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StructureDefinition: HeadCircum - XML

Orders and Observations Work Group Maturity Level: 1Trial UseUse Context: Any

HeadCircum

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="headcircum"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">to do</div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueString value="Trial Use"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-summary">
    <valueMarkdown value="#### Complete Summary of the Mandatory Requirements

1.  One code in `Observation.code` which must have
    -   a fixed `Observation.code.coding.system`=**'http ://loinc.org'**
    -   a fixed  `Observation.code.coding.code`= **'9843-4'**
    -   Other additional Codings are allowed in `Observation.code`- e.g. more specific
     LOINC
        Codes, SNOMED CT concepts, system specific codes. All codes
        SHALL have an system value
1. Either one Observation.valueQuantity or, if there is no value, one code in Observation.DataAbsent
    Reason
   - Each Observation.valueQuantity must have:
     - One numeric value in Observation.valueQuantity.value
     - a fixed Observation.valueQuantity.system=&quot;http://unitsofmeasure.org&quot;
     - a UCUM unit code in Observation.valueQuantity.code = **'cm', or '[in_i]'**"/> 
  </extension> 
  <url value="http://hl7.org/fhir/StructureDefinition/headcircum"/> 
  <name value="Vital Signs Profile"/> 
  <title value="VitalSigns"/> 
  <status value="draft"/> 
  <experimental value="false"/> 
  <date value="2016-03-25"/> 
  <publisher value="Health Level Seven International (Orders and Observations Workgroup)"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://www.hl7.org/Special/committees/orders/index.cfm Orders and Observations"/> 
    </telecom> 
  </contact> 
  <description value="FHIR Head Circumference Profile"/> 
  <fhirVersion value="3.4.0"/> 
  <mapping> 
    <identity value="workflow"/> 
    <uri value="http://hl7.org/fhir/workflow"/> 
    <name value="Workflow Pattern"/> 
  </mapping> 
  <mapping> 
    <identity value="sct-concept"/> 
    <uri value="http://snomed.info/conceptdomain"/> 
    <name value="SNOMED CT Concept Domain Binding"/> 
  </mapping> 
  <mapping> 
    <identity value="v2"/> 
    <uri value="http://hl7.org/v2"/> 
    <name value="HL7 v2 Mapping"/> 
  </mapping> 
  <mapping> 
    <identity value="rim"/> 
    <uri value="http://hl7.org/v3"/> 
    <name value="RIM Mapping"/> 
  </mapping> 
  <mapping> 
    <identity value="w5"/> 
    <uri value="http://hl7.org/fhir/fivews"/> 
    <name value="FiveWs Pattern"/> 
  </mapping> 
  <mapping> 
    <identity value="sct-attr"/> 
    <uri value="http://snomed.info/sct"/> 
    <name value="SNOMED CT Attribute Binding"/> 
  </mapping> 
  <kind value="resource"/> 
  <abstract value="false"/> 
  <type value="Observation"/> 
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/vitalsigns"/> 
  <derivation value="constraint"/> 
  <snapshot> 
    <element id="Observation">
      <path value="Observation"/> 
      <short value="FHIR Head Circumference Profile"/> 
      <definition value="This profile defines  how to represent Head Circumference observations in FHIR using a
       standard LOINC code and UCUM units of measure."/> 
      <comment value="Used for simple observations such as device measurements, laboratory atomic results, vital
       signs, height, weight, smoking status, comments, etc.  Other resources are used to provide
       context for observations such as laboratory reports, etc."/> 
      <alias value="Vital Signs"/> 
      <alias value="Measurement"/> 
      <alias value="Results"/> 
      <alias value="Tests"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <constraint> 
        <key value="dom-2"/> 
        <severity value="error"/> 
        <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/> 
        <expression value="contained.contained.empty()"/> 
        <xpath value="not(parent::f:contained and f:contained)"/> 
        <source value="DomainResource"/> 
      </constraint> 
      <constraint> 
        <key value="dom-4"/> 
        <severity value="error"/> 
        <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or
         a meta.lastUpdated"/> 
        <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/> 
        <xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/> 
        <source value="DomainResource"/> 
      </constraint> 
      <constraint> 
        <key value="dom-3"/> 
        <severity value="error"/> 
        <human value="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"/> 
        <expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonica
        l) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(refer
        ence = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(c
        anonical) = '#').exists()).not()).trace('unmatched', id).empty()"/> 
        <xpath value="not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@va
        lue=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))"/> 
        <source value="DomainResource"/> 
      </constraint> 
      <constraint> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
          <valueBoolean value="true"/> 
        </extension> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
          <valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display
           the resource to a human safely. Including a guman readable representation in the resource
           makes for a much more robust eco-system and cheaper handling of resources by intermediary
           systems. Some ecosystems restrict distribution of resources to only those systems that
           do fully understand the resources, and as a consequence implementers may believe that
           the narrative is superfluous. However experience shows that such eco-systems often open
           up to new participants over time."/> 
        </extension> 
        <key value="dom-6"/> 
        <severity value="warning"/> 
        <human value="A resource should have narrative for robust management"/> 
        <expression value="text.div.exists()"/> 
        <xpath value="exists(f:text/h:div)"/> 
        <source value="DomainResource"/> 
      </constraint> 
      <constraint> 
        <key value="dom-5"/> 
        <severity value="error"/> 
        <human value="If a resource is contained in another resource, it SHALL NOT have a security label"/> 
        <expression value="contained.meta.security.empty()"/> 
        <xpath value="not(exists(f:contained/*/f:meta/f:security))"/> 
        <source value="DomainResource"/> 
      </constraint> 
      <constraint> 
        <key value="obs-7"/> 
        <severity value="error"/> 
        <human value="If Observation.code is the same as a Observation.component.code then the value element
         associated with the code SHALL NOT be present"/> 
        <expression value="value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and
         (coding.system = %resource.code.coding.system)).empty()"/> 
        <xpath value="not(f:*[starts-with(local-name(.), 'value')] and (for $coding in f:code/f:coding return
         f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value] [f:system/@value=$coding/f:system/@
        value]))"/> 
        <source value="Observation"/> 
      </constraint> 
      <constraint> 
        <key value="obs-6"/> 
        <severity value="error"/> 
        <human value="dataAbsentReason SHALL only be present if Observation.value[x] is not present"/> 
        <expression value="dataAbsentReason.empty() or value.empty()"/> 
        <xpath value="not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))"/> 
        <source value="Observation"/> 
      </constraint> 
      <constraint> 
        <key value="vs-2"/> 
        <severity value="error"/> 
        <human value="If there is no component or hasMember element then either a value[x] or a data absent
         reason must be present."/> 
        <expression value="(component.empty() and hasMember.empty()) implies (dataAbsentReason or value)"/> 
        <xpath value="f:component or f:memberOF or f:*[starts-with(local-name(.), 'value')] or f:dataAbsentReason"/> 
        <source value="Observation"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="Entity. Role, or Act"/> 
      </mapping> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 363787002 |Observable entity|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="Observation[classCode=OBS, moodCode=EVN]"/> 
      </mapping> 
    </element> 
    <element id="Observation.id">
      <path value="Observation.id"/> 
      <short value="Logical id of this artifact"/> 
      <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this
       value never changes."/> 
      <comment value="The only time that a resource does not have an id is when it is being submitted to the
       server using a create operation."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Resource.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="id"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Observation.meta">
      <path value="Observation.meta"/> 
      <short value="Metadata about the resource"/> 
      <definition value="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."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Resource.meta"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Meta"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Observation.implicitRules">
      <path value="Observation.implicitRules"/> 
      <short value="A set of rules under which this content was created"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Resource.implicitRules"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="uri"/> 
      </type> 
      <isModifier value="true"/> 
      <isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional
       knowledge about the resource that modifies it's meaning or interpretation"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Observation.language">
      <path value="Observation.language"/> 
      <short value="Language of the resource content"/> 
      <definition value="The base language in which the resource is written."/> 
      <comment value="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)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Resource.language"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
          <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/> 
        </extension> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Language"/> 
        </extension> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true"/> 
        </extension> 
        <strength value="extensible"/> 
        <description value="A human language."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/languages"/> 
      </binding> 
    </element> 
    <element id="Observation.text">
      <path value="Observation.text"/> 
      <short value="Text summary of the resource, for human interpretation"/> 
      <definition value="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 &quot;clinically
       safe&quot; for a human to just read the narrative. Resource definitions may define what
       content should be represented in the narrative to ensure clinical safety."/> 
