languages.html	NRT
Device.text	0	1	Narrative	Text summary of the resource, for human interpretation	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.	Contained resources do not have a 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.				NRT
Device.contained	0	*	Resource	Contained, inline Resources	These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.	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.				NRT
Device.extension	0	*	Extension	Additional content defined by implementations	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 managable, 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.	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.				NRT
Device.modifierExtension	0	*	Extension	Extensions that cannot be ignored	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 managable, 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.	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.				NRT
Device.identifier	0	*	Identifier	Instance identifier	Unique instance identifiers assigned to a device by manufacturers other organizations or owners.	Certain attributes, like serial number and UDI Carrier (the HRF or AIDC barcode string) are not device instance identifiers as they are not consistently able to uniquely identify the instance of a device, thus are not appropriate to be used to value Device.identifier. The barcode string from a barcode present on a device label or package may identify the instance, include names given to the device in local usage, or may identify the type of device. If the identifier identifies the type of device, Device.type element should be used. The identifier is typically valued if the serialNumber or lotNumber is not valued and represents a different type of identifier. However, it is permissible to still include those identifiers in DeviceDefinition.identifier with the appropriate identifier.type.				NRT
Device.definition	0	1	CodeableReference(DeviceDefinition)	The reference to the definition for the device	The reference to the definition for the device.					NR
Device.udiCarrier	0	*	BackboneElement	Unique Device Identifier (UDI) Barcode string	Unique device identifier (UDI) assigned to device label or package. Note that the Device may include multiple udiCarriers as it either may include just the udiCarrier for the jurisdiction it is sold, or for multiple jurisdictions it could have been sold.	UDI may identify an unique instance of a device, or it may only identify the type of the device. See [UDI mappings](device-mappings.html#udi) for a complete mapping of UDI parts to Device.				MS[0..*]
Device.udiCarrier.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
Device.udiCarrier.extension	0	*	Extension	Additional content defined by implementations	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 managable, 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.	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.				NRT
Device.udiCarrier.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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 managable, 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.	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.				NRT
Device.udiCarrier.deviceIdentifier	0	1	string	Mandatory fixed portion of UDI	The device identifier (DI) is a mandatory, fixed portion of a UDI that identifies the labeler and the specific version or model of a device.					MS[0..1]
Device.udiCarrier.issuer	0	1	uri	UDI Issuing Organization	Organization that is charged with issuing UDIs for devices. For example, the US FDA issuers include: 1) GS1: http://hl7.org/fhir/NamingSystem/gs1-di, 2) HIBCC: http://hl7.org/fhir/NamingSystem/hibcc-diI, 3) ICCBBA for blood containers: http://hl7.org/fhir/NamingSystem/iccbba-blood-di, 4) ICCBA for other devices: http://hl7.org/fhir/NamingSystem/iccbba-other-di # Informationsstelle für Arzneispezialitäten (IFA GmbH) (EU only): http://hl7.org/fhir/NamingSystem/ifa-gmbh-di.					NR
Device.udiCarrier.jurisdiction	0	1	uri	Regional UDI authority	The identity of the authoritative source for UDI generation within a jurisdiction. All UDIs are globally unique within a single namespace with the appropriate repository uri as the system. For example, UDIs of devices managed in the U.S. by the FDA, the value is http://hl7.org/fhir/NamingSystem/us-fda-udi or in the European Union by the European Commission http://hl7.org/fhir/NamingSystem/eu-ec-udi.					NR
Device.udiCarrier.carrierAIDC	0	1	base64Binary	UDI Machine Readable Barcode String	The full UDI carrier of the Automatic Identification and Data Capture (AIDC) technology representation of the barcode string as printed on the packaging of the device - e.g., a barcode or RFID. Because of limitations on character sets in XML and the need to round-trip JSON data through XML, AIDC Formats *SHALL* be base64 encoded.	The AIDC form of UDIs should be scanned or otherwise used for the identification of the device whenever possible to minimize errors in records resulting from manual transcriptions. If separate barcodes for DI and PI are present, concatenate the string with DI first and in order of human readable expression on label.				MS[0..1]
Device.udiCarrier.carrierHRF	0	1	string	UDI Human Readable Barcode String	The full UDI carrier as the human readable form (HRF) representation of the barcode string as printed on the packaging of the device.	If separate barcodes for DI and PI are present, concatenate the string with DI first and in order of human readable expression on label.				MS[0..1]
Device.udiCarrier.entryType	0	1	code	barcode | rfid | manual | card | self-reported | electronic-transmission | unknown	A coded entry to indicate how the data was entered.		required	Codes to identify how UDI data was entered.	http://hl7.org/fhir/R4/valueset-udi-entry-type.html	MS[0..1]
Device.status	0	1	code		Status of the Device availability.		required	The record status of the device.	http://hl7.org/fhir/R4/valueset-device-status.html	MS[0..1]
Device.statusReason	0	*	Extensible/Codeable Concept		Reason for the status of the Device availability.					NR
Device.distinctIdentifier	0	1	string		The distinct identification string as required by regulation for a human cell, tissue, or cellular and tissue-based product.	For example, this applies to devices in the United States regulated under Code of Federal Regulation 21CFR§1271.290(c).				MS[0..1]
Device.manufacturer	0	1	string	Name of device manufacturer	A name of the manufacturer or entity legally responsible for the device.					NR
Device.manufactureDate	0	1	dateTime	Date when the device was made	The date and time when the device was manufactured.					NR
Device.expirationDate	0	1	dateTime	Date and time of expiry of this device (if applicable)	The date and time beyond which this device is no longer valid or should not be used (if applicable).					NR
Device.lotNumber	0	1	string	Lot number of manufacture	Lot number assigned by the manufacturer.					NR
Device.serialNumber	0	1	string	Serial number assigned by the manufacturer	The serial number assigned by the organization when the device was manufactured.	Alphanumeric Maximum 20. While a serial number is a type of identifier, in the context of devices for which a UDI is required, thus a serial number may be part of the production identifier, it is more informative to have the serial number as a dedicated attribute together with the other UDI production identifier. When the device is not subject to including the UDI (e.g., its presence and exchange is not mandated by local regulatory requirements or specific use case at hand), thus the concept of production identifiers is not relevant as a set, it remains helpful for consistency to still use Device.serialNumber rather than using Device.identifier with an appropriate type. Systems that do not realize an identifier is a serial number may place it in Device.identifier or if the identifier.system is known for the serial number, it may also be populated in the Device.identifier as a globally unique id_.				NR
Device.deviceName	0	*	BackboneElement	The name or names of the device as known to the manufacturer and/or patient	This represents the manufacturer's name of the device as provided by the device, from a UDI label, or by a person describing the Device. This typically would be used when a person provides the name(s) or when the device represents one of the names available from DeviceDefinition.					MS [0..*]
Device.deviceName.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
Device.deviceName.extension	0	*	Extension	Additional content defined by implementations	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 managable, 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.	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.				NRT
Device.deviceName.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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 managable, 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.	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.				NRT
Device.deviceName.name	1	1	string	The name of the device.	Name of the device					R[1..1]
Device.deviceName.type	1	1	code		udi-label-name | user-friendly-name | patient-reported-name | manufacturer-name | model-name | other		required	Device Name Type	https://hl7.org/fhir/R4/valueset-device-nametype.html	R[1..1]
Device.modelNumber	0	1	string	The manufacturer's model number for the device	The manufacturer's model number for the device.					NR
Device.partNumber	0	1	string	The part number or catalog number of the device	The part number or catalog number of the device.	Alphanumeric Maximum 20.				NR
Device.type	0	1	CodeableConcept	The kind or type of device	The kind or type of device. A device instance may have more than one type - in which case those are the types that apply to the specific instance of the device.	Multiple device types are use when a device is categorized in more than one context – for example, hybrid devices in which the device is both of type gateway and sensor.	Extensible	Codes to identify medical devices.	https://hl7.org/fhir/R4/valueset-device-type.html	R[1..1]
Device.specialization	0	*	Backbone Element		The capabilities supported on a device, the standards to which the device conforms for a particular purpose, and used for the communication.					NR
Device.specialization.systemType	1	1	Codeable Concept		The standard that is used to operate and communicate.					NR
Device.specialization.version	0	1	string		The version of the standard that is used to operate and communicate	This is a business versionId, not a resource version id				NR
Device.version	0	*	BackboneElement	The actual design of the device or software version running on the device	The actual design of the device or software version running on the device.					NR
Device.version.type	0	1	CodeableConcept	The type of the device version, e.g. manufacturer, approved, internal	The type of the device version, e.g. manufacturer, approved, internal.		example Note: This element does not have an example value set in v4.0.1 so we have listed Version 5 value set	The type of version indicated for the device.	http://hl7.org/fhir/ValueSet/device-versiontype	NR
Device.version.component	0	1	Identifier		A single component of the device version					NR
Device.version.value	1	1	string	The version text	The version text.					NR
Device.property	0	*	BackboneElement		The actual configuration settings of a device as it actually operates, e.g., regulation status, time properties.					NR
Device.property.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NR
Device.property.extension	0	*	Extension	Additional content defined by implementations	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 managable, 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.	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.				NRT
Device.property.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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 managable, 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).	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.				NRT
Device.property.type	1	1	CodeableConcept		Updated definition-Code that specifies the property DeviceDefinitionPropetyCode (Extensible)		example Note: This element does not have an example value set in v4.0.1 so we have listed Version 5 value set	Device property type.	http://hl7.org/fhir/ValueSet/device-property-type	NR
Device.property.valueQuantity	0	*	Quantity	Value of the property	Property value as a quantity.					NR
Device.property.valueCode	0	*	Codeable Concept		Property value as a code, e.g., NTP4 (synced to NTP).					NR
Device.patient	0	1	Reference (Patient)		Patient information, If the device is affixed to a person.	If the device is implanted in a patient, then need to associate the device to the patient.				R[1..1]
Device.owner	0	1	Reference(Organization)	Organization responsible for device	An organization that is responsible for the provision and ongoing maintenance of the device.					NR
Device.contact	0	*	ContactPoint	Details for human/organization for support	Contact details for an organization or a particular human that is responsible for the device.	used for troubleshooting etc.				NR
Device.location	0	1	Reference(Location)	Where the device is found	The place where the device can be found.					NR
Device.url	0	1	uri	Network address to contact device	A network address on which the device may be contacted directly.	If the device is running a FHIR server, the network address should be the Base URL from which a conformance statement may be retrieved.				NR
Device.note	0	*	Annotation	Device notes and comments	Descriptive information, usage information or implantation information that is not captured in an existing element.					NR
Device.safety	0	*	CodeableConcept	Safety Characteristics of Device	Provides additional safety characteristics about a medical device. For example devices containing latex.		example Note: This element does not have an example value set in v4.0.1 so we have listed Version 5 value set		http://hl7.org/fhir/ValueSet/device-safety	NR
Device.parent	0	1	Reference(Device)		The parent device.	For example a vital signs monitor (parent) where three separate modules can be plugged into such as interchangeable blood pressure, oximeter, temperature modules. These modules are represented as devices with the .parent valued to the vital signs monitor when plugged in.				NR

---

Sheet 7: Diagnostic Report-R4

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Path	Min	Max	Data Type(s)	FHIR Short Description	FHIR Definition	Comments	Binding Strength	Binding Description	FHIR Binding Value Set	ACH dQM
DiagnosticReport	0	*		US Core Diagnostic Report Profile for Report and Note exchange	Clinical Testing and Imaging tests performed on a patient that results in structured or unstructured (narrative) findings specific to the patient.	This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.				MS [0..*]
DiagnosticReport.id	0	1	string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.				R[1..1]
DiagnosticReport.basedOn	0	*	Reference(CarePlan|ImmunizationRecommendation|MedicationRequest|NutritionOrder|ServiceRequest)	What was requested	Details concerning a service requested.	Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.				MS [0..*]
DiagnosticReport.status	1	1	code	registered | partial | preliminary | final +	The status of the diagnostic report.		required	DiagnosticReportStatus	https://hl7.org/fhir/R4/valueset-diagnostic-report-status.html	R[1..1]
DiagnosticReport.category	0	*	CodeableConcept	Service category	A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.	Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.	extensible	DiagnosticServiceSectionCodes	http://hl7.org/fhir/ValueSet/diagnostic-service-sections	R[1..*]
DiagnosticReport.code	1	1	CodeableConcept	US Core Report Code	The test, panel, report, or note that was ordered.	The typical patterns for codes are: 1) a LOINC code either as a translation from a "local" code or as a primary code, or 2) a local code only if no suitable LOINC exists, or 3) both the local and the LOINC translation. Systems SHALL be capable of sending the local code if one exists.	extensible	LOINCDiagnosticReportCodes	https://hl7.org/fhir/R4/valueset-report-codes.html	R[1..1]
DiagnosticReport.subject	0	1	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)	The subject of the report - usually, but not always, the patient	The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.				http://hl7.org/fhir/ValueSet/report-codes	R[1..1]
DiagnosticReport.encounter	0	1	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)	Health care event when test ordered	The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.	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).				MS [0..1]
DiagnosticReport.effective[x]	0	1	dateTime Period	Clinically relevant time/time-period for report	The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.	If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.				R[1..1]
DiagnosticReport.issued	0	1	instant	DateTime this version was made	The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.	May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.				MS[0..1]
DiagnosticReport.conclusionCode	0	*	CodeableConcept	Codes for the clinical conclusion of test results	One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.		example	Diagnosis codes provided as adjuncts to the report.	http://hl7.org/fhir/ValueSet/clinical-findings	MS[0..*]
DiagnosticReport.meta	0	1	Meta	Metadata about the resource	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.					NRT
DiagnosticReport.implicitRules	0	1	uri	A set of rules under which this content was created	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.	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.				NRT
DiagnosticReport.language	0	1	code	Language of the resource content	The base language in which the resource is written.	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).	preferred	A human language.	http://hl7.org/fhir/ValueSet/languages	NRT
DiagnosticReport.text	0	1	Narrative	Text summary of the resource, for human interpretation	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.	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.				NRT
DiagnosticReport.contained	0	*	Resource	Contained, inline Resources	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.	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.				NRT
DiagnosticReport.extension	0	*	Extension	Additional content defined by implementations	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.	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.				NRT
DiagnosticReport.modifierExtension	0	*	Extension	Extensions that cannot be ignored	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).	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.				NRT
DiagnosticReport.identifier	0	*	Identifier	Business identifier for report	Identifiers assigned to this report by the performer or other systems.	Usually assigned by the Information System of the diagnostic service provider (filler id).				NRT
DiagnosticReport.performer	0	*	Reference(US Core Practitioner Profile | US Core Organization Profile)	Responsible Diagnostic Service	The diagnostic service that is responsible for issuing the report.	This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.				NR
DiagnosticReport.resultsInterpreter	0	*	Reference(Practitioner|PractitionerRole|Organization|CareTeam)	Primary result interpreter	The practitioner or organization that is responsible for the report's conclusions and interpretations.	Might not be the same entity that takes responsibility for the clinical report.				NR
DiagnosticReport.specimen	0	*	Reference(Specimen)	Specimens this report is based on	Details about the specimens on which this diagnostic report is based.	If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.				NR
DiagnosticReport.result	0	*	Reference(US Core Laboratory Result Observation Profile)	Observations	[Observations](http://hl7.org/fhir/R4/observation.html) that are part of this diagnostic report.	Observations can contain observations.				NR
DiagnosticReport.imagingStudy	0	*	Reference(ImagingStudy)	Reference to full details of imaging associated with the diagnostic report	One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.	ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.				NRT
DiagnosticReport.media	0	*	BackboneElement	Key images associated with this report	A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).					NRT
DiagnosticReport.media.link	0	1	Reference(Media)	Reference to the image source	Reference to the image source.					NRT
DiagnosticReport.conclusion	0	1	string	Clinical conclusion (interpretation) of test results	Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.					NR
DiagnosticReport.presentedForm	0	*	Attachment	Entire report as issued	Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.	"application/pdf" is recommended as the most reliable and interoperable in this context.				NRT

