Reference

• HL7 FHIR Genomic Reporting Variant
• HL7 v2 Lab Result Interface (LRI) Section 2 Discrete genetic variant panel
• GA4GH Genetic Variation Formats (VCF)
• openEHR Genomic variant result

Overview

The process of producing reportable genomic variants using decision support involves filtering massive raw sequencing datasets into actionable, clinically significant mutations. It relies on computational pipelines and clinical knowledge bases to classify variants based on pathogenicity and relevance to a patient's condition.

The step-by-step process operates as follows:

graph

placerS[Order Placer]
LaboratoryWorkflow

subgraph CDS[Decision Support]
analysis[Primary and Secondary Analysis]
filtering["Annotation and Prioritisation (Filtering)"]
classification[Variant Classification & Interpretation]
end

action[Actionability and Clinical Matching]
report[Final Clinical Review and Reporting]
placer[Order Placer]

placerS --> |Genomic Order| LaboratoryWorkflow
LaboratoryWorkflow --> |GA4GH?| analysis
analysis --> filtering
filtering --> classification
classification -.-> |for background info.| action
CDS --> |Reportable Variants| report
action -.->  report
report --> |Genomic Report| placer  

  classDef green fill:#D5E8D4;
  class placer,placerS green

Primary and Secondary Analysis

Raw sequencing data generated from samples undergoes bioinformatic processing where reads are aligned to a reference genome. This phase performs variant calling, identifying the genetic variations present (such as single nucleotide variants or insertions/deletions) when compared to a standard baseline.

Annotation and Prioritisation (Filtering)

A single genome can contain millions of variants. The Clinical Decision Support System (CDSS) automatically annotates these by appending biological and population context to the variants. It systematically filters out benign background polymorphisms and prioritizes variants based on factors like:

• Population allele frequency: Checking databases to see how common a variant is in healthy populations.
• In silico predictions: Utilizing computational models to determine if an amino acid change is likely to be functionally damaging.

Variant Classification & Interpretation

The CDSS evaluates the remaining variants against established clinical guidelines, such as the ACMG/AMP Guidelines for rare diseases or the AMP/ASCO Guidelines for oncology.

Output Reportable Variant

Actionability and Clinical Matching

For pathogenic or likely pathogenic variants, the decision support system queries updated clinical trial databases and regulatory-approved biomarker lists (like those from ClinGen). The system matches the variant to specific targeted therapies, identifying if a drug is indicated, contraindicated, or if the patient is eligible for a clinical trial.

Final Clinical Review and Reporting

Output Genomic Test Report

The computational outputs are reviewed by Genomic Clinical Scientists or laboratory scientists who confirm the findings, often utilizing tools such as VarSome to adhere to best practices. The finalized, reportable variants are then populated into a structured, evidence-based report. This report is delivered to the treating physician to guide the patient's personalized treatment or diagnostic journey.

Reportable Variant

MOCKUP

Summary Variant

Detailed Variant

• Key Elements Table
• Differential Table
• Snapshot Table
• Obligations
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	GenomicObservation	Measurements and simple assertions Constraints: obs-6, obs-7, obs-value-1
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension				Content/Rules for all slices
extension:bodyStructure		0..1	Reference(BodyStructure)	R5: Observed body structure (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.bodyStructure Constraints: ext-1
extension:triggeredBy		0..*	(Complex)	R5: Triggering observation(s) (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy Constraints: ext-1
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
Slices for extension				Content/Rules for all slices
extension:observation		1..1	Extension	Extension Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"observation"
value[x]		1..1	Reference(Observation: Medical Test Result (EU core))	Triggering observation
extension:type		1..1	Extension	R5: reflex | repeat | re-run (new) Constraints: ext-1
url		1..1	uri	"type"
value[x]		1..1	code	reflex | repeat | re-run Binding: R5ObservationTriggeredbytypeForR4 (0.1.0) (required): The type of TriggeredBy Observation.
extension:reason		0..1	Extension	R5: Reason that the observation was triggered (new) Constraints: ext-1
url		1..1	uri	"reason"
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy"
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..*	Identifier	Business Identifier for observation
status	?!Σ	1..1	code	Observation Status (HL7 v2 OBX-11) Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:labCategory		0..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
coding	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: laboratory
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
category:geCategory		0..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
coding	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0074
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: GE
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
code	Σ	1..1	CodeableConcept	Indicates archetype/FHIR Profile Binding: Medical Test Result Code (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 69548-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	Σ	1..1	Reference(Patient)	Who and/or what the observation is about
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
encounter	SΣ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	OΣ	1..1		Clinically relevant time/time-period for observation (HL7 v2 OBX-14) Obligations Actor Source SHOULD:populate-if-known Order Filler from Observation SHOULD:populate-if-known Order Placer from Observation SHOULD:populate-if-known Automation Manager from Observation
effectiveDateTime			dateTime
effectivePeriod			Period
Slices for value[x]	ΣC	0..1		Actual result (HL7 v2 OBX-5) Slice: Unordered, Closed by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual result
value[x]:valueDateTime	SΣC	0..1	dateTime	Actual result
value[x]:valueString	SΣC	0..1	string	Actual result
referenceRange	SC	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
derivedFrom	Σ	0..*	Reference(Observation: Medical Test Result (EU core) | ImagingStudy)	Related measurements the observation is made from Slice: Unordered, Open by profile:resolve()
Slices for component	Σ	1..*	BackboneElement	Component results Slice: Unordered, Open by value:code
component:All Slices				Content/Rules for all slices
Slices for extension				Content/Rules for all slices
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Medical Test Result Code (example)
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
component:conclusion-string	Σ	0..1	BackboneElement	Clinical Conclusion
Slices for extension				Content/Rules for all slices
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	conclusion-string Binding: Medical Test Result Code (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: conclusion-string
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Slices for value[x]				Content/Rules for all slices
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
component:gene-studied	Σ	0..*	BackboneElement	Gene Studied
Slices for extension				Content/Rules for all slices
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	48018-6 Binding: Medical Test Result Code (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 48018-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Slices for value[x]				Content/Rules for all slices
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
component:representative-transcript-ref-seq	Σ	0..*	BackboneElement	Reference Transcript
Slices for extension				Content/Rules for all slices
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	51958-7 Binding: Medical Test Result Code (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 51958-7
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Slices for value[x]				Content/Rules for all slices
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
Documentation for this format