      <comment value="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 &quot;text blob&quot;
       or where text is additionally entered raw or narrated and encoded information is added
       later."/> 
      <alias value="narrative"/> 
      <alias value="html"/> 
      <alias value="xhtml"/> 
      <alias value="display"/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="DomainResource.text"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Narrative"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="Act.text?"/> 
      </mapping> 
    </element> 
    <element id="Observation.contained">
      <path value="Observation.contained"/> 
      <short value="Contained, inline Resources"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="inline resources"/> 
      <alias value="anonymous resources"/> 
      <alias value="contained resources"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="DomainResource.contained"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Resource"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Observation.extension">
      <path value="Observation.extension"/> 
      <short value="Additional Content defined by implementations"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="DomainResource.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Observation.modifierExtension">
      <path value="Observation.modifierExtension"/> 
      <short value="Extensions that cannot be ignored"/> 
      <definition value="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.
       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)."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="DomainResource.modifierExtension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="true"/> 
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource
       that contains them"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Observation.identifier">
      <path value="Observation.identifier"/> 
      <short value="Business Identifier for observation"/> 
      <definition value="A unique identifier assigned to this observation."/> 
      <requirements value="Allows observations to be distinguished and referenced."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.identifier"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Identifier"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.identifier"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.identifier"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX.21  For OBX segments from systems without OBX-21 support a combination of ORC/OBR
         and OBX must be negotiated between trading partners to uniquely identify the OBX segment.
         Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3
         + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC
         + OBX-3 + OBX-4."/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="id"/> 
      </mapping> 
    </element> 
    <element id="Observation.basedOn">
      <path value="Observation.basedOn"/> 
      <short value="Fulfills plan, proposal or order"/> 
      <definition value="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."/> 
      <requirements value="Allows tracing of authorization for the event and tracking whether proposals/recommendations
       were acted upon."/> 
      <alias value="Fulfills"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.basedOn"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceRequest"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/NutritionOrder"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.basedOn"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="ORC"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".inboundRelationship[typeCode=COMP].source[moodCode=EVN]"/> 
      </mapping> 
    </element> 
    <element id="Observation.partOf">
      <path value="Observation.partOf"/> 
      <short value="Part of referenced event"/> 
      <definition value="A larger event of which this particular Observation is a component or step.  For example,
        an observation as part of a procedure."/> 
      <comment value="To link an Observation to an Encounter use `context`.  See the  [Notes](observation.html#obsgrouping
      ) below for guidance on referencing another Observation."/> 
      <alias value="Container"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.partOf"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationDispense"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationStatement"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Procedure"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Immunization"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ImagingStudy"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.partOf"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="Varies by domain"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=FLFS].target"/> 
      </mapping> 
    </element> 
    <element id="Observation.status">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
        <valueString value="default: final"/> 
      </extension> 
      <path value="Observation.status"/> 
      <short value="registered | preliminary | final | amended +"/> 
      <definition value="The status of the result value."/> 
      <comment value="This element is labeled as a modifier because the status contains codes that mark the
       resource as not currently valid."/> 
      <requirements value="Need to track the status of individual results. Some results are finalized before the
       whole report is finalized."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.status"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="true"/> 
      <isModifierReason value="This element is labeled as a modifier because it is a status element that contains status
       entered-in-error which means that the resource should not be treated as valid"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Status"/> 
        </extension> 
        <strength value="required"/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-status"/> 
      </binding> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.status"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.status"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 445584004 |Report by finality status|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-11"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="status  Amended &amp; Final are differentiated by whether it is the subject of a ControlAct
         event with a type of &quot;revise&quot;"/> 
      </mapping> 
    </element> 
    <element id="Observation.category">
      <path value="Observation.category"/> 
      <slicing> 
        <discriminator> 
          <type value="value"/> 
          <path value="coding.code"/> 
        </discriminator> 
        <discriminator> 
          <type value="value"/> 
          <path value="coding.system"/> 
        </discriminator> 
        <ordered value="false"/> 
        <rules value="open"/> 
      </slicing> 
      <short value="Classification of  type of observation"/> 
      <definition value="A code that classifies the general type of observation being made."/> 
      <comment value="In addition to the required category valueset, this element allows various categorization
       schemes based on the owner’s definition of the category and effectively multiple categories
       can be used at once.  The level of granularity is defined by the category concepts in
       the value set."/> 
      <requirements value="Used for filtering what observations are retrieved and displayed."/> 
      <min value="1"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.category"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationCategory"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="Codes for high level observation categories."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-category"/> 
      </binding> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.class"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quo
        t;].code"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat">
      <path value="Observation.category"/> 
      <sliceName value="VSCat"/> 
      <short value="Classification of  type of observation"/> 
      <definition value="A code that classifies the general type of observation being made."/> 
      <comment value="In addition to the required category valueset, this element allows various categorization
       schemes based on the owner’s definition of the category and effectively multiple categories
       can be used at once.  The level of granularity is defined by the category concepts in
       the value set."/> 
      <requirements value="Used for filtering what observations are retrieved and displayed."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.category"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationCategory"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="Codes for high level observation categories."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-category"/> 
      </binding> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.class"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quo
        t;].code"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.id">
      <path value="Observation.category.id"/> 
      <representation value="xmlAttr"/> 
      <short value="xml:id (or equivalent in JSON)"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.extension">
      <path value="Observation.category.extension"/> 
      <slicing> 
        <discriminator> 
          <type value="value"/> 
          <path value="url"/> 
        </discriminator> 
        <description value="Extensions are always sliced by (at least) url"/> 
        <rules value="open"/> 
      </slicing> 
      <short value="Additional content defined by implementations"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.coding">
      <path value="Observation.category.coding"/> 
      <short value="Code defined by a terminology system"/> 
      <definition value="A reference to a code defined by a terminology system."/> 
      <comment value="Codes may be defined very casually in enumerations, or code lists, up to very formal definitions
       such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of
       codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one
       of the coding values will be labeled as UserSelected = true."/> 
      <requirements value="Allows for alternative encodings within a code system, and translations to other code
       systems."/> 
      <min value="1"/> 
      <max value="*"/> 
      <base> 
        <path value="CodeableConcept.coding"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Coding"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.1-8, C*E.10-22"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="union(., ./translation)"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.coding.id">
      <path value="Observation.category.coding.id"/> 
      <representation value="xmlAttr"/> 
      <short value="xml:id (or equivalent in JSON)"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.coding.extension">