---

Sheet 8: Dx Rpt Lab-US Core

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FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Comments	Binding Strength	Binding Description	FHIR Binding Value Set	ACH dQM
DiagnosticReport	0	*			A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports	The US Core Diagnostic Report Profile is based upon the core FHIR DiagnosticReport Resource and created to meet the 2015 Edition Common Clinical Data Set 'Laboratory test(s) and Laboratory value(s)/result(s)' requirements.	This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.				MS [0..*]
DiagnosticReport.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.				R [1..1]
DiagnosticReport.meta	0	1		Meta	Metadata about the resource	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.					NRT
DiagnosticReport.implicitRules	0	1		uri	A set of rules under which this content was created	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.	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.				NRT
DiagnosticReport.language	0	1		code	Language of the resource content	The base language in which the resource is written.	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).	preferred	CommonLanguages Max Binding: All Languages	http://hl7.org/fhir/ValueSet/languages	NRT
DiagnosticReport.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.	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.				NRT
DiagnosticReport.contained	0	*		Resource	Contained, inline Resources	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.	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.				NRT
DiagnosticReport.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
DiagnosticReport.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).	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.				NRT
DiagnosticReport.identifier	0	*		Identifier	Business identifier for report	Identifiers assigned to this report by the performer or other systems.	Usually assigned by the Information System of the diagnostic service provider (filler id).				NRT
DiagnosticReport.basedOn	0	*		Reference(CarePlan|ImmunizationRecommendation|MedicationRequest|NutritionOrder|ServiceRequest)	What was requested	Details concerning a service requested.	Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.				NR
DiagnosticReport.status	1	1	Y	code	registered | partial | preliminary | final +	The status of the diagnostic report.		required		http://hl7.org/fhir/R4/ValueSet/diagnostic-report-status	R [1..1]
DiagnosticReport.category	1	*	Y	CodeableConcept	Service category	A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.	Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.	example	Codes for diagnostic service sections.	http://hl7.org/fhir/R4/ValueSet/diagnostic-service-sections	R [1..*]
DiagnosticReport.category:LaboratorySlice	1	1	Y	CodeableConcept	Service category	A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.	Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.	example	Required Pattern: At least the following		R [1..1]
DiagnosticReport.category:LaboratorySlice.id	0	1		string	Unique id for inter-element referencing						NRT
DiagnosticReport.category:LaboratorySlice.id.extension	0	*		Extension	Additional content defined by implementations						NRT
DiagnosticReport.category:LaboratorySlice.coding	1	*		Coding	Code defined by a terminology system			Complex	Fixed Value: (complex)		NR
DiagnosticReport.category:LaboratorySlice.coding.id	0	1		string	Unique id for inter-element referencing						NRT
DiagnosticReport.category:LaboratorySlice.coding.system	1	1		url	identity of the terminology system			Fixed Value	diagnostiServiceSectionID	https://terminology.hl7.org/5.2.0/CodeSystem-v2-0074.html	NR
DiagnosticReport.category:LaboratorySlice.coding.version	0	1		string	Version of the system - if relevant						NR
DiagnosticReport.category:LaboratorySlice.coding.code	0	2		code	Symbol in syntax defined by the system			Fixed Value			NR
DiagnosticReport.category:LaboratorySlice.coding.display	0	1		string	Representation defined by the system						NR
DiagnosticReport.category:LaboratorySlice.coding.userSelected	0	1		boolean	If this coding was chosen directly by the user						NR
DiagnosticReport.code	1	1	Y	CodeableConcept	US Core Laboratory Report Order Code	The test, panel or battery that was ordered.	UsageNote= The typical patterns for codes are: 1) a LOINC code either as a translation from a "local" code or as a primary code, or 2) a local code only if no suitable LOINC exists, or 3) both the local and the LOINC translation. Systems SHALL be capable of sending the local code if one exists.	extensible	US Core Diagnostic Report Laboratory Codes (LOINC codes)	https://www.hl7.org/fhir/valueset-report-codes.html	R [1..1]
DiagnosticReport.subject	1	1	Y	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)	The subject of the report - usually, but not always, the patient	The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.					R [1..1]
DiagnosticReport.encounter	0	1		Reference(Encounter)	Health care event when test ordered	The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.	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).				NR
DiagnosticReport.effective[x]	1	1	Y	dateTime Period	Specimen Collection Datetime or Period	The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.	If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.				R [1..1]
DiagnosticReport.issued	1	1	Y	instant	DateTime this version was made	The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.	May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.				R [1..1]
DiagnosticReport.performer	0	*	Y	Reference(US Core Practitioner Profile | US Core Organization Profile)	Responsible Diagnostic Service	The diagnostic service that is responsible for issuing the report.	This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.				NR
DiagnosticReport.resultsInterpreter	0	*		Reference(Practitioner|PractitionerRole|Organization|CareTeam)	Primary result interpreter	The practitioner or organization that is responsible for the report's conclusions and interpretations.	Might not be the same entity that takes responsibility for the clinical report.				NR
DiagnosticReport.specimen	0	*		Reference(Specimen)	Specimens this report is based on	Details about the specimens on which this diagnostic report is based.	If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.				MS [0..*]
DiagnosticReport.result	0	*	Y	Reference(US Core Laboratory Result Observation Profile)	Observations	[Observations](http://hl7.org/fhir/R4/observation.html) that are part of this diagnostic report.	Observations can contain observations.				MS [0..*]
DiagnosticReport.imagingStudy	0	*		Reference(ImagingStudy)	Reference to full details of imaging associated with the diagnostic report	One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.	ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.				NRT
DiagnosticReport.media	0	*		BackboneElement	Key images associated with this report	A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).					NRT
DiagnosticReport.media.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
DiagnosticReport.media.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
DiagnosticReport.media.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
DiagnosticReport.media.comment	0	1		string	Comment about the image (e.g. explanation)	A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.	The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.				NRT
DiagnosticReport.media.link	1	1		Reference(Media)	Reference to the image source	Reference to the image source.					NRT
DiagnosticReport.conclusion	0	1		string	Clinical conclusion (interpretation) of test results	Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.					NR
DiagnosticReport.conclusionCode	0	*		CodeableConcept	Codes for the clinical conclusion of test results	One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.		example	SNOMEDCTCLinicalFindings	https://hl7.org/fhir/R4/valueset-clinical-findings.html	NR
DiagnosticReport.presentedForm	0	*		Attachment	Entire report as issued	Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.	"application/pdf" is recommended as the most reliable and interoperable in this context.				NRT

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Sheet 9: Dx Rpt-Report & Note - US Core

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Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Comments	Binding Strength	Binding Description	FHIR Binding Value Set	ACH dQM
DiagnosticReport	0	*			US Core Diagnostic Report Profile for Report and Note exchange	Clinical Testing and Imaging tests performed on a patient that results in structured or unstructured (narrative) findings specific to the patient.	This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.				MS [0..*]
DiagnosticReport.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.				R[1..1]
DiagnosticReport.meta	0	1		Meta	Metadata about the resource	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.					NRT
DiagnosticReport.implicitRules	0	1		uri	A set of rules under which this content was created	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.	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.				NRT
DiagnosticReport.language	0	1		code	Language of the resource content	The base language in which the resource is written.	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).	preferred	A human language.	http://hl7.org/fhir/ValueSet/languages	NRT
DiagnosticReport.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.	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.				NRT
DiagnosticReport.contained	0	*		Resource	Contained, inline Resources	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.	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.				NRT
DiagnosticReport.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
DiagnosticReport.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).	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.				NRT
DiagnosticReport.identifier	0	*		Identifier	Business identifier for report	Identifiers assigned to this report by the performer or other systems.	Usually assigned by the Information System of the diagnostic service provider (filler id).				NRT
DiagnosticReport.basedOn	0	*		Reference(CarePlan|ImmunizationRecommendation|MedicationRequest|NutritionOrder|ServiceRequest)	What was requested	Details concerning a service requested.	Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.				MS [0..*]
DiagnosticReport.status	1	1	Y	code	registered | partial | preliminary | final +	The status of the diagnostic report.		required		https://hl7.org/fhir/R4/valueset-diagnostic-report-status.html	R[1..1]
DiagnosticReport.category	0	*	Y	CodeableConcept	Service category	A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.	Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.	required		https://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-diagnosticreport-category.html	R[1..*]
DiagnosticReport.code	1	1	Y	CodeableConcept	US Core Report Code	The test, panel, report, or note that was ordered.	The typical patterns for codes are: 1) a LOINC code either as a translation from a "local" code or as a primary code, or 2) a local code only if no suitable LOINC exists, or 3) both the local and the LOINC translation. Systems SHALL be capable of sending the local code if one exists.	extensible	LOINC codes	https://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-diagnosticreport-report-and-note-codes.html	R[1..1]
DiagnosticReport.subject	1	1	Y	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)	The subject of the report - usually, but not always, the patient	The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.					R[1..1]
DiagnosticReport.encounter	0	1	Y	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)	Health care event when test ordered	The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.	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).				MS [0..1]
DiagnosticReport.effective[x]	1	1	Y	dateTime Period	Clinically relevant time/time-period for report	The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.	If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.				R[1..1]
DiagnosticReport.issued	0	1	Y	instant	DateTime this version was made	The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.	May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.				MS[0..1]
DiagnosticReport.performer	0	*	Y	Reference(US Core Practitioner Profile | US Core Organization Profile)	Responsible Diagnostic Service	The diagnostic service that is responsible for issuing the report.	This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.				NR
DiagnosticReport.resultsInterpreter	0	*		Reference(Practitioner|PractitionerRole|Organization|CareTeam)	Primary result interpreter	The practitioner or organization that is responsible for the report's conclusions and interpretations.	Might not be the same entity that takes responsibility for the clinical report.				NR
DiagnosticReport.specimen	0	*		Reference(Specimen)	Specimens this report is based on	Details about the specimens on which this diagnostic report is based.	If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.				NR
DiagnosticReport.result	0	*	Y	Reference(US Core Laboratory Result Observation Profile)	Observations	[Observations](http://hl7.org/fhir/R4/observation.html) that are part of this diagnostic report.	Observations can contain observations.				NR
DiagnosticReport.imagingStudy	0	*	Y	Reference(ImagingStudy)	Reference to full details of imaging associated with the diagnostic report	One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.	ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.				NRT
DiagnosticReport.media	0	*	Y	BackboneElement	Key images associated with this report	A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).					NRT
DiagnosticReport.media.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
DiagnosticReport.media.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
DiagnosticReport.media.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
DiagnosticReport.media.comment	0	1		string	Comment about the image (e.g. explanation)	A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.	The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.				NRT
DiagnosticReport.media.link	1	1	Y	Reference(Media)	Reference to the image source	Reference to the image source.					NRT
DiagnosticReport.conclusion	0	1		string	Clinical conclusion (interpretation) of test results	Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.					NR
DiagnosticReport.conclusionCode	0	*		CodeableConcept	Codes for the clinical conclusion of test results	One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.		example	Diagnosis codes provided as adjuncts to the report.	https://hl7.org/fhir/R4/valueset-clinical-findings.html	MS[0..*]
DiagnosticReport.presentedForm	0	*	Y	Attachment	Entire report as issued	Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.	"application/pdf" is recommended as the most reliable and interoperable in this context.				NRT

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Sheet 10: Encounter-US Core

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FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description	FHIR Binding Value Set	ACH dQM
Encounter	0	*		Encounter	An interaction during which services are provided to the patient	This is basic constraint on Encounter for use in US Core resources.				R [1..*]
Encounter.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R [1..1]
Encounter.meta	0	1		Meta	Metadata about the resource	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.				NRT
Encounter.implicitRules	0	1		uri	A set of rules under which this content was created	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.				NRT
Encounter.language	0	1		code	Language of the resource content	The base language in which the resource is written.	Preferred Max Binding	CommonLanguages AllLanguages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
Encounter.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.				NRT
Encounter.contained	0	*		Resource	Contained, inline Resources	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.				NRT
Encounter.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Encounter.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).				NRT
Encounter.identifier	0	*	Y	Identifier	Identifier(s) by which this encounter is known	Identifier(s) by which this encounter is known.				R [1..*]
Encounter.identifier.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Encounter.identifier.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Encounter.identifier.use	0	1		code	usual | official | temp | secondary | old (If known)	The purpose of this identifier.	required	IdentifierUse	http://hl7.org/fhir/R4/ValueSet/identifier-use	MS [0..1]
Encounter.identifier.type	0	1		CodeableConcept	Description of identifier	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.	extensible	IdentifierType	http://hl7.org/fhir/R4/ValueSet/identifier-type	MS[0..1]
Encounter.identifier.system	1	1	Y	uri	The namespace for the identifier value	Establishes the namespace for the value - that is, a URL that describes a set values that are unique.				R[1..1]
Encounter.identifier.value	1	1	Y	string	The value that is unique	The portion of the identifier typically relevant to the user and which is unique within the context of the system.				R [1..1]
Encounter.identifier.period	0	1		Period	Time period when id is/was valid for use	Time period during which identifier is/was valid for use.				MS [0..1]
Encounter.identifier.assigner	0	1		Reference(Organization)	Organization that issued id (may be just text)	Organization that issued/manages the identifier.				NRT
Encounter.status	1	1	Y	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled +	planned | arrived | triaged | in-progress | onleave | finished | cancelled +.	required	EncounterStatus	https://hl7.org/fhir/R4/valueset-encounter-status.html	R [1..1] The following constraints are written into the CQL: 'in-progress', 'finished', 'triaged', 'onleave', 'entered-in-error'
Encounter.statusHistory	0	*		BackboneElement	List of past encounter statuses	The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them.				NR
Encounter.statusHistory.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Encounter.statusHistory.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Encounter.statusHistory.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Encounter.statusHistory.status	1	1		code	planned | arrived | triaged | in-progress | onleave | finished | cancelled +	planned | arrived | triaged | in-progress | onleave | finished | cancelled +.	required	EncounterStatus	http://hl7.org/fhir/R4/ValueSet/encounter-status	NR
Encounter.statusHistory.period	1	1		Period	The time that the episode was in the specified status	The time that the episode was in the specified status.				NR
Encounter.class	1	1	Y	Coding	Classification of patient encounter	Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.	extensible	ActEncounterCode	http://hl7.org/fhir/R4/v3/ActEncounterCode/vs.html	R [1..1] The following constraints are written into the CQL: 'inpatient acute', 'inpatient encounter', 'inpatient non-acute' 'observation encounter', short stay', 'emergency'
Encounter.classHistory	0	*		BackboneElement	List of past encounter classes	The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.				MS [0..*]
Encounter.classHistory.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Encounter.classHistory.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Encounter.classHistory.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Encounter.classHistory.class	1	1		Coding	inpatient | outpatient | ambulatory | emergency +	inpatient | outpatient | ambulatory | emergency +.	extensible	ActEncounterCode	https://terminology.hl7.org/1.0.0//ValueSet-v3-ActEncounterCode.html	R [1..1]
Encounter.classHistory.period	1	1		Period	The time that the episode was in the specified class	The time that the episode was in the specified class.				R [1..1]
Encounter.type	1	*	Y	CodeableConcept	Specific type of encounter	Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).	extensible	USCoreEncounterType	https://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-encounter-type.html	R [1..*] The following constraints are written into the CQL: "Emergency Department Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292' "Observation Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143' "Encounter Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307'
Encounter.serviceType	0	1		CodeableConcept	Specific type of service	Broad categorization of the service that is to be provided (e.g. cardiology).	example	ServiceType	http://hl7.org/fhir/R4/ValueSet/service-type	NR
Encounter.priority	0	1		CodeableConcept	Indicates the urgency of the encounter	Indicates the urgency of the encounter.	example	ActPriority	https://terminology.hl7.org/1.0.0//ValueSet-v3-ActPriority.html	NR
Encounter.subject	1	1	Y	Reference(US Core Patient Profile)	The patient or group present at the encounter	The patient or group present at the encounter.				R [1..1]
Encounter.episodeOfCare	0	*		Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against	Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).				NRT
Encounter.basedOn	0	*		Reference(ServiceRequest)	The ServiceRequest that initiated this encounter	The request this encounter satisfies (e.g. incoming referral or procedure request).				NRT
Encounter.participant	0	*	Y	BackboneElement	List of participants involved in the encounter	The list of people responsible for providing the service.				NRT
Encounter.participant.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Encounter.participant.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Encounter.participant.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Encounter.participant.type	0	*	Y	CodeableConcept	Role of participant in encounter	Role of participant in encounter.	extensible	ParticipantType	http://hl7.org/fhir/R4/ValueSet/encounter-participant-type	NRT
Encounter.participant.period	0	1	Y	Period	Period of time during the encounter that the participant participated	The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.				NRT
Encounter.participant.individual	0	1	Y	Reference(US Core Practitioner Profile)	Persons involved in the encounter other than the patient	Persons involved in the encounter other than the patient.				NRT
Encounter.appointment	0	*		Reference(Appointment)	The appointment that scheduled this encounter	The appointment that scheduled this encounter.				NRT
Encounter.period	0	1	Y	Period	The start and end time of the encounter	The start and end time of the encounter.				R[1..1]
Encounter.length	0	1		Duration	Quantity of time the encounter lasted (less time absent)	Quantity of time the encounter lasted. This excludes the time during leaves of absence.				NR
Encounter.reasonCode	0	*	Y	CodeableConcept	Coded reason the encounter takes place	Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.	preferred	EncounterReasonCodes	http://hl7.org/fhir/R4/ValueSet/encounter-reason	MS [0..*]
Encounter.reasonReference	0	*	Y	Reference(Condition | Procedure | Observation | ImmunizationRecommendation)	Reason the encounter takes place (reference)	Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.				NR
Encounter.diagnosis	0	*		BackboneElement	The list of diagnosis relevant to this encounter	The list of diagnosis relevant to this encounter.				MS [0..*]
Encounter.diagnosis.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Encounter.diagnosis.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Encounter.diagnosis.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Encounter.diagnosis.condition	1	1		Reference(Condition|Procedure)	The diagnosis or procedure relevant to the encounter	Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.				R [1..1]
Encounter.diagnosis.use	0	1		CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).	preferred	DiagnosisRole	https://hl7.org/fhir/R4/valueset-diagnosis-role.html	MS [0..1]
Encounter.diagnosis.rank	0	1		positiveInt	Ranking of the diagnosis (for each role type)	Ranking of the diagnosis (for each role type).				MS [0..1]
Encounter.account	0	*		Reference(Account)	The set of accounts that may be used for billing for this Encounter	The set of accounts that may be used for billing for this Encounter.				NR
Encounter.hospitalization	0	1	Y	BackboneElement	Details about the admission to a healthcare service	Details about the admission to a healthcare service.				MS [0..1]
Encounter.hospitalization.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Encounter.hospitalization.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Encounter.hospitalization.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Encounter.hospitalization.preAdmissionIdentifier	0	1		Identifier	Pre-admission identifier	Pre-admission identifier.				NR
Encounter.hospitalization.origin	0	1		Reference(Location|Organization)	The location/organization from which the patient came before admission	The location/organization from which the patient came before admission.				MS [0..1]
Encounter.hospitalization.admitSource	0	1		CodeableConcept	From where patient was admitted (physician referral, transfer)	From where patient was admitted (physician referral, transfer).	preferred	AdmitSource	https://hl7.org/fhir/R4/valueset-encounter-admit-source.html	R [1..1]
Encounter.hospitalization.reAdmission	0	1		CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission	Whether this hospitalization is a readmission and why if known.	preferred	Hl7VSReAdmissionIndicator	https://terminology.hl7.org/1.0.0//ValueSet-v2-0092.html	MS [0..1]
Encounter.hospitalization.dietPreference	0	*		CodeableConcept	Diet preferences reported by the patient	Diet preferences reported by the patient.	preferred	Diet	http://hl7.org/fhir/R4/ValueSet/encounter-diet	MS [0..1]
Encounter.hospitalization.specialCourtesy	0	*		CodeableConcept	Special courtesies (VIP, board member)	Special courtesies (VIP, board member).	preferred	SpecialCourtesy	http://hl7.org/fhir/R4/ValueSet/encounter-special-courtesy	NR
Encounter.hospitalization.specialArrangement	0	*		CodeableConcept	Wheelchair, translator, stretcher, etc.	Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.	preferred	SpecialArrangements	http://hl7.org/fhir/R4/ValueSet/encounter-special-arrangements	NR
Encounter.hospitalization.destination	0	1		Reference(Location|Organization)	Location/organization to which the patient is discharged	Location/organization to which the patient is discharged.				NR
Encounter.hospitalization.dischargeDisposition	0	1	Y	CodeableConcept	Category or kind of location after discharge	Category or kind of location after discharge.	preferred	DischargeDisposition	http://hl7.org/fhir/R4/ValueSet/encounter-discharge-disposition	MS [0..1]
Encounter.location	0	*	Y	BackboneElement	List of locations where the patient has been	List of locations where the patient has been during this encounter.				R [1..*] The following constraints are written into the CQL: Inpatient, Emergency, and Observation Locations 2.16.840.1.113762.1.4.1046.265
Encounter.location.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Encounter.location.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Encounter.location.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Encounter.location.location	1	1	Y	Reference(Location)	Location the encounter takes place	The location where the encounter takes place.				R [1..1]
Encounter.location.status	0	1		code	planned | active | reserved | completed	The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.	required	EncounterLocationStatus	http://hl7.org/fhir/R4/ValueSet/encounter-location-status	MS [0..1]
Encounter.location.physicalType	0	1		CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.)	This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query.	extensible	LocationType	http://hl7.org/fhir/R4/valueset-location-physical-type.html	MS [0..1]
Encounter.location.period	0	1		Period	Time period during which the patient was present at the location	Time period during which the patient was present at the location.				R [1..1]
Encounter.serviceProvider	0	1	Y	Reference(Organization)	The organization (facility) responsible for this encounter	The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.				NRT
Encounter.partOf	0	1		Reference(Encounter)	Another Encounter this encounter is part of	Another Encounter of which this encounter is a part of (administratively or in time).				NR