Name	Order Filler	Order Placer	Automation Manager
Observation
Slices for extension
Slices for category
effective[x]	SHOULD:populate-if-known	SHOULD:populate-if-known	SHOULD:populate-if-known
Slices for value[x]
Slices for component
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.extension:triggeredBy.​extension:type.value[x]	Base	required	Cross-version ValueSet R5.TriggeredBytype for use in FHIR R4	📍0.1.0	Extensions for Using Data Elements from FHIR R5 in FHIR R4 v0.1
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.category:labCategory	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.category:geCategory	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.component.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component:conclusion-string.​code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.component:conclusion-string.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component:gene-studied.​code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.component:gene-studied.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component:representative-transcript-ref-seq.​code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.component:representative-transcript-ref-seq.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	Observation.extension:bodyStructure, Observation.extension:triggeredBy, Observation.extension:triggeredBy.extension, Observation.extension:triggeredBy.extension:observation, Observation.extension:triggeredBy.extension:type, Observation.extension:triggeredBy.extension:reason, Observation.extension:value-r5, Observation.modifierExtension, Observation.value[x]:valueQuantity.extension:uncertainty, Observation.referenceRange.modifierExtension, Observation.component.extension:value-r5, Observation.component.modifierExtension, Observation.component.value[x]:valueQuantity.extension:uncertainty, Observation.component:conclusion-string.extension:value-r5, Observation.component:conclusion-string.modifierExtension, Observation.component:conclusion-string.value[x]:valueQuantity.extension:uncertainty, Observation.component:gene-studied.extension:value-r5, Observation.component:gene-studied.modifierExtension, Observation.component:gene-studied.value[x]:valueQuantity.extension:uncertainty, Observation.component:representative-transcript-ref-seq.extension:value-r5, Observation.component:representative-transcript-ref-seq.modifierExtension, Observation.component:representative-transcript-ref-seq.value[x]:valueQuantity.extension:uncertainty	Must have either extensions or value[x], not both	extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text	low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
obs-value-1	error	Observation	The elements Observation.extension:value-r5 and Observation.value[x] SHALL not be used simultaneously.	value.empty() or extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value').empty()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	GenomicObservation	Measurements and simple assertions
code		1..1	CodeableConcept	Indicates archetype/FHIR Profile Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 69548-6
Slices for component				Content/Rules for all slices
component:gene-studied		0..*	BackboneElement	Gene Studied
code		1..1	CodeableConcept	48018-6 Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 48018-6
component:representative-transcript-ref-seq		0..*	BackboneElement	Reference Transcript
code		1..1	CodeableConcept	51958-7 Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 51958-7
Documentation for this format