      <path value="Observation.category.coding.extension"/> 
      <slicing> 
        <discriminator> 
          <type value="value"/> 
          <path value="url"/> 
        </discriminator> 
        <description value="Extensions are always sliced by (at least) url"/> 
        <rules value="open"/> 
      </slicing> 
      <short value="Additional content defined by implementations"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.coding.system">
      <path value="Observation.category.coding.system"/> 
      <short value="Identity of the terminology system"/> 
      <definition value="The identification of the code system that defines the meaning of the symbol in the code."/> 
      <comment value="The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be
       references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of
       FHIR defined special URIs or it should reference to some definition that establishes the
       system clearly and unambiguously."/> 
      <requirements value="Need to be unambiguous about the source of the definition of the symbol."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.system"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="uri"/> 
      </type> 
      <fixedUri value="http://terminology.hl7.org/CodeSystem/observation-category"/> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.3"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./codeSystem"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.coding.version">
      <path value="Observation.category.coding.version"/> 
      <short value="Version of the system - if relevant"/> 
      <definition value="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."/> 
      <comment value="Where the terminology does not clearly define what string should be used to identify code
       system versions, the recommendation is to use the date (expressed in FHIR date format)
       on which that version was officially published as the version date."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.version"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.7"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./codeSystemVersion"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.coding.code">
      <path value="Observation.category.coding.code"/> 
      <short value="Symbol in syntax defined by the system"/> 
      <definition value="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)."/> 
      <requirements value="Need to refer to a particular code in the system."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.code"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <fixedCode value="vital-signs"/> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.1"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./code"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.coding.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/> 
      </extension> 
      <path value="Observation.category.coding.display"/> 
      <short value="Representation defined by the system"/> 
      <definition value="A representation of the meaning of the code in the system, following the rules of the
       system."/> 
      <requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not
       know  the system."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.display"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.2 - but note this is not well followed"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="CV.displayName"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.coding.userSelected">
      <path value="Observation.category.coding.userSelected"/> 
      <short value="If this coding was chosen directly by the user"/> 
      <definition value="Indicates that this coding was chosen by a user directly - e.g. off a pick list of available
       items (codes or displays)."/> 
      <comment value="Amongst a set of alternatives, a directly chosen code is the most appropriate starting
       point for new translations. There is some ambiguity about what exactly 'directly chosen'
       implies, and trading partner agreement may be needed to clarify the use of this element
       and its consequences more completely."/> 
      <requirements value="This has been identified as a clinical safety criterium - that this exact system/code
       pair was chosen explicitly, rather than inferred by the system based on some rules or
       language processing."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.userSelected"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="boolean"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="Sometimes implied by being first"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="CD.codingRationale"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected
         fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target
         dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [     fhir:source &quot;true&quot;;
             fhir:target dt:CDCoding.codingRationale\#O   ]"/> 
      </mapping> 
    </element> 
    <element id="Observation.category:VSCat.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/> 
      </extension> 
      <path value="Observation.category.text"/> 
      <short value="Plain text representation of the concept"/> 
      <definition value="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."/> 
      <comment value="Very often the text is the same as a displayName of one of the codings."/> 
      <requirements value="The codes from the terminologies do not always capture the correct meaning with all the
       nuances of the human using them, or sometimes there is no appropriate code at all. In
       these cases, the text is used to capture the full meaning of the source."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="CodeableConcept.text"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.9. But note many systems use C*E.2 for this"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./originalText[mediaType/code=&quot;text/plain&quot;]/data"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"/> 
      </mapping> 
    </element> 
    <element id="Observation.code">
      <path value="Observation.code"/> 
      <short value="Head Circumference"/> 
      <definition value="Head Circumference."/> 
      <comment value="additional codes that translate or map to this code are allowed.  For example a more granular
       LOINC code or code that is used locally in a system."/> 
      <requirements value="5. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet
       HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301)."/> 
      <alias value="Name"/> 
      <alias value="Test"/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.code"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="VitalSigns"/> 
        </extension> 
        <strength value="extensible"/> 
        <description value="This identifies the vital sign result type."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-vitalsignresult"/> 
      </binding> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.code"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.what[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 363787002 |Observable entity| OR &lt; 386053000 |Evaluation procedure|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-3"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="code"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-attr"/> 
        <map value="116680003 |Is a|"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.id">
      <path value="Observation.code.id"/> 
      <representation value="xmlAttr"/> 
      <short value="xml:id (or equivalent in JSON)"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.extension">
      <path value="Observation.code.extension"/> 
      <slicing> 
        <discriminator> 
          <type value="value"/> 
          <path value="url"/> 
        </discriminator> 
        <description value="Extensions are always sliced by (at least) url"/> 
        <rules value="open"/> 
      </slicing> 
      <short value="Additional content defined by implementations"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.coding">
      <path value="Observation.code.coding"/> 
      <slicing> 
        <discriminator> 
          <type value="value"/> 
          <path value="code"/> 
        </discriminator> 
        <discriminator> 
          <type value="value"/> 
          <path value="system"/> 
        </discriminator> 
        <ordered value="false"/> 
        <rules value="open"/> 
      </slicing> 
      <short value="Code defined by a terminology system"/> 
      <definition value="A reference to a code defined by a terminology system."/> 
      <comment value="Codes may be defined very casually in enumerations, or code lists, up to very formal definitions
       such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of
       codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one
       of the coding values will be labeled as UserSelected = true."/> 
      <requirements value="Allows for alternative encodings within a code system, and translations to other code
       systems."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="CodeableConcept.coding"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Coding"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.1-8, C*E.10-22"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="union(., ./translation)"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode">
      <path value="Observation.code.coding"/> 
      <sliceName value="HeadCircumCode"/> 
      <short value="Code defined by a terminology system"/> 
      <definition value="A reference to a code defined by a terminology system."/> 
      <comment value="Codes may be defined very casually in enumerations, or code lists, up to very formal definitions
       such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of
       codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one
       of the coding values will be labeled as UserSelected = true."/> 
      <requirements value="Allows for alternative encodings within a code system, and translations to other code
       systems."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="CodeableConcept.coding"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Coding"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.1-8, C*E.10-22"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="union(., ./translation)"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode.id">
      <path value="Observation.code.coding.id"/> 
      <representation value="xmlAttr"/> 
      <short value="xml:id (or equivalent in JSON)"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode.extension">
      <path value="Observation.code.coding.extension"/> 
      <slicing> 
        <discriminator> 
          <type value="value"/> 
          <path value="url"/> 
        </discriminator> 
        <description value="Extensions are always sliced by (at least) url"/> 
        <rules value="open"/> 
      </slicing> 
      <short value="Additional content defined by implementations"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode.system">
      <path value="Observation.code.coding.system"/> 