---

Sheet 11: Implantable Device-US Core

Back to TOC
FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Comments	Binding Strength	Binding Description	Binding Value Set Note: if the binding strength is an example, the binding value set in this column is not required to be used.	ACH dQM
Device	0	*			Item used in healthcare	The US Core Implantable Device Profile is based upon the core FHIR Device Resource and created to meet the 2015 Edition Common Clinical Data Set 'Unique device identifier(s) for a patient’s implantable device(s)' requirements.					MS [0..*]
Device.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.				R [1..1]
Device.meta	0	1		Meta	Metadata about the resource	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.					NRT
Device.implicitRules	0	1		uri	A set of rules under which this content was created	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.	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.				NRT
Device.language	0	1		code	Language of the resource content	The base language in which the resource is written.	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).	preferred	A human language.	https://hl7.org/fhir/R4/valueset-languages.html	NRT
Device.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.	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.				NRT
Device.contained	0	*		Resource	Contained, inline Resources	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.	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.				NRT
Device.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
Device.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).	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.				NRT
Device.identifier	0	*		Identifier	Instance identifier	Unique instance identifiers assigned to a device by manufacturers other organizations or owners.	The barcode string from a barcode present on a device label or package may identify the instance, include names given to the device in local usage, or may identify the type of device. If the identifier identifies the type of device, Device.type element should be used.				NRT
Device.definition	0	1		Reference(DeviceDefinition)	The reference to the definition for the device	The reference to the definition for the device.					NR
Device.udiCarrier	0	1	Y	BackboneElement	Unique Device Identifier (UDI) Barcode string	Unique device identifier (UDI) assigned to device label or package. Note that the Device may include multiple udiCarriers as it either may include just the udiCarrier for the jurisdiction it is sold, or for multiple jurisdictions it could have been sold.	Some devices may not have UDI information (for example. historical data or patient reported data).				MS [0..1]
Device.udiCarrier.carrierAIDC	0	1	Y	base64Binary	UDI Machine Readable Barcode String	The full UDI carrier of the Automatic Identification and Data Capture (AIDC) technology representation of the barcode string as printed on the packaging of the device - e.g., a barcode or RFID. Because of limitations on character sets in XML and the need to round-trip JSON data through XML, AIDC Formats *SHALL* be base64 encoded.	The AIDC form of UDIs should be scanned or otherwise used for the identification of the device whenever possible to minimize errors in records resulting from manual transcriptions. If separate barcodes for DI and PI are present, concatenate the string with DI first and in order of human readable expression on label.				MS [0..1]
Device.udiCarrier.carrierHRF	0	1	Y	string	UDI Human Readable Barcode String	The full UDI carrier as the human readable form (HRF) representation of the barcode string as printed on the packaging of the device.	If separate barcodes for DI and PI are present, concatenate the string with DI first and in order of human readable expression on label.				MS [0..1]
Device.udiCarrier.deviceIdentifier	1	1	Y	string	Mandatory fixed portion of UDI	The device identifier (DI) is a mandatory, fixed portion of a UDI that identifies the labeler and the specific version or model of a device.					R [1..1]
Device.udiCarrier.entryType	0	1		code	barcode | rfid | manual +	A coded entry to indicate how the data was entered.		required	Codes to identify how UDI data was entered.	http://hl7.org/fhir/ValueSet/udi-entry-type|4.0.1	NR
Device.udiCarrier.issuer	0	1		uri	UDI Issuing Organization	Organization that is charged with issuing UDIs for devices. For example, the US FDA issuers include : 1) GS1: http://hl7.org/fhir/NamingSystem/gs1-di, 2) HIBCC: http://hl7.org/fhir/NamingSystem/hibcc-dI, 3) ICCBBA for blood containers: http://hl7.org/fhir/NamingSystem/iccbba-blood-di, 4) ICCBA for other devices: http://hl7.org/fhir/NamingSystem/iccbba-other-di.					NR
Device.udiCarrier.jurisdiction	0	1		uri	Regional UDI authority	The identity of the authoritative source for UDI generation within a jurisdiction. All UDIs are globally unique within a single namespace with the appropriate repository uri as the system. For example, UDIs of devices managed in the U.S. by the FDA, the value is http://hl7.org/fhir/NamingSystem/fda-udi.					NR
Device.status	0	1		code	active | inactive | entered-in-error | unknown	Status of the Device availability.	This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the device (record)as not currently valid.	required	The availability status of the device.	https://hl7.org/fhir/R4/valueset-device-status.html	MS [0..1]
Device.statusReason	0	*		CodeableConcept	online | paused | standby | offline | not-ready | transduc-discon | hw-discon | off	Reason for the status of the Device availability.		extensible	The availability status reason of the device.	http://hl7.org/fhir/R4/ValueSet/device-status-reason	NR
Device.distinctIdentifier	0	1		string	The distinct identification string	The distinct identification string as required by regulation for a human cell, tissue, or cellular and tissue-based product.	For example, this applies to devices in the United States regulated under Code of Federal Regulation 21CFR§1271.290(c).				MS[0..1]
Device.manufacturer	0	1		string	Name of device manufacturer	A name of the manufacturer.					NR
Device.manufactureDate	0	1	Y	dateTime	Date when the device was made	The date and time when the device was manufactured.					MS [0..1]
Device.expirationDate	0	1	Y	dateTime	Date and time of expiry of this device (if applicable)	The date and time beyond which this device is no longer valid or should not be used (if applicable).					MS [0..1]
Device.lotNumber	0	1	Y	string	Lot number of manufacture	Lot number assigned by the manufacturer.					MS [0..1]
Device.serialNumber	0	1	Y	string	Serial number assigned by the manufacturer	The serial number assigned by the organization when the device was manufactured.	Alphanumeric Maximum 20.				MS [0..1]
Device.deviceName	0	*		BackboneElement	The name of the device as given by the manufacturer	This represents the manufacturer's name of the device as provided by the device, from a UDI label, or by a person describing the Device. This typically would be used when a person provides the name(s) or when the device represents one of the names available from DeviceDefinition.					MS [0..*]
Device.deviceName.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
Device.deviceName.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
Device.deviceName.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
Device.deviceName.name	1	1		string	The name of the device	The name of the device.					R [1..1]
Device.deviceName.type	1	1		code	udi-label-name | user-friendly-name | patient-reported-name | manufacturer-name | model-name | other	The type of deviceName. UDILabelName | UserFriendlyName | PatientReportedName | ManufactureDeviceName | ModelName.		required	The type of name the device is referred by.	https://hl7.org/fhir/R4/valueset-device-nametype.html	R [1..1]
Device.modelNumber	0	1		string	The model number for the device	The model number for the device.					NR
Device.partNumber	0	1		string	The part number of the device	The part number of the device.	Alphanumeric Maximum 20.				NR
Device.type	1	1	Y	CodeableConcept	The kind or type of device	The kind or type of device.		extensible	Codes to identify medical devices	http://hl7.org/fhir/R4/valueset-device-kind.html	R [1..1]
Device.specialization	0	*		BackboneElement	The capabilities supported on a device, the standards to which the device conforms for a particular purpose, and used for the communication	The capabilities supported on a device, the standards to which the device conforms for a particular purpose, and used for the communication.					NR
Device.specialization.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
Device.specialization.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
Device.specialization.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
Device.specialization.systemType	1	1		CodeableConcept	The standard that is used to operate and communicate	The standard that is used to operate and communicate.					NR
Device.specialization.version	0	1		string	The version of the standard that is used to operate and communicate	The version of the standard that is used to operate and communicate.					NR
Device.version	0	*		BackboneElement	The actual design of the device or software version running on the device	The actual design of the device or software version running on the device.					NR
Device.version.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
Device.version.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
Device.version.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
Device.version.type	0	1		CodeableConcept	The type of the device version	The type of the device version.					NR
Device.version.component	0	1		Identifier	A single component of the device version	A single component of the device version.					NR
Device.version.value	1	1		string	The version text	The version text.					NR
Device.property	0	*		BackboneElement	The actual configuration settings of a device as it actually operates, e.g., regulation status, time properties	The actual configuration settings of a device as it actually operates, e.g., regulation status, time properties.					NR
Device.property.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
Device.property.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
Device.property.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
Device.property.type	1	1		CodeableConcept	Code that specifies the property DeviceDefinitionPropetyCode (Extensible)	Code that specifies the property DeviceDefinitionPropetyCode (Extensible).					NR
Device.property.valueQuantity	0	*		Quantity	Property value as a quantity	Property value as a quantity.					NR
Device.property.valueCode	0	*		CodeableConcept	Property value as a code, e.g., NTP4 (synced to NTP)	Property value as a code, e.g., NTP4 (synced to NTP).					NR
Device.patient	1	1	Y	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)	Patient to whom Device is affixed	Patient information, If the device is affixed to a person.					R [1..1]
Device.owner	0	1		Reference(http://hl7.org/fhir/R4/organization.html)	Organization responsible for device	An organization that is responsible for the provision and ongoing maintenance of the device.					NR
Device.contact	0	*		contactPoint	Details for human/organization for support	Contact details for an organization or a particular human that is responsible for the device.	used for troubleshooting etc.				NR
Device.location	0	1		Reference(http://hl7.org/fhir/R4/location.html)	Where the device is found	The place where the device can be found.					NR
Device.url	0	1		uri	Network address to contact device	A network address on which the device may be contacted directly.	If the device is running a FHIR server, the network address should be the Base URL from which a conformance statement may be retrieved.				NR
Device.note	0	*		Annotation	Device notes and comments	Descriptive information, usage information or implantation information that is not captured in an existing element.					NR
Device.safety	0	*		CodeableConcept	Safety Characteristics of Device	Provides additional safety characteristics about a medical device. For example devices containing latex.		Example		https://hl7.org/fhir/STU3/valueset-device-safety.html	NR
Device.parent	0	1		Reference(http://hl7.org/fhir/R4/device.html)	The parent device	The parent device.					NR

---

Sheet 12: Lab Result Observation-US Core

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FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description (Value Set Name)	Binding Value Set	ACH dQM
Observation	0	*		Observation	Measurements and simple assertions	This profile is created to meet the 2015 Edition Common Clinical Data Set 'Laboratory test(s) and Laboratory value(s)/result(s)' requirements.				MS [0..*]
Observation.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R [1..1]
Observation.meta	0	1		Meta	Metadata about the resource	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.				NRT
Observation.implicitRules	0	1		uri	A set of rules under which this content was created	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.				NRT
Observation.language	0	1		code	Language of the resource content	The base language in which the resource is written.	preferred	CommonLanguages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
Observation.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.				NRT
Observation.contained	0	*		Resource	Contained, inline Resources	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.				NRT
Observation.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Observation.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).				NRT
Observation.identifier	0	*		Identifier	Business Identifier for observation	A unique identifier assigned to this observation.				NRT
Observation.basedOn	0	*		Reference(CarePlan|DeviceRequest|ImmunizationRecommendation|MedicationRequest|NutritionOrder|ServiceRequest)	Fulfills plan, proposal or order	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.				NR
Observation.partOf	0	*		Reference(MedicationAdministration|MedicationDispense|MedicationStatement|Procedure|Immunization|ImagingStudy)	Part of referenced event	A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.				NR
Observation.status	1	1	Y	code	registered | preliminary | final | amended +	The status of the result value.	required	ObservationStatus	http://hl7.org/fhir/R4/ValueSet/observation-status	R [1..1]
Observation.category	1	*	Y	Slice Definition	Classification of type of observation Slice: Unordered, Open by pattern:$this	A code that classifies the general type of observation being made.	preferred	ObservationCategoryCodes	https://hl7.org/fhir/R4/valueset-observation-category.html	R [1..*]
Observation.category:Laboratory	1	1	Y	CodeableConcept	Classification of type of observation	A code that classifies the general type of observation being made.	preferred	ObservationCategoryCodes	http://hl7.org/fhir/ValueSet/observation-category	R [1..1]
Observation.category:Laboratory.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Observation.category:Laboratory.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Observation.category:Laboratory.coding	1	*	Y	Coding	Code defined by a terminology system	A reference to a code defined by a terminology system.				NR
Observation.category:Laboratory.coding.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NR
Observation.category:Laboratory.coding.extension	0	*		Extension	Additional content defined by implementations	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.				NR
Observation.category:Laboratory.coding.system	1	1	Y	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category	The identification of the code system that defines the meaning of the symbol in the code.				NR
Observation.category:Laboratory.coding.version	0	1		string	Version of the system - if relevant	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.				NR
Observation.category:Laboratory.coding.code	1	1	Y	code	Symbol in syntax defined by the system Fixed Value: laboratory	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).				NR
Observation.category:Laboratory.coding.display	0	1		string	Representation defined by the system	A representation of the meaning of the code in the system, following the rules of the system.				NR
Observation.category:Laboratory.coding.userSelected	0	1		boolean	If this coding was chosen directly by the user	Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).				NR
Observation.category:Laboratory.text	0	1		string	Plain text representation of the concept	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.				NR
Observation.code	1	1	Y	CodeableConcept	Laboratory Test Name	The test that was performed. A LOINC **SHALL** be used if the concept is present in LOINC.	extensible	LOINCCodes	https://hl7.org/fhir/R4/valueset-observation-codes.html	R [1..1]
Observation.subject	1	1	Y	Reference(US Core Patient Profile)	Who and/or what the observation is about	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.				R [1..1]
Observation.focus	0	*		Reference(Resource)	What the observation is about, when it is not about the subject of record	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.				NR
Observation.encounter	0	1		Reference(Encounter)	Healthcare event during which this observation is made	The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.				MS [0..1]
Observation.effective[x]	0	1	Y	dateTime Period	Clinically relevant time/time-period for observation us-core-1: Datetime must be at least to day.	For lab tests this is the specimen collection date. For Ask at Order Entry Questions (AOE)'s this is the date the question was asked.				R [1..1]
Observation.issued	0	1		instant	Date/Time this version was made available	The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.				MS [0..1]
Observation.performer	0	*		Reference(Practitioner|PractitionerRole|Organization|CareTeam|Patient|RelatedPerson)	Who is responsible for the observation	Who was responsible for asserting the observed value as "true".				NR
Observation.value[x]	0	1	Y	Quantity CodeableConcept string boolean integer Range Ratio SampledData time dateTime Period	Result Value	The Laboratory result value. If a coded value, the valueCodeableConcept.code **SHOULD** be selected from [SNOMED CT](http://hl7.org/fhir/ValueSet/uslab-obs-codedresults) if the concept exists. If a numeric value, valueQuantity.code **SHALL** be selected from [UCUM](http://unitsofmeasure.org). A FHIR [UCUM Codes value set](http://hl7.org/fhir/STU3/valueset-ucum-units.html) that defines all UCUM codes is in the FHIR specification.				MS [0..1]
Observation.dataAbsentReason	0	1	Y	CodeableConcept	Why the result is missing	Provides a reason why the expected value in the element Observation.value[x] is missing.	extensible	DataAbsentReason	http://hl7.org/fhir/R4/ValueSet/data-absent-reason	MS [0..1]
Observation.interpretation	0	*		CodeableConcept	High, low, normal, etc.	A categorical assessment of an observation value. For example, high, low, normal.	extensible	ObservationInterpretationCodes	https://hl7.org/fhir/R4/valueset-observation-interpretation.html	MS [0..*]
Observation.note	0	*		Annotation	Comments about the observation	Comments about the observation or the results.				NR
Observation.bodySite	0	1		CodeableConcept	Observed body part	Indicates the site on the subject's body where the observation was made (i.e. the target site).	example	SNOMEDCTBodyStructures	https://hl7.org/fhir/R4/valueset-body-site.html	MS [0..1]
Observation.method	0	1		CodeableConcept	How it was done	Indicates the mechanism used to perform the observation.	extensible	ObservationMethods	https://hl7.org/fhir/R4/valueset-observation-methods.html	MS [0..1]
Observation.specimen	0	1		Reference(Specimen)	Specimen used for this observation	The specimen that was used when this observation was made.				MS [0..1]
Observation.device	0	1		Reference(Device|DeviceMetric)	(Measurement) Device	The device used to generate the observation data.				NR
Observation.referenceRange	0	*		BackboneElement	Provides guide for interpretation	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.				NR
Observation.referenceRange.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Observation.referenceRange.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Observation.referenceRange.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Observation.referenceRange.low	0	1		SimpleQuantity	Low Range, if relevant	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).				NR
Observation.referenceRange.high	0	1		SimpleQuantity	High Range, if relevant	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).				NR
Observation.referenceRange.type	0	1		CodeableConcept	Reference range qualifier	Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.	preferred	ObservationReferenceRangeMeaningCodes	https://hl7.org/fhir/R4/valueset-referencerange-meaning.html	NR
Observation.referenceRange.appliesTo	0	*		CodeableConcept	Reference range population	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.	example	ObservationReferenceRangeAppliesToCodes	https://hl7.org/fhir/R4/valueset-referencerange-appliesto.html	NR
Observation.referenceRange.age	0	1		Range	Applicable age range, if relevant	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.				NR
Observation.referenceRange.text	0	1		string	Text based reference range in an observation	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".				NR
Observation.hasMember	0	*		Reference(Observation|QuestionnaireResponse|MolecularSequence)	Related resource that belongs to the Observation group	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.				NR
Observation.derivedFrom	0	*		Reference(DocumentReference|ImagingStudy|Media|QuestionnaireResponse|Observation|MolecularSequence)	Related measurements the observation is made from	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.				NR
Observation.component	0	*		BackboneElement	Component results	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.				MS [0..*]
Observation.component.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Observation.component.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Observation.component.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Observation.component.code	1	1		CodeableConcept	Type of component observation (code / type)	Describes what was observed. Sometimes this is called the observation "code".	extensible	LOINCCodes	http://hl7.org/fhir/R4/valueset-observation-codes.html	R [1..1]
Observation.component.value[x]	0	1		Quantity CodeableConcept string boolean integer Range Ratio SampledData time dateTime Period	Actual component result	The information determined as a result of making the observation, if the information has a simple value.				MS [0..1]
Observation.component.dataAbsentReason	0	1		CodeableConcept	Why the component result is missing	Provides a reason why the expected value in the element Observation.component.value[x] is missing.	extensible	DataAbsentReason	http://hl7.org/fhir/R4/ValueSet/data-absent-reason	NR
Observation.component.interpretation	0	*		CodeableConcept	High, low, normal, etc.	A categorical assessment of an observation value. For example, high, low, normal.	extensible	ObservationInterpretationCodes	https://hl7.org/fhir/R4/valueset-observation-interpretation.html	MS [0..*]
Observation.component.referenceRange	0	*			Provides guide for interpretation of component result	Guidance on how to interpret the value by comparison to a normal or recommended range.				NR