Name
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	GenomicObservation	Measurements and simple assertions Constraints: obs-6, obs-7, obs-value-1
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the observation Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:bodyStructure		0..1	Reference(BodyStructure)	R5: Observed body structure (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.bodyStructure Constraints: ext-1
extension:triggeredBy		0..*	(Complex)	R5: Triggering observation(s) (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
Slices for extension				Content/Rules for all slices
extension:observation		1..1	Extension	Extension Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"observation"
value[x]		1..1	Reference(Observation: Medical Test Result (EU core))	Triggering observation
extension:type		1..1	Extension	R5: reflex | repeat | re-run (new) Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"type"
value[x]		1..1	code	reflex | repeat | re-run Binding: R5ObservationTriggeredbytypeForR4 (0.1.0) (required): The type of TriggeredBy Observation.
extension:reason		0..1	Extension	R5: Reason that the observation was triggered (new) Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"reason"
value[x]		0..1	string	Reason that the observation was triggered
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy"
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
value[x]		0..1	Attachment	Actual result
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!Σ	1..1	code	Observation Status (HL7 v2 OBX-11) Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:labCategory		0..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: laboratory
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
category:geCategory		0..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0074
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: GE
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	Σ	1..1	CodeableConcept	Indicates archetype/FHIR Profile Binding: Medical Test Result Code (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 69548-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	Σ	1..1	Reference(Patient)	Who and/or what the observation is about
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	NHSIdentifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
focus	Σ	0..*	Reference(Patient (EU core) | RelatedPerson | Group | Device | Location (EU core))	What the observation is about, when it is not about the subject of record
encounter	SΣ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	OΣ	0..1	CorrelationIdentifier	Logical reference, when literal reference is not known Obligations Actor Source SHALL:populate-if-known Order Filler from Observation SHALL:populate-if-known Order Placer from Observation SHALL:populate-if-known Automation Manager from Observation
display	Σ	0..1	string	Text alternative for the resource
effective[x]	OΣ	1..1		Clinically relevant time/time-period for observation (HL7 v2 OBX-14) Obligations Actor Source SHOULD:populate-if-known Order Filler from Observation SHOULD:populate-if-known Order Placer from Observation SHOULD:populate-if-known Automation Manager from Observation
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference(PractitionerRole)	Who is responsible for the observation
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:performerFunction		0..1	CodeableConcept	Type of performance URL: http://hl7.org/fhir/StructureDefinition/event-performerFunction Binding: Performer Function Codes (extensible)
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Slices for value[x]	ΣC	0..1		Actual result (HL7 v2 OBX-5) Slice: Unordered, Closed by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual result
value[x]:valueDateTime	SΣC	0..1	dateTime	Actual result
value[x]:valueString	SΣC	0..1	string	Actual result
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen		0..1	Reference(Specimen)	Specimen used for the observation
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	SC	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity(4.0.1)	Low Range, if relevant
high	C	0..1	SimpleQuantity(4.0.1)	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation: Medical Test Result (EU core))	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(Observation: Medical Test Result (EU core) | ImagingStudy)	Related measurements the observation is made from Slice: Unordered, Open by profile:resolve()
Slices for component	Σ	1..*	BackboneElement	Component results Slice: Unordered, Open by value:code
component:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
value[x]		0..1	Attachment	Actual result
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Medical Test Result Code (example)
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
component:conclusion-string	Σ	0..1	BackboneElement	Clinical Conclusion
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
value[x]		0..1	Attachment	Actual result
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	conclusion-string Binding: Medical Test Result Code (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: conclusion-string
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Slices for value[x]				Content/Rules for all slices
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
component:gene-studied	Σ	0..*	BackboneElement	Gene Studied
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
value[x]		0..1	Attachment	Actual result
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	48018-6 Binding: Medical Test Result Code (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 48018-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Slices for value[x]				Content/Rules for all slices
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
component:representative-transcript-ref-seq	Σ	0..*	BackboneElement	Reference Transcript
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:value-r5		0..1	(Complex)	only for Diagrams or Pictures URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value"
value[x]		0..1	Attachment	Actual result
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	51958-7 Binding: Medical Test Result Code (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 51958-7
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Slices for value[x]				Content/Rules for all slices
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:uncertainty		0..1	decimal	Standard Deviation (same units as the quantity) URL: http://hl7.org/fhir/StructureDefinition/iso21090-uncertainty
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Name	Order Filler	Order Placer	Automation Manager
Observation
Slices for extension
Slices for category
encounter
identifier	SHALL:populate-if-known	SHALL:populate-if-known	SHALL:populate-if-known
effective[x]	SHOULD:populate-if-known	SHOULD:populate-if-known	SHOULD:populate-if-known
Slices for value[x]
Slices for component
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Observation.extension:triggeredBy.​extension:type.value[x]	Base	required	Cross-version ValueSet R5.TriggeredBytype for use in FHIR R4	📍0.1.0	Extensions for Using Data Elements from FHIR R5 in FHIR R4 v0.1
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.category:labCategory	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.category:geCategory	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.subject.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Observation.encounter.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Observation.performer.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Observation.value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Observation.method	Base	example	Observation Methods	📍4.0.1	FHIR Std.
Observation.referenceRange.​type	Base	preferred	Observation Reference Range Meaning Codes	📍4.0.1	FHIR Std.
Observation.referenceRange.​appliesTo	Base	example	Observation Reference Range Applies To Codes	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.component.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.component:conclusion-string.​code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.component:conclusion-string.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component:conclusion-string.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component:conclusion-string.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.component:gene-studied.​code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.component:gene-studied.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component:gene-studied.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component:gene-studied.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.component:representative-transcript-ref-seq.​code	Base	example	Medical Test Result Code	📦2.0.0	HL7 Europe Base and Core FHIR IG v2.0
Observation.component:representative-transcript-ref-seq.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component:representative-transcript-ref-seq.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component:representative-transcript-ref-seq.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text	low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
obs-value-1	error	Observation	The elements Observation.extension:value-r5 and Observation.value[x] SHALL not be used simultaneously.	value.empty() or extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value').empty()