      <short value="Identity of the terminology system"/> 
      <definition value="The identification of the code system that defines the meaning of the symbol in the code."/> 
      <comment value="The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be
       references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of
       FHIR defined special URIs or it should reference to some definition that establishes the
       system clearly and unambiguously."/> 
      <requirements value="Need to be unambiguous about the source of the definition of the symbol."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.system"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="uri"/> 
      </type> 
      <fixedUri value="http://loinc.org"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.3"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./codeSystem"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode.version">
      <path value="Observation.code.coding.version"/> 
      <short value="Version of the system - if relevant"/> 
      <definition value="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."/> 
      <comment value="Where the terminology does not clearly define what string should be used to identify code
       system versions, the recommendation is to use the date (expressed in FHIR date format)
       on which that version was officially published as the version date."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.version"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.7"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./codeSystemVersion"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode.code">
      <path value="Observation.code.coding.code"/> 
      <short value="Symbol in syntax defined by the system"/> 
      <definition value="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)."/> 
      <requirements value="Need to refer to a particular code in the system."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.code"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <fixedCode value="9843-4"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.1"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./code"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/> 
      </extension> 
      <path value="Observation.code.coding.display"/> 
      <short value="Representation defined by the system"/> 
      <definition value="A representation of the meaning of the code in the system, following the rules of the
       system."/> 
      <requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not
       know  the system."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.display"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.2 - but note this is not well followed"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="CV.displayName"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode.userSelected">
      <path value="Observation.code.coding.userSelected"/> 
      <short value="If this coding was chosen directly by the user"/> 
      <definition value="Indicates that this coding was chosen by a user directly - e.g. off a pick list of available
       items (codes or displays)."/> 
      <comment value="Amongst a set of alternatives, a directly chosen code is the most appropriate starting
       point for new translations. There is some ambiguity about what exactly 'directly chosen'
       implies, and trading partner agreement may be needed to clarify the use of this element
       and its consequences more completely."/> 
      <requirements value="This has been identified as a clinical safety criterium - that this exact system/code
       pair was chosen explicitly, rather than inferred by the system based on some rules or
       language processing."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Coding.userSelected"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="boolean"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="Sometimes implied by being first"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="CD.codingRationale"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected
         fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target
         dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [     fhir:source &quot;true&quot;;
             fhir:target dt:CDCoding.codingRationale\#O   ]"/> 
      </mapping> 
    </element> 
    <element id="Observation.code.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/> 
      </extension> 
      <path value="Observation.code.text"/> 
      <short value="Plain text representation of the concept"/> 
      <definition value="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."/> 
      <comment value="Very often the text is the same as a displayName of one of the codings."/> 
      <requirements value="The codes from the terminologies do not always capture the correct meaning with all the
       nuances of the human using them, or sometimes there is no appropriate code at all. In
       these cases, the text is used to capture the full meaning of the source."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="CodeableConcept.text"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="C*E.9. But note many systems use C*E.2 for this"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./originalText[mediaType/code=&quot;text/plain&quot;]/data"/> 
      </mapping> 
      <mapping> 
        <identity value="orim"/> 
        <map value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"/> 
      </mapping> 
    </element> 
    <element id="Observation.subject">
      <path value="Observation.subject"/> 
      <short value="Who and/or what the observation is about"/> 
      <definition value="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."/> 
      <comment value="One would expect this element to be a cardinality of 1..1. The only circumstance in which
       the subject can be missing is when the observation is made by a device that does not know
       the patient. In this case, the observation SHALL be matched to a patient through some
       context/channel matching technique, and at this point, the observation should be updated."/> 
      <requirements value="Observations have no value if you don't know who or what they're about."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.subject"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.subject"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.subject[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="PID-3"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="participation[typeCode=RTGT] "/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.subject"/> 
      </mapping> 
    </element> 
    <element id="Observation.focus">
      <path value="Observation.focus"/> 
      <short value="What the observation is about, when it is not about the subject of record"/> 
      <definition value="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."/> 
      <comment value="Typically, an observation is made about the subject - a patient, or group of patients,
       location, or device - and the distinction between the subject and what is directly measured
       for an observation is specified in the observation code itself ( e.g., &quot;Blood Glucose&quot;)
       and does not need to be represented separately using this element.  Use `specimen` if
       a reference to a specimen is required.  If a code is required instead of a resource use
       either  `bodysite` for bodysites or the standard extension [focusCode](extension-observation-focusCo
      de.html)."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.focus"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.subject[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-3"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="participation[typeCode=SBJ]"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.subject"/> 
      </mapping> 
    </element> 
    <element id="Observation.context">
      <path value="Observation.context"/> 
      <short value="Healthcare event during which this observation is made"/> 
      <definition value="The healthcare event  (e.g. a patient and healthcare provider interaction) during which
       this observation is made."/> 
      <comment value="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 or episode but still
       be tied to the context of the encounter or episode (e.g. pre-admission laboratory tests)."/> 
      <requirements value="For some observations it may be important to know the link between an observation and
       a particular encounter."/> 
      <alias value="Encounter"/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.context"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.context"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.context"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="PV1"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"/> 
      </mapping> 
    </element> 
    <element id="Observation.effective[x]">
      <path value="Observation.effective[x]"/> 
      <short value="Often just a dateTime for Vital Signs"/> 
      <definition value="Often just a dateTime for Vital Signs."/> 
      <comment value="At least a date should be present unless this observation is a historical report.  For
       recording imprecise or &quot;fuzzy&quot; times (For example, a blood glucose measurement
       taken &quot;after breakfast&quot;) use the [Timing](datatypes.html#timing) datatype which
       allow the measurement to be tied to regular life events."/> 
      <requirements value="Knowing when an observation was deemed true is important to its relevance as well as determining
       trends."/> 
      <alias value="Occurrence"/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.effective[x]"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="dateTime"/> 
      </type> 
      <type> 
        <code value="Period"/> 
      </type> 
      <constraint> 
        <key value="vs-1"/> 
        <severity value="error"/> 
        <human value="Datetime must be at least to day."/> 
        <expression value="($this as dateTime).toString().length() &gt;= 8"/> 
        <xpath value="f:matches(effectiveDateTime,/\d{4}-[01]\d-[0-3]\dT[0-2]\d:[0-5]\d([+-][0-2]\d:[0-5]\d|Z)/)"/> 
      </constraint> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.occurrence[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.done[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-14, and/or OBX-19 after v2.4  (depends on who observation made)"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="effectiveTime"/> 
      </mapping> 
    </element> 
    <element id="Observation.issued">
      <path value="Observation.issued"/> 
      <short value="Date/Time this version was made available"/> 
      <definition value="The date and time this version of the observation was made available to providers, typically
       after the results have been reviewed and verified."/> 
      <comment value="For Observations that don’t require review and verification, it may be the same as the
       [`lastUpdated` ](resource-definitions.html#Meta.lastUpdated) time of the resource itself.