---

Sheet 13: Location-US Core

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FHIR Path	Min	Max	Must Support	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description	Binding Value Set	ACH dQM
Location	0	*			Details and position information for a physical place	Details and position information for a physical place where services are provided and resources and participants may be stored, found, contained, or accommodated.				R [1..*]
Location.id	0	1	Y	string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R [1..1]
Location.meta	0	1		Meta	Metadata about the resource	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.				NRT
Location.implicitRules	0	1		uri	A set of rules under which this content was created	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.				NRT
Location.language	0	1		code	Language of the resource content	The base language in which the resource is written.	preferred	CommonLanguages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
Location.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.				NRT
Location.contained	0	*		Resource	Contained, inline Resources	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.				NRT
Location.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Location.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).				NRT
Location.identifier	0	*		Identifier	Unique code or number identifying the location to its users	Unique code or number identifying the location to its users.				NRT
Location.status	0	1	Y	code	active | suspended | inactive	The status property covers the general availability of the resource, not the current value which may be covered by the operationStatus, or by a schedule/slots if they are configured for the location.	required	LocationStatus	https://hl7.org/fhir/R4/valueset-location-status.html	MS [0..1]
Location.operationalStatus	0	1		Coding	The operational status of the location (typically only for a bed/room)	The operational status covers operation values most relevant to beds (but can also apply to rooms/units/chairs/etc. such as an isolation unit/dialysis chair). This typically covers concepts such as contamination, housekeeping, and other activities like maintenance.	preferred	hl7VS-bedStatus	http://terminology.hl7.org/ValueSet/v2-0116	NR
Location.name	1	1	Y	string	Name of the location as used by humans	Name of the location as used by humans. Does not need to be unique.				R [1..1]
Location.alias	0	*		string	A list of alternate names that the location is known as, or was known as, in the past	A list of alternate names that the location is known as, or was known as, in the past.				MS [0..*]
Location.description	0	1		string	Additional details about the location that could be displayed as further information to identify the location beyond its name	Description of the Location, which helps in finding or referencing the place.				NR
Location.mode	0	1		code	instance | kind	Indicates whether a resource instance represents a specific location or a class of locations.	required	LocationMode	https://hl7.org/fhir/R4/valueset-location-mode.html	NR
Location.type	0	*		CodeableConcept	Type of function performed	Indicates the type of function performed at the location.	extensible	ServiceDeliveryLocationRoleType	http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType	R [1..*] The following constraint is written into the CQL: valueset "Inpatient, Emergency, and Observation Locations": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265'
Location.telecom	0	*	Y	ContactPoint	Contact details of the location	The contact details of communication devices available at the location. This can include phone numbers, fax numbers, mobile numbers, email addresses and web sites.				MS [0..*]
Location.address	0	1	Y	Address	Physical location	Physical location.				MS [0..1]
Location.address.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Location.address.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Location.address.use	0	1		code	home | work | temp | old | billing - purpose of this address	The purpose of this address.	required	AddressUse	https://hl7.org/fhir/R4/valueset-address-use.html	MS [0..1]
Location.address.type	0	1		code	postal | physical | both	Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.	required	AddressType	https://hl7.org/fhir/R4/valueset-address-type.html	NR
Location.address.text	0	1		string	Text representation of the address	Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.				NR
Location.address.line	0	*	Y	string	Street name, number, direction & P.O. Box etc.	This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.				NR
Location.address.city	0	1	Y	string	Name of city, town etc.	The name of the city, town, suburb, village or other community or delivery center.				NR
Location.address.district	0	1		string	District name (aka county)	The name of the administrative area (county).				NR
Location.address.state	0	1	Y	string	Sub-unit of country (abbreviations ok)	Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).	extensible	USPS Two Letter Alphabetic Codes	https://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-usps-state.html	NR
Location.address.postalCode	0	1	Y	string	US Zip Codes	A postal code designating a region defined by the postal service.				NR
Location.address.country	0	1		string	Country (e.g. can be ISO 3166 2 or 3 letter code)	Country - a nation as commonly understood or generally accepted.				NR
Location.address.period	0	1		Period	Time period when address was/is in use	Time period when address was/is in use.				NR
Location.physicalType	0	1		CodeableConcept	Physical form of the location	Physical form of the location, e.g. building, room, vehicle, road.	extensible	Physical form of the location.	https://hl7.org/fhir/R4/valueset-location-physical-type.html	MS [0..1]
Location.position	0	1		BackboneElement	The absolute geographic location	The absolute geographic location of the Location, expressed using the WGS84 datum (This is the same co-ordinate system used in KML).				NR
Location.position.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Location.position.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Location.position.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Location.position.longitude	1	1		decimal	Longitude with WGS84 datum	Longitude. The value domain and the interpretation are the same as for the text of the longitude element in KML (see notes below).				NR
Location.position.latitude	1	1		decimal	Latitude with WGS84 datum	Latitude. The value domain and the interpretation are the same as for the text of the latitude element in KML (see notes below).				NR
Location.position.altitude	0	1		decimal	Altitude with WGS84 datum	Altitude. The value domain and the interpretation are the same as for the text of the altitude element in KML (see notes below).				NR
Location.managingOrganization	0	1	Y	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)	Organization responsible for provisioning and upkeep	The organization responsible for the provisioning and upkeep of the location.				NR
Location.partOf	0	1		Reference(Location)	Another Location this one is physically a part of	Another Location of which this Location is physically a part of.				MS [0..1]
Location.hoursOfOperation	0	*		BackboneElement	What days/times during a week is this location usually open	What days/times during a week is this location usually open.				NR
Location.hoursOfOperation.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Location.hoursOfOperation.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Location.hoursOfOperation.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Location.hoursOfOperation.daysOfWeek	0	*		code	mon | tue | wed | thu | fri | sat | sun	Indicates which days of the week are available between the start and end Times.	required	The days of the week.	https://hl7.org/fhir/R4/valueset-days-of-week.html	NR
Location.hoursOfOperation.allDay	0	1		boolean	The Location is open all day	The Location is open all day.				NR
Location.hoursOfOperation.openingTime	0	1		time	Time that the Location opens	Time that the Location opens.				NR
Location.hoursOfOperation.closingTime	0	1		time	Time that the Location closes	Time that the Location closes.				NR
Location.availabilityExceptions	0	1		string	Description of availability exceptions	A description of when the locations opening ours are different to normal, e.g. public holiday availability. Succinctly describing all possible exceptions to normal site availability as detailed in the opening hours Times.				NR
Location.endpoint	0	*		Reference(Endpoint)	Technical endpoints providing access to services operated for the location	Technical endpoints providing access to services operated for the location.				NR

---

Sheet 14: Medication-US Core

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FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description	Binding Value Set	ACH dQM
Medication	0	*		Medication	Definition of a Medication	The US Core Medication Profile is based upon the core FHIR Medication Resource and created to meet the 2015 Edition Common Clinical Data Set 'Medications' requirements.				MS [0..*]
Medication.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R [1..1]
Medication.meta	0	1		Meta	Metadata about the resource	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.				NRT
Medication.implicitRules	0	1		uri	A set of rules under which this content was created	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.				NRT
Medication.language	0	1		code	Language of the resource content	The base language in which the resource is written. (ex English)	preferred	CommonLanguages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
Medication.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.				NRT
Medication.contained	0	*		Resource	Contained, inline Resources	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.				NRT
Medication.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Medication.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).				NRT
Medication.identifier	0	*		Identifier	Business identifier for this medication	Business identifier for this medication.				NRT
Medication.code	1	1	Y	CodeableConcept	Codes that identify this medication	A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systems.	extensible	USCoreMedicationCodes	http://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-medication-codes.html	R [1..1]
Medication.status	0	1		code	active | inactive | entered-in-error	A code to indicate if the medication is in active use.	required	Medication Status Codes	https://hl7.org/fhir/R4/valueset-medication-status.html	MS [0..*]
Medication.manufacturer	0	1		Reference(Organization)	Manufacturer of the item	Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product.				NR
Medication.form	0	1		CodeableConcept	powder | tablets | capsule +	Describes the form of the item. Powder; tablets; capsule.	extensible	4.0.1 SNOMEDCTFormCodes	https://hl7.org/fhir/R4/valueset-medication-form-codes.html	MS [0..1]
Medication.amount	0	1		Ratio	Amount of drug in package	Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.).				MS [0..1]
Medication.ingredient	0	*		BackboneElement	Active or inactive ingredient	Identifies a particular constituent of interest in the product.				MS [0..*]
Medication.ingredient.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Medication.ingredient.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Medication.ingredient.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Medication.ingredient.item[x]	1	1		CodeableConcept Reference(Substance|Medication)	The actual ingredient or content	The actual ingredient - either a substance (simple ingredient) or another medication of a medication.				R [1..1]
Medication.ingredient.isActive	0	1		boolean	Active ingredient indicator	Indication of whether this ingredient affects the therapeutic action of the drug.				NRT
Medication.ingredient.strength	0	1		Ratio	Quantity of ingredient present	Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet.				NR
Medication.batch	0	1		BackboneElement	Details about packaged medications	Information that only applies to packages (not products).				NR
Medication.batch.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Medication.batch.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Medication.batch.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Medication.batch.lotNumber	0	1		string	Identifier assigned to batch	The assigned lot number of a batch of the specified product.				NR
Medication.batch.expirationDate	0	1		dateTime	When batch will expire	When this specific batch of product will expire.				NR

---

Sheet 15: MedicationAdministration-R4

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FHIRPath	Min	Max	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description (Value Set Name)	Binding Value Set	ACH dQM
MedicationAdministration	0	*		Administration of medication to a patient	Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.				MS [0..*]
MedicationAdministration.id	0	1	id	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R [1..1]
MedicationAdministration.meta	0	1	Meta	Metadata about the resource	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.				NRT
MedicationAdministration.implicitRules	0	1	uri	A set of rules under which this content was created	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.				NRT
MedicationAdministration.language	0	1	code	Language of the resource content	The base language in which the resource is written.	preferred but limited to AllLanguages	CommonLanguages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
MedicationAdministration.text	0	1	Narrative	Text summary of the resource, for human interpretation	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.				NRT
MedicationAdministration.contained	0	*	Resource	Contained, inline Resources	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.				NRT
MedicationAdministration.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
MedicationAdministration.modifierExtension	0	*	Extension	Extensions that cannot be ignored	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).				NRT
MedicationAdministration.identifier	0	*	Identifier	External identifier	Identifiers associated with this Medication Administration that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.				NRT
MedicationAdministration.instantiates	0	*	uri	Instantiates protocol or definition	A protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this event.				NR
MedicationAdministration.partOf	0	*	Reference(MedicationAdministration|Procedure)	Part of referenced event	A larger event of which this particular event is a component or step.				NR
MedicationAdministration.status	1	1	code	in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown	Will generally be set to show that the administration has been completed. For some long running administrations such as infusions, it is possible for an administration to be started but not completed or it may be paused while some other process is under way.	required	MedicationAdministration Status Codes	https://hl7.org/fhir/R4/valueset-medication-admin-status.html	R [1..1]
MedicationAdministration.statusReason	0	*	CodeableConcept	Reason administration not performed	A code indicating why the administration was not performed.	extensible	SNOMEDCTReasonMedicationNotGivenCodes	https://hl7.org/fhir/R4/valueset-reason-medication-not-given-codes.html	MS [0..*]
MedicationAdministration.category	0	1	CodeableConcept	Type of medication usage	Indicates where the medication is expected to be consumed or administered.	extensible	MedicationAdministration Category Codes	https://hl7.org/fhir/R4/valueset-medication-admin-category.html	MS [0..*]
MedicationAdministration.medication[x]	1	1	CodeableConcept Reference(Medication)	What was administered	Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.	extensible	MedicationClinicalDrug (RxNorm code system)	https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.4/expansion	R [1..1]
MedicationAdministration.subject	1	1	Reference(Patient|Group)	Who received medication	The person or animal or group receiving the medication.				R [1..1]
MedicationAdministration.context	0	1	Reference(Encounter|EpisodeOfCare)	Encounter or Episode of Care administered as part of	The visit, admission, or other contact between patient and health care provider during which the medication administration was performed.				MS [0..1]
MedicationAdministration.supportingInformation	0	*	Reference(Any)	Additional information to support administration	Additional information (for example, patient height and weight) that supports the administration of the medication.				NR
MedicationAdministration.effective[x]	1	1	dateTime Period	Start and end time of administration	A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.				R [1..1]
MedicationAdministration.performer	0	*	BackboneElement	Who performed the medication administration and what they did	Indicates who or what performed the medication administration and how they were involved.				NR
MedicationAdministration.performer.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
MedicationAdministration.performer.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
MedicationAdministration.performer.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
MedicationAdministration.performer.function	0	1	CodeableConcept	Type of performance	Distinguishes the type of involvement of the performer in the medication administration.	example	MedicationAdministration Performer Function Codes	https://hl7.org/fhir/R4/valueset-med-admin-perform-function.html	NR
MedicationAdministration.performer.actor	1	1	Reference(Practitioner|PractitionerRole|Patient|RelatedPerson|Device)	Who performed the medication administration	Indicates who or what performed the medication administration.				NR
MedicationAdministration.reasonCode	0	*	CodeableConcept	Reason administration performed	A code indicating why the medication was given.	example	ReasonMedicationGivenCodes	https://hl7.org/fhir/R4/valueset-reason-medication-given-codes.html	MS [0..*]
MedicationAdministration.reasonReference	0	*	Reference(Condition|Observation|DiagnosticReport)	Condition or observation that supports why the medication was administered	Condition or observation that supports why the medication was administered.				MS [0..*]
MedicationAdministration.request	0	1	Reference(MedicationRequest)	Request administration performed against	The original request, instruction or authority to perform the administration.				MS [0..1]
MedicationAdministration.device	0	*	Reference(Device)	Device used to administer	The device used in administering the medication to the patient. For example, a particular infusion pump.				NR
MedicationAdministration.note	0	*	Annotation	Information about the administration	Extra information about the medication administration that is not conveyed by the other attributes.				NR
MedicationAdministration.dosage	0	1	BackboneElement	Details of how medication was taken + Rule: SHALL have at least one of dosage.dose or dosage.rate[x]	Describes the medication dosage information details e.g. dose, rate, site, route, etc.				R [1..1]
MedicationAdministration.dosage.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
MedicationAdministration.dosage.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
MedicationAdministration.dosage.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
MedicationAdministration.dosage.text	0	1	string	Free text dosage instructions e.g. SIG	Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans._x000D__x000D_The dosage instructions should reflect the dosage of the medication that was administered.				NR
MedicationAdministration.dosage.site	0	1	CodeableConcept	Body site administered to	A coded specification of the anatomic site where the medication first entered the body. For example, "left arm".	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes	https://hl7.org/fhir/R4/valueset-approach-site-codes.html	NR
MedicationAdministration.dosage.route	0	1	CodeableConcept	Path of substance into body	A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc.	extensible	SNOMEDCTRouteCodes	https://hl7.org/fhir/R4/valueset-route-codes.html	R [1..1]
MedicationAdministration.dosage.method	0	1	CodeableConcept	How drug was administered	A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV.	example	SNOMEDCTAdministrationMethodCodes	https://hl7.org/fhir/R4/valueset-administration-method-codes.html	MS [0..1]
MedicationAdministration.dosage.dose	0	1	SimpleQuantity	Amount of medication per dose	The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection.				R [1..1]
MedicationAdministration.dosage.rate[x]	0	1	Ratio SimpleQuantity	Dose quantity per unit of time	Identifies the speed with which the medication was or will be introduced into the patient. Typically, the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time, e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.				NR
MedicationAdministration.eventHistory	0	*	Reference(Provenance)	A list of events of interest in the lifecycle	A summary of the events of interest that have occurred, such as when the administration was verified.				NR