        For Observations that do require review and verification for certain updates, it might
       not be the same as the `lastUpdated` time of the resource itself due to a non-clinically
       significant update that doesn’t require the new version to be reviewed and verified again."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.issued"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="instant"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.recorded"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="participation[typeCode=AUT].time"/> 
      </mapping> 
    </element> 
    <element id="Observation.performer">
      <path value="Observation.performer"/> 
      <short value="Who is responsible for the observation"/> 
      <definition value="Who was responsible for asserting the observed value as &quot;true&quot;."/> 
      <requirements value="May give a degree of confidence in the observation and also indicates where follow-up
       questions should be directed."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.performer"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/CareTeam"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.performer.actor"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.actor"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX.15 / (Practitioner)  OBX-16,  PRT-5:PRT-4='RO' /  (Device)  OBX-18 , PRT-10:PRT-4='EQUIP'
         / (Organization)  OBX-23,  PRT-8:PRT-4='PO'"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="participation[typeCode=PRF]"/> 
      </mapping> 
    </element> 
    <element id="Observation.value[x]">
      <path value="Observation.value[x]"/> 
      <short value="Vital Signs value are recorded using the Quantity data type. For supporting observations
       such as Cuff size could use other datatypes such as CodeableConcept."/> 
      <definition value="Vital Signs value are recorded using the Quantity data type. For supporting observations
       such as Cuff size could use other datatypes such as CodeableConcept."/> 
      <comment value="An observation may have; 1)  a single value here, 2)  both a value and a set of related
       or component values,  or 3)  only a set of related or component values. If a value is
       present, the datatype for this element should be determined by Observation.code.  A CodeableConcept
       with just a text would be used instead of a string if the field was usually coded, or
       if the type associated with the Observation.code defines a coded value.  For additional
       guidance, see the [Notes section](observation.html#notes) below."/> 
      <requirements value="9. SHALL contain exactly one [1..1] value with @xsi:type=&quot;PQ&quot; (CONF:7305)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.value[x]"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Quantity"/> 
      </type> 
      <condition value="obs-7"/> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 441742003 |Evaluation finding|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX.2, OBX.5, OBX.6"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="value"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-attr"/> 
        <map value="363714003 |Interprets|"/> 
      </mapping> 
    </element> 
    <element id="Observation.value[x].id">
      <path value="Observation.value[x].id"/> 
      <representation value="xmlAttr"/> 
      <short value="xml:id (or equivalent in JSON)"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.value[x].extension">
      <path value="Observation.value[x].extension"/> 
      <slicing> 
        <discriminator> 
          <type value="value"/> 
          <path value="url"/> 
        </discriminator> 
        <description value="Extensions are always sliced by (at least) url"/> 
        <rules value="open"/> 
      </slicing> 
      <short value="Additional content defined by implementations"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.value[x].value">
      <path value="Observation.value[x].value"/> 
      <short value="Numerical value (with implicit precision)"/> 
      <definition value="The value of the measured amount. The value includes an implicit precision in the presentation
       of the value."/> 
      <comment value="The implicit precision in the value should always be honored. Monetary values have their
       own rules for handling precision (refer to standard accounting text books)."/> 
      <requirements value="Precision is handled implicitly in almost all cases of measurement."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Quantity.value"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="decimal"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="SN.2  / CQ - N/A"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value"/> 
      </mapping> 
    </element> 
    <element id="Observation.value[x].comparator">
      <path value="Observation.value[x].comparator"/> 
      <short value="&lt; | &lt;= | &gt;= | &gt; - how to understand the value"/> 
      <definition value="How the value should be understood and represented - whether the actual value is greater
       or less than the stated value due to measurement issues; e.g. if the comparator is &quot;&lt;&quot;
       , then the real value is &lt; stated value."/> 
      <requirements value="Need a framework for handling measures where the value is &lt;5ug/L or &gt;400mg/L due
       to the limitations of measuring methodology."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Quantity.comparator"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <meaningWhenMissing value="If there is no comparator, then there is no modification of the value"/> 
      <isModifier value="true"/> 
      <isModifierReason value="This is labeled as &quot;Is Modifier&quot; because the comparator modifies the interpretation
       of the value significantly. If there is no comparator, then there is no modification of
       the value"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="QuantityComparator"/> 
        </extension> 
        <strength value="required"/> 
        <description value="How the Quantity should be understood and represented."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/quantity-comparator"/> 
      </binding> 
      <mapping> 
        <identity value="v2"/> 
        <map value="SN.1  / CQ.1"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="IVL properties"/> 
      </mapping> 
    </element> 
    <element id="Observation.value[x].unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/> 
      </extension> 
      <path value="Observation.value[x].unit"/> 
      <short value="Unit representation"/> 
      <definition value="A human-readable form of the unit."/> 
      <requirements value="There are many representations for units of measure and in many contexts, particular representations
       are fixed and required. I.e. mcg for micrograms."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Quantity.unit"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="(see OBX.6 etc.) / CQ.2"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="PQ.unit"/> 
      </mapping> 
    </element> 
    <element id="Observation.value[x].system">
      <path value="Observation.value[x].system"/> 
      <short value="System that defines coded unit form"/> 
      <definition value="The identification of the system that provides the coded form of the unit."/> 
      <requirements value="Need to know the system that defines the coded form of the unit."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Quantity.system"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="uri"/> 
      </type> 
      <fixedUri value="http://unitsofmeasure.org"/> 
      <condition value="qty-3"/> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="(see OBX.6 etc.) / CQ.2"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="CO.codeSystem, PQ.translation.codeSystem"/> 
      </mapping> 
    </element> 
    <element id="Observation.value[x].code">
      <path value="Observation.value[x].code"/> 
      <short value="Coded responses from the common UCUM units for vital signs value set."/> 
      <definition value="Coded responses from the common UCUM units for vital signs value set."/> 
      <comment value="The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or
       ISO 4217 for currency.  The context of use may additionally require a code from a particular
       system."/> 
      <requirements value="Need a computable form of the unit that is fixed across all forms. UCUM provides this
       for quantities, but SNOMED CT provides many units of interest."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Quantity.code"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="BodyLengthUnits"/> 
        </extension> 
        <strength value="required"/> 
        <description value="Common UCUM units for body length measures such as Body Height and Head Circumference."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/ucum-bodylength"/> 
      </binding> 
      <mapping> 
        <identity value="v2"/> 
        <map value="(see OBX.6 etc.) / CQ.2"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="PQ.code, MO.currency, PQ.translation.code"/> 
      </mapping> 
    </element> 
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason"/> 
      <short value="Why the result is missing"/> 
      <definition value="Provides a reason why the expected value in the element Observation.value[x] is missing."/> 
      <comment value="Null or exceptional values can be represented two ways in FHIR Observations.  One way
       is to simply include them in the value set and represent the exceptions in the value.
        For example, measurement values for a serology test could be  &quot;detected&quot;, &quot;not
       detected&quot;, &quot;inconclusive&quot;, or  &quot;specimen unsatisfactory&quot;.   