---

Sheet 16: MedicationRequest-US Core

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FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Comments	Binding Strength	Binding Description	Binding Value Set	ACH dQM
MedicationRequest	0	*			Ordering of medication for patient or group	The US Core Medication Request (Order) Profile is based upon the core FHIR MedicationRequest Resource and created to meet the 2015 Edition Common Clinical Data Set 'Medications' requirements.					MS [0..*]
MedicationRequest.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.				R [1..1]
MedicationRequest.meta	0	1		Meta	Metadata about the resource	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.					NRT
MedicationRequest.implicitRules	0	1		uri	A set of rules under which this content was created	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.	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.				NRT
MedicationRequest.language	0	1		code	Language of the resource content	The base language in which the resource is written.	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).	preferred	CommonLanguages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
MedicationRequest.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.	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.				NRT
MedicationRequest.contained	0	*		Resource	Contained, inline Resources	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.	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.				NRT
MedicationRequest.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
MedicationRequest.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).	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.				NRT
MedicationRequest.identifier	0	*		Identifier	External ids for this request	Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.	This is a business identifier, not a resource identifier.				NRT
MedicationRequest.status	1	1	Y	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown	A code specifying the current state of the order. Generally, this will be active or completed state.	This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.	required	medicationrequest Status	https://hl7.org/fhir/R4/valueset-medicationrequest-status.html	R [1..1]
MedicationRequest.statusReason	0	1		CodeableConcept	Reason for current status+F14	Captures the reason for the current state of the MedicationRequest.	This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.	extensible	medicationRequest Status Reason Codes	https://hl7.org/fhir/R4/valueset-medicationrequest-status-reason.html	MS[0..1]
MedicationRequest.intent	1	1	Y	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option	Whether the request is a proposal, plan, or an original order.	It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.	required	medicationRequest Intent	https://hl7.org/fhir/R4/valueset-medicationrequest-intent.html	R [1..1]
MedicationRequest.category	0	*		CodeableConcept	Type of medication usage	Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).	The category can be used to include where the medication is expected to be consumed or other types of requests.	extensible	medicationRequest Category Codes	https://hl7.org/fhir/R4/valueset-medicationrequest-category.html	MS [0..*]
MedicationRequest.priority	0	1		code	routine | urgent | asap | stat	Indicates how quickly the Medication Request should be addressed with respect to other requests.		required	RequestPriority	https://hl7.org/fhir/R4/valueset-request-priority.html	MS [0..1]
MedicationRequest.doNotPerform	0	1		boolean	True if request is prohibiting action	If true indicates that the provider is asking for the medication request not to occur.	If do not perform is not specified, the request is a positive request e.g. "do perform".				MS [0..1]
MedicationRequest.reported[x]	0	1	Y	boolean Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)	Reported rather than primary record	Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.					MS [0..1]
MedicationRequest.medication[x]	1	1	Y	CodeableConcept Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication)	Medication to be taken	Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.	If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.	extensible	US Core Medication Codes (RxNorm)	http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4	R [1..1]
MedicationRequest.subject	1	1	Y	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)	Who or group medication request is for	A link to a resource representing the person or set of individuals to whom the medication will be given.	The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.				R [1..1]
MedicationRequest.encounter	0	1	Y	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)	Encounter created as part of encounter/admission/stay	The Encounter during which this [x] was created or to which the creation of this record is tightly associated.	This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.				MS [0..1]
MedicationRequest.supportingInformation	0	*		Reference(Resource)	Information to support ordering of the medication	Include additional information (for example, patient height and weight) that supports the ordering of the medication.					NRT
MedicationRequest.authoredOn	1	1	Y	dateTime	When request was initially authored	The date (and perhaps time) when the prescription was initially written or authored on.					R [1..1]
MedicationRequest.requester	1	1	Y	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile)	Who/What requested the Request	The individual, organization, or device that initiated the request and has responsibility for its activation.					NR
MedicationRequest.performer	0	1		Reference(Practitioner|PractitionerRole|Organization|Patient|Device|RelatedPerson|CareTeam)	Intended performer of administration	The specified desired performer of the medication treatment (e.g. the performer of the medication administration).					NRT
MedicationRequest.performerType	0	1		CodeableConcept	Desired kind of performer of the medication administration	Indicates the type of performer of the administration of the medication.	If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.	example	Procedure Performer Role Codes	https://hl7.org/fhir/R4/valueset-performer-role.html	NRT
MedicationRequest.recorder	0	1		Reference(Practitioner|PractitionerRole)	Person who entered the request	The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.					NR
MedicationRequest.reasonCode	0	*		CodeableConcept	Reason or indication for ordering or not ordering the medication	The reason or the indication for ordering or not ordering the medication.	This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.	example	Condition/Problem/Diagnosis Codes	https://hl7.org/fhir/R4/valueset-condition-code.html	MS [0..*]
MedicationRequest.reasonReference	0	*		Reference(Condition|Observation)	Condition or observation that supports why the prescription is being written	Condition or observation that supports why the medication was ordered.	This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.				MS [0..*]
MedicationRequest.instantiatesCanonical	0	*		canonical	Instantiates FHIR protocol or definition	The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.	can include a version number (FHIR based)				MS [0..*]
MedicationRequest.instantiatesUri	0	*		uri	Instantiates external protocol or definition	The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.					MS [0..*]
MedicationRequest.basedOn	0	*		Reference(CarePlan|MedicationRequest|ServiceRequest|ImmunizationRecommendation)	What request fulfills	A plan or request that is fulfilled in whole or in part by this medication request.					NRT
MedicationRequest.groupIdentifier	0	1		Identifier	Composite request this is part of	A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription.					NRT
MedicationRequest.courseOfTherapyType	0	1		CodeableConcept	Overall pattern of medication administration	The description of the overall pattern of the administration of the medication to the patient.	This attribute should not be confused with the protocol of the medication.	example	Medication request course of therapy codes	http://hl7.org/fhir/R4/ValueSet/medicationrequest-course-of-therapy	MS[0..1]
MedicationRequest.insurance	0	*		Reference(Coverage|ClaimResponse)	Associated insurance coverage	Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.					NRT
MedicationRequest.note	0	*		Annotation	Information about the prescription	Extra information about the prescription that could not be conveyed by the other attributes.					NRT
MedicationRequest.dosageInstruction	0	*	Y	Dosage	How the medication should be taken	Indicates how the medication is to be used by the patient.	There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.				MS [0..*]
MedicationRequest.dosageInstruction.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
MedicationRequest.dosageInstruction.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
MedicationRequest.dosageInstruction.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
MedicationRequest.dosageInstruction.sequence	0	1		integer	The order of the dosage instructions	Indicates the order in which the dosage instructions should be applied or interpreted.					NRT
MedicationRequest.dosageInstruction.text	0	1	Y	string	Free text dosage instructions e.g. SIG	Free text dosage instructions e.g. SIG.					MS [0..1]
MedicationRequest.dosageInstruction.additionalInstruction	0	*		CodeableConcept	Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"	Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").	Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.	example	A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".	http://hl7.org/fhir/R4/ValueSet/additional-instruction-codes	NRT
MedicationRequest.dosageInstruction.patientInstruction	0	1		string	Patient or consumer oriented instructions	Instructions in terms that are understood by the patient or consumer.					NR
MedicationRequest.dosageInstruction.timing	0	1		Timing	When medication should be administered	When medication should be administered.	This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.				MS [0..1]
MedicationRequest.dosageInstruction.asNeeded[x]	0	1		boolean CodeableConcept	Take "as needed" (for x)	Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).	Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".	example	A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.	https://hl7.org/fhir/R4/valueset-medication-as-needed-reason.html	MS [0..1]
MedicationRequest.dosageInstruction.site	0	1		CodeableConcept	Body site to administer to	Body site to administer to.	If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](http://hl7.org/fhir/R4/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.	example	A coded concept describing the site location the medicine enters into or onto the body.	https://hl7.org/fhir/R4/valueset-approach-site-codes.html	MS [0..1]
MedicationRequest.dosageInstruction.route	0	1		CodeableConcept	How drug should enter body	How drug should enter body.		extensible	A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.	http://hl7.org/fhir/R4/ValueSet/route-codes	R [1..1]
MedicationRequest.dosageInstruction.method	0	1		CodeableConcept	Technique for administering medication	Technique for administering medication.	Terminologies used often pre-coordinate this term with the route and or form of administration.	example	A coded concept describing the technique by which the medicine is administered.	http://hl7.org/fhir/R4/ValueSet/administration-method-codes	MS [0..1]
MedicationRequest.dosageInstruction.doseAndRate	0	*		Element	Amount of medication administered	The amount of medication administered.					MS [0..*]
MedicationRequest.dosageInstruction.doseAndRate.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
MedicationRequest.dosageInstruction.doseAndRate.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
MedicationRequest.dosageInstruction.doseAndRate.type	0	1		CodeableConcept	The kind of dose or rate specified	The kind of dose or rate specified, for example, ordered or calculated.		example	The kind of dose or rate specified.	http://hl7.org/fhir/R4/ValueSet/dose-rate-type	MS [0..1]
MedicationRequest.dosageInstruction.doseAndRate.dose[x]	0	1		Range Quantity {SimpleQuantity}	Amount of medication per dose	Amount of medication per dose.	Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.				MS [0..1]
MedicationRequest.dosageInstruction.doseAndRate.rate[x]	0	1		Ratio RangeQuantity {SimpleQuantity}	Amount of medication per unit of time	Amount of medication per unit of time.	It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate._x000D__x000D_It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.				MS [0..1]
MedicationRequest.dosageInstruction.maxDosePerPeriod	0	1		Ratio	Upper limit on medication per unit of time	Upper limit on medication per unit of time.	This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".				NRT
MedicationRequest.dosageInstruction.maxDosePerAdministration	0	1		Quantity {SimpleQuantity}	Upper limit on medication per administration	Upper limit on medication per administration.	This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.				NRT
MedicationRequest.dosageInstruction.maxDosePerLifetime	0	1		Quantity {SimpleQuantity}	Upper limit on medication per lifetime of the patient	Upper limit on medication per lifetime of the patient.					NRT
MedicationRequest.dispenseRequest	0	1		BackboneElement	Medication supply authorization	Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.					NRT
MedicationRequest.dispenseRequest.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
MedicationRequest.dispenseRequest.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
MedicationRequest.dispenseRequest.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
MedicationRequest.dispenseRequest.initialFill	0	1		BackboneElement	First fill details	Indicates the quantity or duration for the first dispense of the medication.	If populating this element, either the quantity or the duration must be included.				NRT
MedicationRequest.dispenseRequest.initialFill.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
MedicationRequest.dispenseRequest.initialFill.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
MedicationRequest.dispenseRequest.initialFill.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
MedicationRequest.dispenseRequest.initialFill.quantity	0	1		Quantity {SimpleQuantity}	First fill quantity	The amount or quantity to provide as part of the first dispense.					NRT
MedicationRequest.dispenseRequest.initialFill.duration	0	1		Duration	First fill duration	The length of time that the first dispense is expected to last.					NRT
MedicationRequest.dispenseRequest.dispenseInterval	0	1		Duration	Minimum period of time between dispenses	The minimum period of time that must occur between dispenses of the medication.					NRT
MedicationRequest.dispenseRequest.validityPeriod	0	1		Period	Time period supply is authorized for	This indicates the validity period of a prescription (stale dating the Prescription).	It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.				NRT
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed	0	1		unsignedInt	Number of refills authorized	An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense.	If displaying "number of authorized fills", add 1 to this number.				NRT
MedicationRequest.dispenseRequest.quantity	0	1		Quantity {SimpleQuantity}	Amount of medication to supply per dispense	The amount that is to be dispensed for one fill.					NRT
MedicationRequest.dispenseRequest.expectedSupplyDuration	0	1		Duration	Number of days supply per dispense	Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.	In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.				NRT
MedicationRequest.dispenseRequest.performer	0	1		Reference(Organization)	Intended dispenser	Indicates the intended dispensing Organization specified by the prescriber.					NRT
MedicationRequest.substitution	0	1		BackboneElement	Any restrictions on medication substitution	Indicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.					NRT
MedicationRequest.substitution.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
MedicationRequest.substitution.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
MedicationRequest.substitution.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
MedicationRequest.substitution.allowed[x]	1	1		boolean CodeableConcept	Whether substitution is allowed or not	True if the prescriber allows a different drug to be dispensed from what was prescribed.	This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.	example	ActSubstanceAdminSubstitutionCode	https://terminology.hl7.org/5.5.0/ValueSet-v3-ActSubstanceAdminSubstitutionCode.html	NRT
MedicationRequest.substitution.reason	0	1		CodeableConcept	Why should (not) substitution be made	Indicates the reason for the substitution, or why substitution must or must not be performed.		example	SubstanceAdminSubstitutionReason	http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason	NRT
MedicationRequest.priorPrescription	0	1		Reference(MedicationRequest)	An order/prescription that is being replaced	A link to a resource representing an earlier order related order or prescription.		Y			NRT
MedicationRequest.detectedIssue	0	*		Reference(DetectedIssue)	Clinical Issue with action	Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.	This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.	Y			NRT
MedicationRequest.eventHistory	0	*		Reference(Provenance)	A list of events of interest in the lifecycle	Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.	This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).	Y			NRT