The alternate way is to use the value element for actual observations and use the explicit
       dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason
       code &quot;error&quot; could be used when the measurement was not completed. Note that
       an observation may only be reported if there are values to report. For example differential
       cell counts values may be reported only when &gt; 0.  Because of these options, use-case
       agreements are required to interpret general observations for null or exceptional values."/> 
      <requirements value="For many results it is necessary to handle exceptional values in measurements."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.dataAbsentReason"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <condition value="obs-6"/> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationValueAbsentReason"/> 
        </extension> 
        <strength value="extensible"/> 
        <description value="Codes specifying why the result (`Observation.value[x]`) is missing."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/> 
      </binding> 
      <mapping> 
        <identity value="v2"/> 
        <map value="N/A"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="value.nullFlavor"/> 
      </mapping> 
    </element> 
    <element id="Observation.interpretation">
      <path value="Observation.interpretation"/> 
      <short value="High, low, normal, etc."/> 
      <definition value="A categorical assessment of an observation value.  For example, high, low, normal."/> 
      <comment value="Historically used for laboratory results (known as 'abnormal flag' ),  its use extends
       to other use cases where coded interpretations  are relevant.  Often reported as one or
       more simple compact codes often placed adjacent to the result value in reports and flow
       sheets to signal the meaning/normalcy status of the result."/> 
      <requirements value="For some results, particularly numeric results, an interpretation is necessary to fully
       understand the significance of a result."/> 
      <alias value="Abnormal Flag"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.interpretation"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationInterpretation"/> 
        </extension> 
        <strength value="extensible"/> 
        <description value="Codes identifying interpretations of observations."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation"/> 
      </binding> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 260245000 |Findings values|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-8"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="interpretationCode"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-attr"/> 
        <map value="363713009 |Has interpretation|"/> 
      </mapping> 
    </element> 
    <element id="Observation.comment">
      <path value="Observation.comment"/> 
      <short value="Comments about the test result value"/> 
      <definition value="Comments about the test result value may include statements about significant, unexpected
       or unreliable results values, or information about the its source when this is relevant
       to its interpretation."/> 
      <requirements value="Need to be able to provide free text additional information."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.comment"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="subjectOf.observationEvent[code=&quot;annotation&quot;].value"/> 
      </mapping> 
    </element> 
    <element id="Observation.bodySite">
      <path value="Observation.bodySite"/> 
      <short value="Observed body part"/> 
      <definition value="Indicates the site on the subject's body where the observation was made (i.e. the target
       site)."/> 
      <comment value="Only used if not implicit in code found in Observation.code.  In many systems, this may
       be represented as a related observation instead of an inline component.   

If the use case requires BodySite to be handled as a separate resource (e.g. to identify
       and track separately) then use the standard extension[ bodyStructure](extension-bodystructure.html)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.bodySite"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="BodySite"/> 
        </extension> 
        <strength value="example"/> 
        <description value="Codes describing anatomical locations. May include laterality."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/body-site"/> 
      </binding> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 123037004 |Body structure|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-20"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="targetSiteCode"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-attr"/> 
        <map value="718497002 |Inherent location|"/> 
      </mapping> 
    </element> 
    <element id="Observation.method">
      <path value="Observation.method"/> 
      <short value="How it was done"/> 
      <definition value="Indicates the mechanism used to perform the observation."/> 
      <comment value="Only used if not implicit in code for Observation.code."/> 
      <requirements value="In some cases, method can impact results and is thus used for determining whether results
       can be compared or determining significance of results."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.method"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationMethod"/> 
        </extension> 
        <strength value="example"/> 
        <description value="Methods for simple observations."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-methods"/> 
      </binding> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-17"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="methodCode"/> 
      </mapping> 
    </element> 
    <element id="Observation.specimen">
      <path value="Observation.specimen"/> 
      <short value="Specimen used for this observation"/> 
      <definition value="The specimen that was used when this observation was made."/> 
      <comment value="Should only be used if not implicit in code found in `Observation.code`.  Observations
       are not made on specimens themselves; they are made on a subject, but in many cases by
       the means of a specimen. Note that although specimens are often involved, they are not
       always tracked and reported explicitly. Also note that observation resources may be used
       in contexts that track the specimen explicitly (e.g. Diagnostic Report)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.specimen"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 123038009 |Specimen|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="SPM segment"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="participation[typeCode=SPC].specimen"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-attr"/> 
        <map value="704319004 |Inherent in|"/> 
      </mapping> 
    </element> 
    <element id="Observation.device">
      <path value="Observation.device"/> 
      <short value="(Measurement) Device"/> 
      <definition value="The device used to generate the observation data."/> 
      <comment value="An extension should be used if further typing of the device is needed.  Devices used to
       support obtaining an observation can be represented using an extension or the [Provenance](provenanc
      e.html) resource. (e.g., a device gateway such as a smart phone)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.device"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceComponent"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceMetric"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 49062001 |Device|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-17 / PRT -10"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="participation[typeCode=DEV]"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-attr"/> 
        <map value="424226004 |Using device|"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange">
      <path value="Observation.referenceRange"/> 
      <short value="Provides guide for interpretation"/> 
      <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range."/> 
      <comment value="Most observations only have one generic reference range. Systems MAY choose to restrict
       to only supplying the relevant reference range based on knowledge about the patient (e.g.,
       specific to the patient's age, gender, weight and other factors), but this might not be
       possible or appropriate. Whenever more than one reference range is supplied, the differences
       between them SHOULD be provided in the reference range and/or age properties."/> 
      <requirements value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance
       of a particular result. Need to be able to provide multiple reference ranges for different
       contexts."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.referenceRange"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="BackboneElement"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <constraint> 
        <key value="obs-3"/> 
        <severity value="error"/> 
        <human value="Must have at least a low or a high or text"/> 
        <expression value="low.exists() or high.exists() or text.exists()"/> 
        <xpath value="(exists(f:low) or exists(f:high)or exists(f:text))"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX.7"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange.id">
      <path value="Observation.referenceRange.id"/> 
      <representation value="xmlAttr"/> 
      <short value="xml:id (or equivalent in JSON)"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange.extension">
      <path value="Observation.referenceRange.extension"/> 
      <short value="Additional content defined by implementations"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange.modifierExtension">
      <path value="Observation.referenceRange.modifierExtension"/> 
      <short value="Extensions that cannot be ignored if unrecognized"/> 
      <definition value="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.
       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)."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <alias value="modifiers"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="BackboneElement.modifierExtension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="true"/> 
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element
       that contains them"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange.low">
      <path value="Observation.referenceRange.low"/> 
      <short value="Low Range, if relevant"/> 
      <definition value="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 &gt;=5 - &lt;=9). If the
       low bound is omitted,  it is assumed to be meaningless (e.g. reference range is &lt;=2.3)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.referenceRange.low"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Quantity"/> 
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> 
      </type> 
      <condition value="obs-3"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-7"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="value:IVL_PQ.low"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange.high">
      <path value="Observation.referenceRange.high"/> 
      <short value="High Range, if relevant"/> 
      <definition value="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 &gt;=5 - &lt;=9). If the
       high bound is omitted,  it is assumed to be meaningless (e.g. reference range is &gt;=
       2.3)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.referenceRange.high"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Quantity"/> 
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> 
      </type> 
      <condition value="obs-3"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-7"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="value:IVL_PQ.high"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange.type">
      <path value="Observation.referenceRange.type"/> 
      <short value="Reference range qualifier"/> 
      <definition value="Codes to indicate the what part of the targeted reference population it applies to. For
       example, the normal or therapeutic range."/> 
      <comment value="This SHOULD be populated if there is more than one range.  If this element is not present
       then the normal range is assumed."/> 
      <requirements value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic,
       etc.,  - for proper interpretation."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.referenceRange.type"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeMeaning"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="Code for the meaning of a reference range."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/> 
      </binding> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 260245000 |Findings values| OR  
&lt; 365860008 |General clinical state finding| 
OR 
&lt; 250171008 |Clinical history or observation findings| OR  
&lt; 415229000 |Racial group| OR 
&lt; 365400002 |Finding of puberty stage| OR
&lt; 443938003 |Procedure carried out on subject|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-10"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="interpretationCode"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange.appliesTo">
      <path value="Observation.referenceRange.appliesTo"/> 
      <short value="Reference range population"/> 
      <definition value="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."/> 
      <comment value="This SHOULD be populated if there is more than one range.  If this element is not present
       then the normal population is assumed."/> 
      <requirements value="Need to be able to identify the target population for proper interpretation."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.referenceRange.appliesTo"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeType"/> 
        </extension> 
        <strength value="example"/> 
        <description value="Codes identifying the population the reference range applies to."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-appliesto"/> 
      </binding> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 260245000 |Findings values| OR  
&lt; 365860008 |General clinical state finding| 
OR 
&lt; 250171008 |Clinical history or observation findings| OR  
&lt; 415229000 |Racial group| OR 
&lt; 365400002 |Finding of puberty stage| OR
&lt; 443938003 |Procedure carried out on subject|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-10"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="interpretationCode"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange.age">
      <path value="Observation.referenceRange.age"/> 
      <short value="Applicable age range, if relevant"/> 
      <definition value="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."/> 
      <requirements value="Some analytes vary greatly over age."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.referenceRange.age"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Range"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=&quot;age&quot;].value"/> 
      </mapping> 
    </element> 
    <element id="Observation.referenceRange.text">
      <path value="Observation.referenceRange.text"/> 
      <short value="Text based reference range in an observation"/> 
      <definition value="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 &quot;Negative&quot
      ; or a list or table of &quot;normals&quot;."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.referenceRange.text"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-7"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="value:ST"/> 
      </mapping> 
    </element> 
    <element id="Observation.hasMember">
      <path value="Observation.hasMember"/> 
      <short value="Used when reporting vital signs panel components"/> 
      <definition value="Used when reporting vital signs panel components."/> 
      <comment value="When using this element, an observation will typically have either a value or a set of
       related resources, although both may be present in some cases.  For a discussion on the
       ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping)
       below.  Note that a system may calculate results from [QuestionnaireResponse](questionnaireresponse.
      html)  into a final score and represent the score as an Observation."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.hasMember"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Sequence"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/vitalsigns"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="Relationships established by OBX-4 usage"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="outBoundRelationship"/> 
      </mapping> 
    </element> 
    <element id="Observation.derivedFrom">
      <path value="Observation.derivedFrom"/> 
      <short value="Related measurements the observation is made from"/> 
      <definition value="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."/> 
      <comment value="All the reference choices that are listed in this element can represent clinical observations
       and other measurements that may be the source for a derived value.  The most common reference
       will be another Observation.  For a discussion on the ways Observations can assembled
       in groups together, see [Notes](observation.html#obsgrouping) below."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.derivedFrom"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ImagingStudy"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Media"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Sequence"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/vitalsigns"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="Relationships established by OBX-4 usage"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".targetObservation"/> 
      </mapping> 
    </element> 
    <element id="Observation.component">
      <path value="Observation.component"/> 
      <short value="Used when reporting systolic and diastolic blood pressure."/> 
      <definition value="Used when reporting systolic and diastolic blood pressure."/> 
      <comment value="For a discussion on the ways Observations can be assembled in groups together see [Notes](observatio
      n.html#notes) below."/> 
      <requirements value="Component observations share the same attributes in the Observation resource as the primary
       observation and are always treated a part of a single observation (they are not separable).
         However, the reference range for the primary observation value is not inherited by the
       component values and is required when appropriate for each component observation."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.component"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="BackboneElement"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <constraint> 
        <key value="vs-3"/> 
        <severity value="error"/> 
        <human value="If there is no a value a data absent reason must be present"/> 
        <expression value="value.exists() or dataAbsentReason.exists()"/> 
        <xpath value="f:*[starts-with(local-name(.), 'value')] or f:dataAbsentReason"/> 
      </constraint> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="containment by OBX-4?"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="outBoundRelationship[typeCode=COMP]"/> 
      </mapping> 
    </element> 
    <element id="Observation.component.id">
      <path value="Observation.component.id"/> 
      <representation value="xmlAttr"/> 
      <short value="xml:id (or equivalent in JSON)"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.component.extension">
      <path value="Observation.component.extension"/> 
      <short value="Additional content defined by implementations"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Observation.component.modifierExtension">
      <path value="Observation.component.modifierExtension"/> 
      <short value="Extensions that cannot be ignored if unrecognized"/> 
      <definition value="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.
       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)."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <alias value="modifiers"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="BackboneElement.modifierExtension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="true"/> 
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element
       that contains them"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Observation.component.code">
      <path value="Observation.component.code"/> 
      <short value="Type of component observation (code / type)"/> 
      <definition value="Describes what was observed. Sometimes this is called the observation &quot;code&quot;."/> 
      <comment value="*All* code-value and  component.code-component.value pairs need to be taken into account
       to correctly understand the meaning of the observation."/> 
      <requirements value="Knowing what kind of observation is being made is essential to understanding the observation."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.component.code"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="VitalSigns"/> 
        </extension> 
        <strength value="extensible"/> 
        <description value="This identifies the vital sign result type."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-vitalsignresult"/> 
      </binding> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.what[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 363787002 |Observable entity| OR 
&lt; 386053000 |Evaluation procedure|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-3"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="code"/> 
      </mapping> 
    </element> 
    <element id="Observation.component.value[x]">
      <path value="Observation.component.value[x]"/> 
      <short value="Vital Sign Value recorded with UCUM"/> 
      <definition value="Vital Sign Value recorded with UCUM."/> 
      <comment value="Used when observation has a set of component observations. An observation may have both
       a value (e.g. an  Apgar score)  and component observations (the observations from which
       the Apgar score was derived). If a value is present, the datatype for this element should
       be determined by Observation.code. A CodeableConcept with just a text would be used instead
       of a string if the field was usually coded, or if the type associated with the Observation.code
       defines a coded value.  For additional guidance, see the [Notes section](observation.html#notes)
       below."/> 
      <requirements value="9. SHALL contain exactly one [1..1] value with @xsi:type=&quot;PQ&quot; (CONF:7305)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.component.value[x]"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Quantity"/> 
      </type> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <type> 
        <code value="string"/> 
      </type> 
      <type> 
        <code value="boolean"/> 
      </type> 
      <type> 
        <code value="integer"/> 
      </type> 
      <type> 
        <code value="Range"/> 
      </type> 
      <type> 
        <code value="Ratio"/> 
      </type> 
      <type> 
        <code value="SampledData"/> 
      </type> 
      <type> 
        <code value="time"/> 
      </type> 
      <type> 
        <code value="dateTime"/> 
      </type> 
      <type> 
        <code value="Period"/> 
      </type> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="VitalSignsUnits"/> 
        </extension> 
        <strength value="required"/> 
        <description value="Common UCUM units for recording Vital Signs."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/ucum-vitals-common"/> 
      </binding> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="363714003 |Interprets| &lt; 441742003 |Evaluation finding|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX.2, OBX.5, OBX.6"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="value"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-attr"/> 
        <map value="363714003 |Interprets|"/> 
      </mapping> 
    </element> 
    <element id="Observation.component.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason"/> 
      <short value="Why the component result is missing"/> 
      <definition value="Provides a reason why the expected value in the element Observation.component.value[x]
       is missing."/> 
      <comment value="&quot;Null&quot; or exceptional values can be represented two ways in FHIR Observations.