---

Sheet 17: Observation-R4

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FHIR Path	Min	Max	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description (Value Set Name)	Binding Value Set	ACH dQM
Observation	0	*	DomainResource	Measurements and simple assertions	Measurements and simple assertions made about a patient, device or other subject.				MS [0..*]
Observation.id	0	1	id	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R[1..1]
Observation.meta	0	1	Meta	Metadata about the resource	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.				NRT
Observation.implicitRules	0	1	uri	A set of rules under which this content was created	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.				NRT
Observation.language	0	1	code	Language of the resource content	The base language in which the resource is written.	preferred but limited to AllLanguages	CommonLanguages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
Observation.text	0	1	Narrative	Text summary of the resource, for human interpretation	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.				NRT
Observation.contained	0	*	Resource	Contained, inline Resources	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.				NRT
Observation.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Observation.modifierExtension	0	*	Extension	Extensions that cannot be ignored	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).				NRT
Observation.identifier	0	*	Identifier	Business Identifier for observation	A unique identifier assigned to this observation.				NRT
Observation.basedOn	0	*	Reference(CarePlan|DeviceRequest|ImmunizationRecommendation|MedicationRequest|NutritionOrder|ServiceRequest)	Fulfills plan, proposal or order	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.				NRT
Observation.partOf	0	*	Reference(MedicationAdministration|MedicationDispense|MedicationStatement|Procedure|Immunization|ImagingStudy)	Part of referenced event	A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.				MS[0..*]
Observation.status	1	1	code	registered | preliminary | final | amended +	The status of the result value.	required	ObservationStatus	https://hl7.org/fhir/R4/valueset-observation-status.html	R [1..1]
Observation.category	0	*	CodeableConcept	Classification of type of observation	A code that classifies the general type of observation being made.	preferred	ObservationCategoryCodes	https://hl7.org/fhir/R4/valueset-observation-category.html	R [1..*] CQL constrains to these Categories: Social-history, vital-signs, imaging, laboratory, procedure, survey
Observation.code	1	1	CodeableConcept	Type of observation (code / type)	Describes what was observed. Sometimes this is called the observation "name".	extensible	LOINCCodes	https://hl7.org/fhir/R4/valueset-observation-codes.html	R [1..1]
Observation.subject	0	1	Reference(Patient | Group | Device | Location)	Who and/or what the observation is about	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.				R [1..1]
Observation.focus	0	*	Reference(Any)	What the observation is about, when it is not about the subject of record	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.				NR
Observation.encounter	0	1	Reference(Encounter)	Healthcare event during which this observation is made	The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.				MS [0..1]
Observation.effective[x]	0	1	dateTime Period Timing Instant	Clinically relevant time/time-period for observation	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.				R [1..1]
Observation.issued	0	1	instant	Date/Time this version was made available	The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.				MS [0..1]
Observation.performer	0	*	Reference(Practitioner|PractitionerRole|Organization|CareTeam|Patient|RelatedPerson)	Who is responsible for the observation	Who was responsible for asserting the observed value as "true".				NR
Observation.value[x]	0	1	Quantity CodeableConcept string boolean integer Range Ratio SampledData time dateTime Period	Actual result	The information determined as a result of making the observation, if the information has a simple value.				MS [0..1]
Observation.dataAbsentReason	0	1	CodeableConcept	Why the result is missing	Provides a reason why the expected value in the element Observation.value[x] is missing.	extensible	DataAbsentReason	https://hl7.org/fhir/R4/valueset-data-absent-reason.html	NR
Observation.interpretation	0	*	CodeableConcept	High, low, normal, etc.	A categorical assessment of an observation value. For example, high, low, normal.	extensible	ObservationInterpretationCodes	https://hl7.org/fhir/R4/valueset-observation-interpretation.html	MS [0..*]
Observation.note	0	*	Annotation	Comments about the observation	Comments about the observation or the results.				NR
Observation.bodySite	0	1	CodeableConcept	Observed body part	Indicates the site on the subject's body where the observation was made (i.e. the target site).	extensible	SNOMEDCTBodyStructures	https://hl7.org/fhir/R4/valueset-body-site.html	MS [0..1]
Observation.method	0	1	CodeableConcept	How it was done	Indicates the mechanism used to perform the observation.	extensible	ObservationMethods	https://hl7.org/fhir/R4/valueset-observation-methods.html	MS [0..1]
Observation.specimen	0	1	Reference(Specimen)	Specimen used for this observation	The specimen that was used when this observation was made.				NR
Observation.device	0	1	Reference(Device|DeviceMetric)	(Measurement) Device	The device used to generate the observation data.				NR
Observation.referenceRange	0	*	BackboneElement	Provides guide for interpretation + Rule: Must have at least a low or a high or text	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.				MS[0..*]
Observation.referenceRange.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Observation.referenceRange.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Observation.referenceRange.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Observation.referenceRange.low	0	1	SimpleQuantity	Low Range, if relevant	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).				MS [0..1]
Observation.referenceRange.high	0	1	SimpleQuantity	High Range, if relevant	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).				MS [0..1]
Observation.referenceRange.type	0	1	CodeableConcept	Reference range qualifier	Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.	preferred	ObservationReferenceRangeMeaningCodes	https://hl7.org/fhir/R4/valueset-referencerange-meaning.html	NR
Observation.referenceRange.appliesTo	0	*	CodeableConcept	Reference range population	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.	example	ObservationReferenceRangeAppliesToCodes	https://hl7.org/fhir/R4/valueset-referencerange-appliesto.html	NR
Observation.referenceRange.age	0	1	Range	Applicable age range, if relevant	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.				MS [0..1]
Observation.referenceRange.text	0	1	string	Text based reference range in an observation	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".				NR
Observation.hasMember	0	*	Reference(Observation|QuestionnaireResponse|MolecularSequence)	Related resource that belongs to the Observation group	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.				MS [0..*]
Observation.derivedFrom	0	*	Reference(DocumentReference|ImagingStudy|Media|QuestionnaireResponse|Observation|MolecularSequence)	Related measurements the observation is made from	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.				NR
Observation.component	0	*	BackboneElement	Component results	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.				MS [0..*]
Observation.component.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Observation.component.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Observation.component.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Observation.component.code	1	1	CodeableConcept	Type of component observation (code / type)	Describes what was observed. Sometimes this is called the observation "code".	extensible	LOINCCodes	https://hl7.org/fhir/R4/valueset-observation-codes.html	R [1..1]
Observation.component.value[x]	0	1	Quantity CodeableConcept string boolean integer Range Ratio SampledData time dateTime Period	Actual component result	The information determined as a result of making the observation, if the information has a simple value.				MS [0..1]
Observation.component.dataAbsentReason	0	1	CodeableConcept	Why the component result is missing	Provides a reason why the expected value in the element Observation.component.value[x] is missing.	extensible	DataAbsentReason	https://hl7.org/fhir/R4/valueset-data-absent-reason.html	NR
Observation.component.interpretation	0	*	CodeableConcept	High, low, normal, etc.	A categorical assessment of an observation value. For example, high, low, normal.	extensible	ObservationInterpretationCodes	https://hl7.org/fhir/R4/valueset-observation-interpretation.html	MS [0..*]
Observation.component.referenceRange	0	*		Provides guide for interpretation of component result	Guidance on how to interpret the value by comparison to a normal or recommended range.				MS [0..*]

---

Sheet 18: Observation-Vital Signs R4

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FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description (Value Set Name)	Binding Value Set	ACH dQM
Observation	0	*		DomainResource	Measurements and simple assertions	Measurements and simple assertions made about a patient, device or other subject.				MS [0..*]
Observation.id	0	1		id	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R[1..1]
Observation.meta	0	1		Meta	Metadata about the resource	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.				NRT
Observation.implicitRules	0	1		uri	A set of rules under which this content was created	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.				NRT
Observation.language	0	1		code	Language of the resource content	The base language in which the resource is written.	preferred but limited to AllLanguages	CommonLanguages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
Observation.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.				NRT
Observation.contained	0	*		Resource	Contained, inline Resources	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.				NRT
Observation.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Observation.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).				NRT
Observation.identifier	0	*		Identifier	Business Identifier for observation	A unique identifier assigned to this observation.				NRT
Observation.basedOn	0	*		Reference(CarePlan|DeviceRequest|ImmunizationRecommendation|MedicationRequest|NutritionOrder|ServiceRequest)	Fulfills plan, proposal or order	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.				NRT
Observation.partOf	0	*		Reference(MedicationAdministration|MedicationDispense|MedicationStatement|Procedure|Immunization|ImagingStudy)	Part of referenced event	A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.				MS[0..*]
Observation.status	1	1	Y	code	registered | preliminary | final | amended +	The status of the result value.	required	ObservationStatus	https://hl7.org/fhir/R4/valueset-observation-status.html	R [1..1]
Observation.category	1	*	Y	CodeableConcept	Classification of type of observation	A code that classifies the general type of observation being made.	preferred	ObservationCategoryCodes		R [1..*]
Observation.category(VSCat)	1	1	Y	CodeableConcept		A code that classifies the general type of observation being made	preferred			R [1..1]
Observation.category.id	0	1		string		Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Observation.category.extension	0	*		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.				NRT
Observation.category.coding	1	*	Y	coding		A reference to a code defined by a terminology system.				R[1..*]
Observation.category.coding.id	0	1	Y	string		Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Observation.category.coding.extension	0	*		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.				NRT
Observation.category.coding.system	1	1	Y	uri		The identification of the code system that defines the meaning of the symbol in the code.			https://hl7.org/fhir/R4/valueset-observation-category.html	R[1..1]
Observation.category.coding.version	0	1		string		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.				NR
Observation.category.coding.code	1	1	Y	code		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).				R[1..1]
Observation.category.coding.display	0	1		string		A representation of the meaning of the code in the system, following the rules of the system.				NR
Observation.category.coding.userSelected	0	1		boolean		Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).				NR
Observation.category.text	0	1		string		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.				NR
Observation.code	1	1	Y	CodeableConcept	Type of observation (code / type)	Describes what was observed. Sometimes this is called the observation "name".	extensible	LOINCCodes	http://hl7.org/fhir/R4/valueset-observation-vitalsignresult.html	R [1..1]
Observation.subject	1	1	Y	Reference(Patient | Group | Device | Location)	Who and/or what the observation is about	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.				R [1..1]
Observation.focus	0	*		Reference(Any)	What the observation is about, when it is not about the subject of record	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.				NR
Observation.encounter	0	1		Reference(Encounter)	Healthcare event during which this observation is made	The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.				MS [0..1]
Observation.effective[x]	1	1	Y	dateTime Period Timing Instant	Clinically relevant time/time-period for observation	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.				R [1..1]
Observation.issued	0	1		instant	Date/Time this version was made available	The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.				MS [0..1]
Observation.performer	0	*		Reference(Practitioner|PractitionerRole|Organization|CareTeam|Patient|RelatedPerson)	Who is responsible for the observation	Who was responsible for asserting the observed value as "true".				NR
Observation.value[x]	0	1	Y	Quantity CodeableConcept string boolean integer Range Ratio SampledData time dateTime Period	Actual result *Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.	The information determined as a result of making the observation, if the information has a simple value.				MS [0..1]
Observation.dataAbsentReason	0	1	Y	CodeableConcept	Why the result is missing	Provides a reason why the expected value in the element Observation.value[x] is missing.	extensible	DataAbsentReason	https://hl7.org/fhir/R4/valueset-data-absent-reason.html	NR
Observation.interpretation	0	*		CodeableConcept	High, low, normal, etc.	A categorical assessment of an observation value. For example, high, low, normal.	extensible	ObservationInterpretationCodes	https://hl7.org/fhir/R4/valueset-observation-interpretation.html	MS [0..*]
Observation.note	0	*		Annotation	Comments about the observation	Comments about the observation or the results.				NR
Observation.bodySite	0	1		CodeableConcept	Observed body part	Indicates the site on the subject's body where the observation was made (i.e. the target site).	extensible	SNOMEDCTBodyStructures	https://hl7.org/fhir/R4/valueset-body-site.html	MS [0..1]
Observation.method	0	1		CodeableConcept	How it was done	Indicates the mechanism used to perform the observation.	extensible	ObservationMethods	https://hl7.org/fhir/R4/valueset-observation-methods.html	MS [0..1]
Observation.specimen	0	1		Reference(Specimen)	Specimen used for this observation	The specimen that was used when this observation was made.				NR
Observation.device	0	1		Reference(Device|DeviceMetric)	(Measurement) Device	The device used to generate the observation data.				NR
Observation.referenceRange	0	*		BackboneElement	Provides guide for interpretation + Rule: Must have at least a low or a high or text	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.				MS[0..*]
Observation.referenceRange.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Observation.referenceRange.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Observation.referenceRange.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Observation.referenceRange.low	0	1		SimpleQuantity	Low Range, if relevant	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).				MS [0..1]
Observation.referenceRange.high	0	1		SimpleQuantity	High Range, if relevant	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).				MS [0..1]
Observation.referenceRange.type	0	1		CodeableConcept	Reference range qualifier	Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.	preferred	ObservationReferenceRangeMeaningCodes	hl7.org/fhir/R4/valueset-referencerange-meaning.html	NR
Observation.referenceRange.appliesTo	0	*		CodeableConcept	Reference range population	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.	example	ObservationReferenceRangeAppliesToCodes	https://hl7.org/fhir/R4/valueset-referencerange-appliesto.html	NR
Observation.referenceRange.age	0	1		Range	Applicable age range, if relevant	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.				MS [0..1]
Observation.referenceRange.text	0	1		string	Text based reference range in an observation	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".				NR
Observation.hasMember	0	*		Reference(Observation|QuestionnaireResponse|MolecularSequence)	Related resource that belongs to the Observation group	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.				MS [0..*]
Observation.derivedFrom	0	*		Reference(DocumentReference|ImagingStudy|Media|QuestionnaireResponse|Observation|MolecularSequence)	Related measurements the observation is made from	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.				NR
Observation.component	0	*	Y	BackboneElement	Component results *Used when reporting systolic and diastolic blood pressure. vs-3: If there is no a value a data absent reason must be present	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.				MS [0..*]
Observation.component.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Observation.component.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Observation.component.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Observation.component.code	1	1	Y	CodeableConcept	Type of component observation (code / type)	Describes what was observed. Sometimes this is called the observation "code".	extensible	LOINCCodes	https://hl7.org/fhir/R4/valueset-observation-vitalsignresult.html	R [1..1]
Observation.component.value[x]	0	1	Y	Quantity CodeableConcept string boolean integer Range Ratio SampledData time dateTime Period	Actual component result	The information determined as a result of making the observation, if the information has a simple value.	required		https://hl7.org/fhir/R4/valueset-ucum-vitals-common.html	MS [0..1]
Observation.component.dataAbsentReason	0	1	Y	CodeableConcept	Why the component result is missing	Provides a reason why the expected value in the element Observation.component.value[x] is missing.	extensible	DataAbsentReason	https://hl7.org/fhir/R4/valueset-ucum-vitals-common.html	NR
Observation.component.interpretation	0	*		CodeableConcept	High, low, normal, etc.	A categorical assessment of an observation value. For example, high, low, normal.	extensible	ObservationInterpretationCodes	https://hl7.org/fhir/R4/valueset-observation-interpretation.html	MS [0..*]
Observation.component.referenceRange	0	*			Provides guide for interpretation of component result	Guidance on how to interpret the value by comparison to a normal or recommended range.				MS [0..*]
Observation.component.referenceRange.low	0	1		SimpleQuantity	Low Range, if relevant	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).				MS[0..1]
Observation.component.referenceRange.high	0	1		SimpleQuantity	High Range, if relevant	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).				MS[0..1]
Observation.component.referenceRange.type	0	1		CodeableConcept	Reference range qualifier	Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.	Preferred	ObservationReferenceRangeMeaningCodes	https://hl7.org/fhir/R4/valueset-referencerange-meaning.html	NR
Observation.component.referenceRange.appliesTo	0	*		CodeableConcept	Reference range population	Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.	Example	ObservationReferenceRangeAppliesToCodes	https://hl7.org/fhir/R4/valueset-referencerange-appliesto.html	NR
Observation.component.referenceRange.age	0	1		Range	Applicable age range, if relevant	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.				MS[0..1]
Observation.component.referenceRange.text	0	1		String	Text based reference range in an observation	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".				NR

---

Sheet 19: Patient-US Core

Back to TOC
FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description	Binding Value Set	ACH dQM (cross-setting for all measures)
Patient	0	*			Information about an individual or animal receiving health care services	The US Core Patient Profile is based upon the core FHIR Patient Resource and designed to meet the applicable patient demographic data elements from the 2015 Edition Common Clinical Data Set.				R [1..1]
Patient.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R [1..1]
Patient.meta	0	1		Meta	Metadata about the resource	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.				NRT
Patient.implicitRules	0	1		uri	A set of rules under which this content was created	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.				NRT
Patient.language	0	1		code	Language of the resource content	The base language in which the resource is written.	preferred	A human language.	http://hl7.org/fhir/ValueSet/languages	NRT
Patient.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.				NRT
Patient.contained	0	*		Resource	Contained, inline Resources	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.				NRT
Patient.extension	0	*		Extension	Extension	An Extension				NR
Patient.extension (race)	0	1	Y	(Complex) optional ‘ombCategory’, optional ‘detailed’ and a required ‘text’. - ‘ombCategory’ component is optional, but allows for up to 5 races from ombCategory-race ValueSet (note this is denoted by the 0..5 cardinality on the 3.1.1 definition of us-core-race o When present, the structure will always following a ‘coding’ datatype, as denoted by ‘valueCoding’ - ‘detailed’ component is also optional, but may be present an infinite number of times, each ‘detailed’ containing one of the 917 race codes o When present, the structure will always following a ‘coding’ datatype, as denoted by ‘valueCoding’ - ‘text’ as required is required to be present, but there are no rules around this data beyond it’ll be a string (ie it likely will be some combination of ombCategory and/or ‘detailed’, if present, but that’s about the as far as I’d go with a safe assumption). http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-race.html	US Core Race Extension	Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the [CDC Race and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories: - American Indian or Alaska Native - Asian - Black or African American - Native Hawaiian or Other Pacific Islander - White.		US Core Race Extension	http://hl7.org/fhir/us/core/StructureDefinition/us-core-race	MS[0...*]
Patient.extension (ethnicity)	0	1	Y	(Complex)	US Core ethnicity Extension	Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The ethnicity codes used to represent these concepts are based upon the [CDC ethnicity and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html) which includes over 900 concepts for representing race and ethnicity of which 43 reference ethnicity. The ethnicity concepts are grouped by and pre-mapped to the 2 OMB ethnicity categories: - Hispanic or Latino - Not Hispanic or Latino.		US Core ethnicity Extension	http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity	MS[0..*]
Patient.extension (sex at birth)	0	1	Y	code	Extension	A code classifying the person's sex assigned at birth as specified by the [Office of the National Coordinator for Health IT (ONC)](https://www.healthit.gov/newsroom/about-onc).	required	Birth Sex	http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex	MS [0..1]
Patient.extension (gender identity)	0	1		Extension {http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity}	Extension	An Extension				MS [0.. *]
Patient.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).				NRT
Patient.identifier	1	*	Y	Identifier	An identifier for this patient	An identifier for this patient.				R [1..*]
Patient.identifier.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NR
Patient.identifier.extension	0	*		Extension	Additional content defined by implementations	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.				NR
Patient.identifier.use	0	1		code	usual | official | temp | secondary | old (If known)	The purpose of this identifier.	required	Identifier Use	https://hl7.org/fhir/R4/valueset-identifier-use.html	MS[0..1]
Patient.identifier.type	0	1		CodeableConcept	Description of identifier	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.	extensible	Identifier Type Codes	https://hl7.org/fhir/R4/valueset-identifier-type.html	MS[0..1]
Patient.identifier.system	1	1	Y	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient	Establishes the namespace for the value - that is, a URL that describes a set values that are unique.				NR
Patient.identifier.value	1	1	Y	string	The value that is unique within the system.	The portion of the identifier typically relevant to the user and which is unique within the context of the system.				R [1..1]
Patient.identifier.period	0	1		Period	Time period when id is/was valid for use	Time period during which identifier is/was valid for use.				MS [0..1]
Patient.identifier.assigner	0	1		Reference(Organization)	Organization that issued id (may be just text)	Organization that issued/manages the identifier.				NR
Patient.active	0	1		boolean	Whether this patient's record is in active use	Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules. It is often used to filter patient lists to exclude inactive patients Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.				NR
Patient.name	1	*	Y	HumanName	A name associated with the patient us-core-8: Either Patient.name.given and/or Patient.name.family SHALL be present or a Data Absent Reason Extension SHALL be present.	A name associated with the individual.				R [1..*]
Patient.name.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NR
Patient.name.extension	0	*		Extension	Additional content defined by implementations	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.				NR
Patient.name.use	0	1		code	usual | official | temp | nickname | anonymous | old | maiden	Identifies the purpose for this name.	required	NameUse	https://hl7.org/fhir/R4/valueset-name-use.html	MS[0..1]
Patient.name.text	0	1		string	Text representation of the full name	Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.				MS[0..1]
Patient.name.family	0	1	Y	string	Family name (often called 'Surname')	The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.				MS[0..1]
Patient.name.given	0	*	Y	string	Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name	Given name.				MS[0..*]
Patient.name.prefix	0	*		string	Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name	Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.				MS[0..*]
Patient.name.suffix	0	*		string	Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name	Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.				MS[0..*]
Patient.name.period	0	1		Period	Time period when name was/is in use	Indicates the period of time when this name was valid for the named person.				MS[0..1]
Patient.telecom	0	*	Y	ContactPoint	A contact detail for the individual	A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.				MS[0..*]
Patient.telecom.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Patient.telecom.extension	0	*		Extension	Additional content defined by implementations	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.				NRT
Patient.telecom.system	1	1	Y	code	phone | fax | email | pager | url | sms | other	Telecommunications form for contact point - what communications system is required to make use of the contact.	required	ContactPointSystem	https://hl7.org/fhir/R4/valueset-contact-point-system.html	R [1..1]
Patient.telecom.value	1	1	Y	string	The actual contact point details	The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).				R [1..1]
Patient.telecom.use	0	1	Y	code	home | work | temp | old | mobile - purpose of this contact point	Identifies the purpose for the contact point.	required	ContactPointUse	https://hl7.org/fhir/R4/valueset-contact-point-use.html	MS[0..1]
Patient.telecom.rank	0	1		positiveInt	Specify preferred order of use (1 = highest)	Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.				MS[0..1]
Patient.telecom.period	0	1		Period	Time period when the contact point was/is in use	Time period when the contact point was/is in use.				MS[0..1]
Patient.gender	1	1	Y	code	male | female | other | unknown	Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.	required	AdminstrativeGender	https://hl7.org/fhir/R4/valueset-administrative-gender.html	R [1..1]
Patient.birthDate	0	1	Y	date	The date of birth for the individual	The date of birth for the individual.				R [1..1]
Patient.deceased[x]	0	1		boolean dateTime	Indicates if the individual is deceased or not	Indicates if the individual is deceased or not.				MS[0..1]
Patient.address	0	*	Y	Address	An address for the individual	An address for the individual.				MS[0..*]
Patient.address.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NR
Patient.address.extension	0	*		Extension	Additional content defined by implementations	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.				NR
Patient.address.use	0	1		code	home | work | temp | old | billing - purpose of this address	The purpose of this address.	required	AddressUse	https://hl7.org/fhir/R4/valueset-address-use.html	MS[0..1]
Patient.address.type	0	1		code	home|postal | physical | both	Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.	required	AddressType	https://hl7.org/fhir/R4/valueset-address-type.html	MS[0..1]
Patient.address.text	0	1		string	Text representation of the address	Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.				MS[0..1]
Patient.address.line	0	*	Y	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label	This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.				MS[0..*]
Patient.address.city	0	1	Y	string	Name of city, town etc.	The name of the city, town, suburb, village or other community or delivery center.				MS[0..1]
Patient.address.district	0	1		string	District name (aka county)	The name of the administrative area (county).				MS[0..1]
Patient.address.state	0	1	Y	string	Sub-unit of country (abbreviations ok)	Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).	extensible	USPS Two Letter Alphabetic Codes	https://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-usps-state.html	MS[0..1]
Patient.address.postalCode	0	1	Y	string	US Zip Codes	A postal code designating a region defined by the postal service.				MS[0..1]
Patient.address.country	0	1		string	Country (e.g. can be ISO 3166 2 or 3 letter code)	Country - a nation as commonly understood or generally accepted.				MS[0..1]
Patient.address.period	0	1	Y	Period	Time period when address was/is in use	Time period when address was/is in use.				MS[0..1]
Patient.maritalStatus	0	1		CodeableConcept	Marital (civil) status of a patient	This field contains a patient's most recent marital (civil) status.	extensible	Marital Status Codes	https://hl7.org/fhir/R4/valueset-marital-status.html	NR
Patient.multipleBirth[x]	0	1		boolean integer	Whether patient is part of a multiple birth	Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).				NR
Patient.photo	0	*		Attachment	Image of the patient	Image of the patient.				NR
Patient.contact	0	*		BackboneElement	A contact party (e.g. guardian, partner, friend) for the patient	A contact party (e.g. guardian, partner, friend) for the patient.				MS[0..*]
Patient.contact.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NR
Patient.contact.extension	0	*		Extension	Additional content defined by implementations	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.				NR
Patient.contact.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Patient.contact.relationship	0	*		CodeableConcept	The kind of relationship	The nature of the relationship between the patient and the contact person.	extensible	The nature of the relationship between a patient and a contact person for that patient.	https://hl7.org/fhir/R4/valueset-patient-contactrelationship.html	MS[0..*]
Patient.contact.name	0	1		HumanName	A name associated with the contact person	A name associated with the contact person.				MS[0..1]
Patient.contact.telecom	0	*		ContactPoint	A contact detail for the person	A contact detail for the person, e.g. a telephone number or an email address.				MS[0..*]
Patient.contact.address	0	1		Address	Address for the contact person	Address for the contact person.				MS[0..1]
Patient.contact.gender	0	1		code	male | female | other | unknown	Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.	required	The gender of a person used for administrative purposes.	https://hl7.org/fhir/R4/valueset-administrative-gender.html	NR
Patient.contact.organization	0	1		Reference(Organization)	Organization that is associated with the contact	Organization on behalf of which the contact is acting or for which the contact is working.				NR
Patient.contact.period	0	1		Period	The period during which this contact person or organization is valid to be contacted relating to this patient	The period during which this contact person or organization is valid to be contacted relating to this patient.				MS[0..1)
Patient.communication	0	*	Y	BackboneElement	A language which may be used to communicate with the patient about his or her health	A language which may be used to communicate with the patient about his or her health.				MS[0..*]
Patient.communication.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NR
Patient.communication.extension	0	*		Extension	Additional content defined by implementations	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.				NR
Patient.communication.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Patient.communication.language	1	1	Y	CodeableConcept	The language which can be used to communicate with the patient about his or her health	The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.	extensible		https://hl7.org/fhir/us/core/STU3.1.1/ValueSet-simple-language.html	R [1..1]
Patient.communication.preferred	0	1		boolean	Language preference indicator	Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).				MS[0..1]
Patient.generalPractitioner	0	*		Reference(Organization|Practitioner|PractitionerRole)	Patient's nominated primary care provider	Patient's nominated care provider.				NR
Patient.managingOrganization	0	1		Reference(Organization)	Organization that is the custodian of the patient record	Organization that is the custodian of the patient record.				NR
Patient.link	0	*		BackboneElement	Link to another patient resource that concerns the same actual person	Link to another patient resource that concerns the same actual patient.				MS[0..*]
Patient.link.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				MS [0..*]
Patient.link.extension	0	*		Extension	Additional content defined by implementations	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.				MS [0..*]
Patient.link.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).				MS [0..*]
Patient.link.other	1	1		Reference(Patient|RelatedPerson)	The other patient or related person resource that the link refers to	The other patient resource that the link refers to.				R [1..1]
Patient.link.type	1	1		code	replaced-by | replaces | refer | seealso	The type of link between this patient resource and another patient resource.	required	LinkType	https://hl7.org/fhir/R4/valueset-link-type.html	R [1..1]

---

Sheet 20: Procedure-US Core

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FHIR Path	Min	Max	Must Support?	Data Type(s)	FHIR Short Description	FHIR Definition	Comments	Binding Strength	Binding Description	Binding Value Set	ACH dQM
Procedure	0	*			An action that is being or was performed on a patient	The US Core Condition Profile is based upon the core FHIR Procedure Resource and created to meet the 2015 Edition Common Clinical Data Set 'Procedures' requirements.					MS [0..*]
Procedure.id	0	1		string	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.				R [1..1]
Procedure.meta	0	1		Meta	Metadata about the resource	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.					NRT
Procedure.implicitRules	0	1		uri	A set of rules under which this content was created	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.	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.				NRT
Procedure.language	0	1		code	Language of the resource content	The base language in which the resource is written.	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).	preferred	A human language.	https://hl7.org/fhir/R4/valueset-languages.html	NRT
Procedure.text	0	1		Narrative	Text summary of the resource, for human interpretation	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.	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.				NRT
Procedure.contained	0	*		Resource	Contained, inline Resources	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.	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.				NRT
Procedure.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
Procedure.modifierExtension	0	*		Extension	Extensions that cannot be ignored	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).	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.				NRT
Procedure.identifier	0	*		Identifier	External Identifiers for this procedure	Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.	This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.				NRT
Procedure.instantiatesCanonical	0	*		canonical(PlanDefinition|ActivityDefinition|Measure|OperationDefinition|Questionnaire)	Instantiates FHIR protocol or definition	The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.					NR
Procedure.instantiatesUri	0	*		uri	Instantiates external protocol or definition	The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.	This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.				NR
Procedure.basedOn	0	*		Reference(CarePlan|ServiceRequest)	A request for this procedure	A reference to a resource that contains details of the request for this procedure.					NR
Procedure.partOf	0	*		Reference(Procedure|Observation|MedicationAdministration)	Part of referenced event	A larger event of which this particular procedure is a component or step.	The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).				NR
Procedure.status	1	1	Y	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown	A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.	The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.	required		http://hl7.org/fhir/R4/ValueSet/event-status	R [1..1]
Procedure.statusReason	0	1		CodeableConcept	Reason for current status	Captures the reason for the current state of the procedure.	This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.	example	A code that identifies the reason a procedure was not performed.	https://hl7.org/fhir/R4/valueset-procedure-not-performed-reason.html	NR
Procedure.category	0	1		CodeableConcept	Classification of the procedure	A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").		example	A code that classifies a procedure for searching, sorting and display purposes.	https://hl7.org/fhir/R4/valueset-procedure-category.html	NR
Procedure.code	1	1	Y	CodeableConcept	Identification of the procedure	The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").		extensible	Codes describing the type of Procedure	https://hl7.org/fhir/us/core/STU3.1.1/ValueSet-us-core-procedure-code.html	R [1..1]
Procedure.subject	1	1	Y	Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)	Who the procedure was performed on	The person, animal or group on which the procedure was performed.					R [1..1]
Procedure.encounter	0	1		Reference(Encounter)	Encounter created as part of	The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.	This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.				MS[0..1]
Procedure.performed[x]	1	1	Y	dateTime Period string Age Range	When the procedure was performed	Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.	Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.				R [1..1] change to R [1..1] Restrict data type to DateTime and Period
Procedure.recorder	0	1		Reference(Patient|RelatedPerson|Practitioner|PractitionerRole)	Who recorded the procedure	Individual who recorded the record and takes responsibility for its content.					NR
Procedure.asserter	0	1		Reference(Patient|RelatedPerson|Practitioner|PractitionerRole)	Person who asserts this procedure	Individual who is making the procedure statement.					NR
Procedure.performer	0	*		BackboneElement	The people who performed the procedure	Limited to "real" people rather than equipment.					NR
Procedure.performer.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
Procedure.performer.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
Procedure.performer.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
Procedure.performer.function	0	1		CodeableConcept	Type of performance	Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.		example	A code that identifies the role of a performer of the procedure.	https://hl7.org/fhir/R4/valueset-performer-role.html	NR
Procedure.performer.actor	1	1		Reference(Practitioner|PractitionerRole|Organization|Patient|RelatedPerson|Device)	The reference to the practitioner	The practitioner who was involved in the procedure.					NR
Procedure.performer.onBehalfOf	0	1		Reference(Organization)	Organization the device or practitioner was acting for	The organization the device or practitioner was acting on behalf of.					NR
Procedure.location	0	1		Reference(Location)	Where the procedure happened	The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.					MS [0..1]
Procedure.reasonCode	0	*		CodeableConcept	Coded reason procedure performed	The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.	Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.	extensible	A code that identifies the reason a procedure is required.	https://hl7.org/fhir/R4/valueset-procedure-reason.html	MS [0..*]
Procedure.reasonReference	0	*		Reference(Condition|Observation|Procedure|DiagnosticReport|DocumentReference)	The justification that the procedure was performed	The justification of why the procedure was performed.	It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.				MS [0..*]
Procedure.bodySite	0	*		CodeableConcept	Target body sites	Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.	If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [procedure-targetbodystructure](http://hl7.org/fhir/R4/extension-procedure-targetbodystructure.html).	extensible	Codes describing anatomical locations. May include laterality.	https://hl7.org/fhir/R4/valueset-body-site.html	MS [0..*]
Procedure.outcome	0	1		CodeableConcept	The result of procedure	The outcome of the procedure - did it resolve the reasons for the procedure being performed?	If outcome contains narrative text only, it can be captured using the CodeableConcept.text.	example	An outcome of a procedure - whether it was resolved or otherwise.	https://hl7.org/fhir/R4/valueset-procedure-outcome.html	NR
Procedure.report	0	*		Reference(DiagnosticReport|DocumentReference|Composition)	Any report resulting from the procedure	This could be a histology result, pathology report, surgical report, etc.	There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.				NR
Procedure.complication	0	*		CodeableConcept	Complication following the procedure	Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.	If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.	example	Codes describing complications that resulted from a procedure.	https://hl7.org/fhir/R4/valueset-condition-code.html	NR
Procedure.complicationDetail	0	*		Reference(Condition)	A condition that is a result of the procedure	Any complications that occurred during the procedure, or in the immediate post-performance period.					NR
Procedure.followUp	0	*		CodeableConcept	Instructions for follow up	If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used.		example	Specific follow up required for a procedure e.g. removal of sutures.	https://hl7.org/fhir/R4/valueset-procedure-followup.html	NR
Procedure.note	0	*		Annotation	Additional information about the procedure	Any other notes and comments about the procedure.					NR
Procedure.focalDevice	0	*		BackboneElement	Manipulated, implanted, or removed device	A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.					NR
Procedure.focalDevice.id	0	1		string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.					NRT
Procedure.focalDevice.extension	0	*		Extension	Additional content defined by implementations	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.	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.				NRT
Procedure.focalDevice.modifierExtension	0	*		Extension	Extensions that cannot be ignored even if unrecognized	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).	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.				NRT
Procedure.focalDevice.action	0	1		CodeableConcept	Kind of change to device	The kind of change that happened to the device during the procedure.		preferred	A kind of change that happened to the device during the procedure.	https://hl7.org/fhir/R4/valueset-device-action.html	NR
Procedure.focalDevice.manipulated	1	1		Reference(Device)	Device that was changed	The device that was manipulated (changed) during the procedure.					NR
Procedure.usedReference	0	*		Reference(Device|Medication|Substance)	Items used during procedure	Identifies medications, devices and any other substance used as part of the procedure.	For devices actually implanted or removed, use Procedure.device.				NR
Procedure.usedCode	0	*		CodeableConcept	Coded items used during the procedure	Identifies coded items that were used as part of the procedure.	For devices actually implanted or removed, use Procedure.device.	example	Codes describing items used during a procedure.	https://hl7.org/fhir/R4/valueset-device-kind.html	NR