        One way is to simply include them in the value set and represent the exceptions in the
       value.  For example, measurement values for a serology test could be  &quot;detected&quot;,
       &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;test not done&quot;. 

The alternate way is to use the value element for actual observations and use the explicit
       dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason
       code &quot;error&quot; could be used when the measurement was not completed.  Because
       of these options, use-case agreements are required to interpret general observations for
       exceptional values."/> 
      <requirements value="For many results it is necessary to handle exceptional values in measurements."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Observation.component.dataAbsentReason"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <condition value="obs-6"/> 
      <mustSupport value="true"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationValueAbsentReason"/> 
        </extension> 
        <strength value="extensible"/> 
        <description value="Codes specifying why the result (`Observation.value[x]`) is missing."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/> 
      </binding> 
      <mapping> 
        <identity value="v2"/> 
        <map value="N/A"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="value.nullFlavor"/> 
      </mapping> 
    </element> 
    <element id="Observation.component.interpretation">
      <path value="Observation.component.interpretation"/> 
      <short value="High, low, normal, etc."/> 
      <definition value="A categorical assessment of an observation value.  For example, high, low, normal."/> 
      <comment value="Historically used for laboratory results (known as 'abnormal flag' ),  its use extends
       to other use cases where coded interpretations  are relevant.  Often reported as one or
       more simple compact codes often placed adjacent to the result value in reports and flow
       sheets to signal the meaning/normalcy status of the result."/> 
      <requirements value="For some results, particularly numeric results, an interpretation is necessary to fully
       understand the significance of a result."/> 
      <alias value="Abnormal Flag"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.component.interpretation"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationInterpretation"/> 
        </extension> 
        <strength value="extensible"/> 
        <description value="Codes identifying interpretations of observations."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation"/> 
      </binding> 
      <mapping> 
        <identity value="sct-concept"/> 
        <map value="&lt; 260245000 |Findings values|"/> 
      </mapping> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX-8"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="interpretationCode"/> 
      </mapping> 
      <mapping> 
        <identity value="sct-attr"/> 
        <map value="363713009 |Has interpretation|"/> 
      </mapping> 
    </element> 
    <element id="Observation.component.referenceRange">
      <path value="Observation.component.referenceRange"/> 
      <short value="Provides guide for interpretation of component result"/> 
      <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range."/> 
      <comment value="Most observations only have one generic reference range. Systems MAY choose to restrict
       to only supplying the relevant reference range based on knowledge about the patient (e.g.,
       specific to the patient's age, gender, weight and other factors), but this might not be
       possible or appropriate. Whenever more than one reference range is supplied, the differences
       between them SHOULD be provided in the reference range and/or age properties."/> 
      <requirements value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance
       of a particular result. Need to be able to provide multiple reference ranges for different
       contexts."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Observation.component.referenceRange"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <contentReference value="#Observation.referenceRange"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="v2"/> 
        <map value="OBX.7"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/> 
      </mapping> 
    </element> 
  </snapshot> 
  <differential> 
    <element id="Observation">
      <path value="Observation"/> 
      <short value="FHIR Head Circumference Profile"/> 
      <definition value="This profile defines  how to represent Head Circumference observations in FHIR using a
       standard LOINC code and UCUM units of measure."/> 
      <min value="0"/> 
      <max value="*"/> 
    </element> 
    <element id="Observation.code">
      <path value="Observation.code"/> 
      <short value="Head Circumference"/> 
      <definition value="Head Circumference."/> 
      <comment value="additional codes that translate or map to this code are allowed.  For example a more granular
       LOINC code or code that is used locally in a system."/> 
      <alias value="Test"/> 
      <alias value="Name"/> 
    </element> 
    <element id="Observation.code.coding">
      <path value="Observation.code.coding"/> 
      <slicing> 
        <discriminator> 
          <type value="value"/> 
          <path value="code"/> 
        </discriminator> 
        <discriminator> 
          <type value="value"/> 
          <path value="system"/> 
        </discriminator> 
        <ordered value="false"/> 
        <rules value="open"/> 
      </slicing> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode">
      <path value="Observation.code.coding"/> 
      <sliceName value="HeadCircumCode"/> 
      <min value="1"/> 
      <max value="1"/> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode.system">
      <path value="Observation.code.coding.system"/> 
      <min value="1"/> 
      <max value="1"/> 
      <type> 
        <code value="uri"/> 
      </type> 
      <fixedUri value="http://loinc.org"/> 
    </element> 
    <element id="Observation.code.coding:HeadCircumCode.code">
      <path value="Observation.code.coding.code"/> 
      <min value="1"/> 
      <max value="1"/> 
      <type> 
        <code value="code"/> 
      </type> 
      <fixedCode value="9843-4"/> 
    </element> 
    <element id="Observation.valueQuantity">
      <path value="Observation.valueQuantity"/> 
    </element> 
    <element id="Observation.valueQuantity.value">
      <path value="Observation.valueQuantity.value"/> 
      <min value="1"/> 
      <max value="1"/> 
      <type> 
        <code value="decimal"/> 
      </type> 
      <mustSupport value="true"/> 
    </element> 
    <element id="Observation.valueQuantity.unit">
      <path value="Observation.valueQuantity.unit"/> 
      <min value="1"/> 
      <max value="1"/> 
      <type> 
        <code value="string"/> 
      </type> 
      <mustSupport value="true"/> 
    </element> 
    <element id="Observation.valueQuantity.system">
      <path value="Observation.valueQuantity.system"/> 
      <min value="1"/> 
      <max value="1"/> 
      <type> 
        <code value="uri"/> 
      </type> 
      <fixedUri value="http://unitsofmeasure.org"/> 
      <mustSupport value="true"/> 
    </element> 
    <element id="Observation.valueQuantity.code">
      <path value="Observation.valueQuantity.code"/> 
      <short value="Coded responses from the common UCUM units for vital signs value set."/> 
      <definition value="Coded responses from the common UCUM units for vital signs value set."/> 
      <min value="1"/> 
      <max value="1"/> 
      <type> 
        <code value="code"/> 
      </type> 
      <mustSupport value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="BodyLengthUnits"/> 
        </extension> 
        <strength value="required"/> 
        <description value="Common UCUM units for body length measures such as Body Height and Head Circumference."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/ucum-bodylength"/> 
      </binding> 
    </element> 
  </differential> 
</StructureDefinition>