---

Sheet 21: Service Request-R4

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FHIR Path	Min	Max	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description	Binding Value Set	ACH dQM
ServiceRequest	0	*		A request for a service to be performed	A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.				MS [0..*]
ServiceRequest.id	0	1	id	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R [1..1]
ServiceRequest.meta	0	1	Meta	Metadata about the resource	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.				NRT
ServiceRequest.implicitRules	0	1	uri	A set of rules under which this content was created	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.				NRT
ServiceRequest.language	0	1	code	Language of the resource content	The base language in which the resource is written.	preferred	Common Languages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
ServiceRequest.text	0	1	Narrative	Text summary of the resource, for human interpretation	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.				NRT
ServiceRequest.contained	0	*	Resource	Contained, inline Resources	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.				NRT
ServiceRequest.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
ServiceRequest.modifierExtension	0	*	Extension	Extensions that cannot be ignored	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).				NRT
ServiceRequest.identifier	0	*	Identifier	Identifiers assigned to this order	Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.				NRT
ServiceRequest.instantiatesCanonical	0	*	canonical(ActivityDefinition|PlanDefinition)	Instantiates FHIR protocol or definition	The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.				NR
ServiceRequest.instantiatesUri	0	*	uri	Instantiates external protocol or definition	The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.				NR
ServiceRequest.basedOn	0	*	Reference(CarePlan|ServiceRequest|MedicationRequest)	What request fulfills	Plan/proposal/order fulfilled by this request.				NR
ServiceRequest.replaces	0	*	Reference(ServiceRequest)	What request replaces	The request takes the place of the referenced completed or terminated request(s).				NR
ServiceRequest.requisition	0	1	Identifier	Composite Request ID	A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.				NR
ServiceRequest.status	1	1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown	The status of the order.	required	RequestStatus	https://hl7.org/fhir/R4/valueset-request-status.html	R [1..1]
ServiceRequest.intent	1	1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option	Whether the request is a proposal, plan, an original order or a reflex order.	required	RequestIntent	https://hl7.org/fhir/R4/valueset-request-intent.html	R [1..1]
ServiceRequest.category	0	*	CodeableConcept	Classification of service	A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").	extensible	Service Request Category Codes	https://hl7.org/fhir/R4/valueset-servicerequest-category.html	MS [0..*]
ServiceRequest.priority	0	1	code	routine | urgent | asap | stat	Indicates how quickly the ServiceRequest should be addressed with respect to other requests.	required	Request priority	https://hl7.org/fhir/R4/valueset-request-priority.html	MS [0..1]
ServiceRequest.doNotPerform	0	1	boolean	True if service/procedure should not be performed	Set this to true if the record is saying that the service/procedure should NOT be performed.				MS [0..1]
ServiceRequest.code	0	1	CodeableConcept	What is being requested/ordered	A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.	extensible	Procedure Codes (SNOMED CT)	https://hl7.org/fhir/R4/valueset-procedure-code.html	MS [0..1]
ServiceRequest.orderDetail	0	*	CodeableConcept	Additional order information	Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.	example	Service Request Order Details Codes	https://hl7.org/fhir/R4/valueset-servicerequest-orderdetail.html	NR
ServiceRequest.quantity[x]	0	1	Quantity RatioRange	Service amount	An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).				NR
ServiceRequest.subject	1	1	Reference(Patient|Group|Location|Device)	Individual or Entity the service is ordered for	On whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).				R [1..1]
ServiceRequest.encounter	0	1	Reference(Encounter)	Encounter in which the request was created	An encounter that provides additional information about the healthcare context in which this request is made.				MS [0..1]
ServiceRequest.occurrence[x]	0	1	dateTime Period Timing	When service should occur	The date/time at which the requested service should occur.				MS [0..1]
ServiceRequest.asNeeded[x]	0	1	boolean CodeableConcept	Preconditions for service	If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.	example	SNOMED CT Medication As Needed Reason Codes	https://hl7.org/fhir/R4/valueset-medication-as-needed-reason.html	MS [0..1]
ServiceRequest.authoredOn	0	1	dateTime	Date request signed	When the request transitioned to being actionable.				R [1..1]
ServiceRequest.requester	0	1	Reference(Practitioner|PractitionerRole|Organization|Patient|RelatedPerson|Device)	Who/what is requesting service	The individual who initiated the request and has responsibility for its activation.				NR
ServiceRequest.performerType	0	1	CodeableConcept	Performer role	Desired type of performer for doing the requested service.	example	Participant Roles	https://hl7.org/fhir/R4/valueset-participant-role.html	NR
ServiceRequest.performer	0	*	Reference(Practitioner|PractitionerRole|Organization|CareTeam|HealthcareService|Patient|Device|RelatedPerson)	Requested performer	The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.				NR
ServiceRequest.locationCode	0	*	CodeableConcept	Requested location	The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.	example	V3 Value SetServiceDeliveryLocationRoleType	https://hl7.org/fhir/R4/v3/ServiceDeliveryLocationRoleType/vs.html	NR
ServiceRequest.locationReference	0	*	Reference(Location)	Requested location	A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.				NR
ServiceRequest.reasonCode	0	*	CodeableConcept	Explanation/Justification for procedure or service	An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in `supportingInfo`.	example	Procedure Reason Codes	https://hl7.org/fhir/R4/valueset-procedure-reason.html	NR
ServiceRequest.reasonReference	0	*	Reference(Condition|Observation|DiagnosticReport|DocumentReference)	Explanation/Justification for service or service	Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in `supportingInfo`.				MS [0..*]
ServiceRequest.insurance	0	*	Reference(Coverage|ClaimResponse)	Associated insurance coverage	Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.				NR
ServiceRequest.supportingInfo	0	*	Reference(Resource)	Additional clinical information	Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.				NR
ServiceRequest.specimen	0	*	Reference(Specimen)	Procedure Samples	One or more specimens that the laboratory procedure will use.				MS [0..*]
ServiceRequest.bodySite	0	*	CodeableConcept	Location on Body	Anatomic location where the procedure should be performed. This is the target site.	example	SNOMED CT Body Structures	https://hl7.org/fhir/R4/valueset-body-site.html	NR
ServiceRequest.note	0	*	Annotation	Comments	Any other notes and comments made about the service request. For example, internal billing notes.				NR
ServiceRequest.patientInstruction	0	1	string	Patient or consumer-oriented instructions	Instructions in terms that are understood by the patient or consumer.				NR
ServiceRequest.relevantHistory	0	*	Reference(Provenance)	Request provenance	Key events in the history of the request.				NR

---

Sheet 22: Specimen-R4

Back to TOC
FHIR Path	Min	Max	Data Type(s)	FHIR Short Description	FHIR Definition	Binding Strength	Binding Description	Binding Value Set	ACH dQM
Specimen	0	*		Sample for analysis	A sample to be used for analysis.				MS [0..*]
Specimen.id	0	1	id	Logical id of this artifact	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.				R [1..1]
Specimen.meta	0	1	Meta	Metadata about the resource	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.				NRT
Specimen.implicitRules	0	1	uri	A set of rules under which this content was created	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.				NRT
Specimen.language	0	1	code	Language of the resource content	The base language in which the resource is written.	preferred	Common Languages	https://hl7.org/fhir/R4/valueset-languages.html	NRT
Specimen.text	0	1	Narrative	Text summary of the resource, for human interpretation	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.				NRT
Specimen.contained	0	*	Resource	Contained, inline Resources	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.				NRT
Specimen.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Specimen.modifierExtension	0	*	Extension	Extensions that cannot be ignored	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).				NRT
Specimen.identifier	0	*	Identifier	External Identifier	Id for specimen.				MS [0..*]
Specimen.accessionIdentifier	0	1	Identifier	Identifier assigned by the lab	The identifier assigned by the lab when accessioning specimen(s). This is not necessarily the same as the specimen identifier, depending on local lab procedures.				MS [0..1]
Specimen.status	0	1	code	available | unavailable | unsatisfactory | entered-in-error	The availability of the specimen.	required	SpecimenStatus	https://hl7.org/fhir/R4/valueset-specimen-status.html	MS[0..1]
Specimen.type	0	1	CodeableConcept	Kind of material that forms the specimen	The kind of material that forms the specimen.	required	V2 Specimen Type	https://hl7.org/fhir/R4/v2/0487/index.html	R [1..1]
Specimen.subject	0	1	Reference(Patient|Group|Device|Substance|Location)	Where the specimen came from. This may be from patient(s), from a location (e.g., the source of an environmental sample), or a sampling of a substance or a device	Where the specimen came from. This may be from patient(s), from a location (e.g., the source of an environmental sample), or a sampling of a substance or a device.				MS [0..1]
Specimen.receivedTime	0	1	dateTime	The time when specimen was received for processing	Time when specimen was received for processing or testing.				NR
Specimen.parent	0	*	Reference(Specimen)	Specimen from which this specimen originated	Reference to the parent (source) specimen which is used when the specimen was either derived from or a component of another specimen.				NR
Specimen.request	0	*	Reference(ServiceRequest)	Why the specimen was collected	Details concerning a service request that required a specimen to be collected.				NR
Specimen.collection	0	1	BackboneElement	Collection details	Details concerning the specimen collection.				R [1..1]
Specimen.collection.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Specimen.collection.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Specimen.collection.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Specimen.collection.collector	0	1	Reference(Practitioner|PractitionerRole)	Who collected the specimen	Person who collected the specimen.				NR
Specimen.collection.collected[x]	0	1	dateTime Period	Collection time	Time when specimen was collected from subject - the physiologically relevant time.				R [1..1]
Specimen.collection.duration	0	1	Duration	How long it took to collect specimen	The span of time over which the collection of a specimen occurred.				NR
Specimen.collection.quantity	0	1	Quantity {SimpleQuantity}	The quantity of specimen collected	The quantity of specimen collected; for instance the volume of a blood sample, or the physical measurement of an anatomic pathology sample.				NR
Specimen.collection.method	0	1	CodeableConcept	Technique used to perform collection	A coded value specifying the technique that is used to perform the procedure.	example	FHIR Specimen Collection Method	https://hl7.org/fhir/R4/valueset-specimen-collection-method.html	NR
Specimen.collection.bodySite	0	1	CodeableConcept	Anatomical collection site	Anatomical location from which the specimen was collected (if subject is a patient). This is the target site. This element is not used for environmental specimens.	extensible	SNOMED CT Body Structures	http://hl7.org/fhir/R4/valueset-body-site.html	R [1..1]
Specimen.collection.fastingStatus[x]	0	1	CodeableConcept Duration	Whether or how long patient abstained from food and/or drink	Abstinence or reduction from some or all food, drink, or both, for a period of time prior to sample collection.	extensible	v2 Relevant Clinical Inforrmation	https://hl7.org/fhir/R4/v2/0916/index.html	NR
Specimen.processing	0	*	BackboneElement	Processing and processing step details	Details concerning processing and processing steps for the specimen.				NR
Specimen.processing.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Specimen.processing.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Specimen.processing.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Specimen.processing.description	0	1	string	Textual description of procedure	Textual description of procedure.				NR
Specimen.processing.procedure	0	1	CodeableConcept	Indicates the treatment step applied to the specimen	A coded value specifying the procedure used to process the specimen.	example	Specimen processing procedure	https://hl7.org/fhir/R4/valueset-specimen-processing-procedure.html	NR
Specimen.processing.additive	0	*	Reference(Substance)	Material used in the processing step	Material used in the processing step.				NR
Specimen.processing.time[x]	0	1	dateTime Period	Date and time of specimen processing	A record of the time or period when the specimen processing occurred. For example the time of sample fixation or the period of time the sample was in formalin.				NR
Specimen.container	0	*	BackboneElement	Direct container of specimen (tube/slide, etc.)	The container holding the specimen. The recursive nature of containers; i.e. blood in tube in tray in rack is not addressed here.				NR
Specimen.container.id	0	1	string	Unique id for inter-element referencing	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.				NRT
Specimen.container.extension	0	*	Extension	Additional content defined by implementations	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.				NRT
Specimen.container.modifierExtension	0	*	Extension	Extensions that cannot be ignored even if unrecognized	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).				NRT
Specimen.container.identifier	0	*	Identifier	Id for the container	Id for container. There may be multiple; a manufacturer's bar code, lab assigned identifier, etc. The container ID may differ from the specimen id in some circumstances.				NRT
Specimen.container.description	0	1	string	Textual description of the container	Textual description of the container.				NR
Specimen.container.type	0	1	CodeableConcept	Kind of container directly associated with specimen	The type of container associated with the specimen (e.g. slide, aliquot, etc.).	example	Specimen container	https://hl7.org/fhir/R4/valueset-specimen-container-type.html	NR
Specimen.container.capacity	0	1	Quantity {SimpleQuantity}	Container volume or size	The capacity (volume or other measure) the container may contain.				NR
Specimen.container.specimenQuantity	0	1	Quantity {SimpleQuantity}	Quantity of specimen within container	The quantity of specimen in the container; may be volume, dimensions, or other appropriate measurements, depending on the specimen type.				NR
Specimen.container.additive[x]	0	1	CodeableConcept Reference(Substance)	Additive associated with container	Introduced substance to preserve, maintain or enhance the specimen. Examples: Formalin, Citrate, EDTA.	example	v2 Additive	http://terminology.hl7.org/ValueSet/v2-0371	NR
Specimen.condition	0	*	CodeableConcept	State of the specimen	A mode or state of being that describes the nature of the specimen.	extensible	v2 Specimen Condition	http://terminology.hl7.org/ValueSet/v2-0493	NR
Specimen.note	0	*	Annotation	Comments	To communicate any details or issues about the specimen or during the specimen collection. (for example: broken vial, sent with patient, frozen).				NR

---

Sheet 23: Metadata

Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition
Version	4.1.0
Name	USCoreCondition
Title	US Core Condition Profile
Status	active
Experimental	false
Date	2020-06-27
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	Defines constraints and extensions on the Condition resource for the minimal set of data to query and retrieve problems and health concerns information.
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	Condition
Base Definition	http://hl7.org/fhir/StructureDefinition/Condition
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition
Version	4.1.0
Name	USCoreCondition
Title	US Core Condition Profile
Status	active
Experimental	false
Date	2020-06-27
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	Defines constraints and extensions on the Condition resource for the minimal set of data to query and retrieve problems and health concerns information.
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	Condition
Base Definition	http://hl7.org/fhir/StructureDefinition/Condition
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference
Version	4.1.0
Name	USCoreDocumentReferenceProfile
Title	US Core DocumentReference Profile
Status	active
Experimental	false
Date	2020-07-02
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	The document reference profile used in US Core.
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	DocumentReference
Base Definition	http://hl7.org/fhir/StructureDefinition/DocumentReference
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter
Version	4.1.0
Name	USCoreEncounterProfile
Title	US Core Encounter Profile
Status	active
Experimental	false
Date	2019-05-21
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	The Encounter referenced in the US Core profiles.
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	Encounter
Base Definition	http://hl7.org/fhir/StructureDefinition/Encounter
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization
Version	4.1.0
Name	USCoreImmunizationProfile
Title	US Core Immunization Profile
Status	active
Experimental	false
Date	2019-08-26
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	Defines constraints and extensions on the Immunization resource for the minimal set of data to query and retrieve patient's immunization information.
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	Immunization
Base Definition	http://hl7.org/fhir/StructureDefinition/Immunization
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-location
Version	4.1.0
Name	USCoreLocation
Title	US Core Location Profile
Status	active
Experimental	false
Date	2019-05-21
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	Defines basic constraints and extensions on the Location resource for use with other US Core resources
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	Location
Base Definition	http://hl7.org/fhir/StructureDefinition/Location
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication
Version	4.1.0
Name	USCoreMedicationProfile
Title	US Core Medication Profile
Status	active
Experimental	false
Date	2019-05-21
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	Defines constraints and extensions on the Medication resource for the minimal set of data to query and retrieve patient retrieving patient's medication information.
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	Medication
Base Definition	http://hl7.org/fhir/StructureDefinition/Medication
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest
Version	4.1.0
Name	USCoreMedicationRequestProfile
Title	US Core MedicationRequest Profile
Status	active
Experimental	false
Date	2020-06-26
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	Defines constraints and extensions on the MedicationRequest resource for the minimal set of data to query and retrieve prescription information.
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	MedicationRequest
Base Definition	http://hl7.org/fhir/StructureDefinition/MedicationRequest
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab
Version	4.1.0
Name	USCoreLaboratoryResultObservationProfile
Title	US Core Laboratory Result Observation Profile
Status	active
Experimental	false
Date	2020-06-27
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	Defines constraints and extensions on the Observation resource for the minimal set of data to query and retrieve laboratory test results
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	Observation
Base Definition	http://hl7.org/fhir/StructureDefinition/Observation
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure
Version	4.1.0
Name	USCoreProcedureProfile
Title	US Core Procedure Profile
Status	active
Experimental	false
Date	2020-06-29
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	Defines constraints and extensions on the Procedure resource for the minimal set of data to query and retrieve patient's procedure information. This profile can be used to record a service or intervention that is or was performed on or for a patient.
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	Procedure
Base Definition	http://hl7.org/fhir/StructureDefinition/Procedure
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/us/core/StructureDefinition/us-core-servicerequest
Version	4.1.0
Name	USCoreServiceRequest
Title	US Core Service Request
Status	active
Experimental
Date	2018-08-22T00:00:00+00:00
Publisher	HL7 International - Cross-Group Projects
Contact	No display for ContactDetail
Jurisdiction	United States of America
Description	Defines constraints and extensions on the ServiceRequest resource for the minimal set of data to query and retrieve orders associated with diagnostic and clinical tests and clinical interventions for a patient
Purpose
Copyright	Used by permission of HL7 International, all rights reserved Creative Commons License
FHIR Version	4.0.1
Kind	resource
Type	ServiceRequest
Base Definition	http://hl7.org/fhir/StructureDefinition/ServiceRequest
Abstract	false
Derivation	constraint
Property	Value
URL	http://hl7.org/fhir/StructureDefinition/Coverage
Version	4.3.0
Name	Coverage
Title
Status	draft
Experimental	false
Date	2022-05-28T12:47:40+10:00
Publisher	Health Level Seven International (Financial Management)
Contact	No display for ContactDetail
Contact	No display for ContactDetail
Description	Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
Purpose	Coverage provides a link between covered parties (patients) and the payors of their healthcare costs (both insurance and self-pay).
Copyright
FHIR Version	4.3.0
Kind	resource
Type	Coverage
Base Definition	http://hl7.org/fhir/StructureDefinition/DomainResource
Abstract	false
Derivation	specialization
Property	Value
URL	http://hl7.org/fhir/StructureDefinition/MedicationAdministration
Version	4.3.0
Name	MedicationAdministration
Title
Status	draft
Experimental	false
Date	2022-05-28T12:47:40+10:00
Publisher	Health Level Seven International (Pharmacy)
Contact	No display for ContactDetail
Contact	No display for ContactDetail
Description	Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.
Purpose
Copyright
FHIR Version	4.3.0
Kind	resource
Type	MedicationAdministration
Base Definition	http://hl7.org/fhir/StructureDefinition/DomainResource
Abstract	false
Derivation	specialization
Property	Value
URL	http://hl7.org/fhir/StructureDefinition/Observation
Version	4.3.0
Name	Observation
Title
Status	active
Experimental	false
Date	2022-05-28T12:47:40+10:00
Publisher	Health Level Seven International (Orders and Observations)
Contact	No display for ContactDetail
Contact	No display for ContactDetail
Description	Measurements and simple assertions made about a patient, device or other subject.
Purpose	Observations are a key aspect of healthcare. This resource is used to capture those that do not require more sophisticated mechanisms.
Copyright
FHIR Version	4.3.0
Kind	resource
Type	Observation
Base Definition	http://hl7.org/fhir/StructureDefinition/DomainResource
Abstract	false
Derivation	specialization
Property	Value
URL	http://hl7.org/fhir/StructureDefinition/Specimen
Version	4.3.0
Name	Specimen
Title
Status	draft
Experimental	false
Date	2022-05-28T12:47:40+10:00
Publisher	Health Level Seven International (Orders and Observations)
Contact	No display for ContactDetail
Contact	No display for ContactDetail
Description	A sample to be used for analysis.
Purpose
Copyright
FHIR Version	4.3.0
Kind	resource
Type	Specimen
Base Definition	http://hl7.org/fhir/StructureDefinition/DomainResource
Abstract	false
Derivation	specialization