MedCom EKG Recording Observation

This page describes how the MedCom Ekg Recording Observation profile is intended to be used within the MedCom EKG Recording standard.

Purpose of the Profile

This profile specifies how the Observation represents the PDF/A-encoded EKG recording using a dedicated extension. It also specifies how the related attachment metadata, acquisition note, and timing information must be captured, and how the required LOINC coding and references to the patient and performing organization must be applied. Read more about this in the following paragrafs.

Use of the valueAttachment Extension

This Observation contains a FHIR extension designed to hold an EKG recording as a PDF/A file encoded in Base64. The valueAttachment element is implemented as an extension because the base value[x] element does not support the Attachment type in FHIR R4. The extension also captures essential metadata for the attachment - the MIME type and the title.

EKG Recording note

This Observation includes a free-text note related to the EKG acquisition, intended for documenting brief, measurement-related remarks. To ensure consistency and concise usage, the note is limited to a maximum length of 1024 characters and allows line breaks.

Line breaks and special characters in the note

Implementations must preserve the logical string value, including line breaks and Unicode characters, across both XML and JSON. Line breaks in FHIR string values must follow the underlying format:

• In JSON, line breaks SHALL be written as the escaped newline sequence \n inside the string.
• In XML, line breaks SHALL be represented either as a literal newline in the element text or as the character reference 
. Escaping of characters in XML SHALL preserve the logical value of the FHIR string. XML-reserved characters &, <, >, and " SHALL be escaped.

Unicode characters (e.g. ÆØÅ, ë, ð, ý) SHALL be supported without restriction in both XML and JSON.

EKG Recording date and time

The effective[x] element is a mandatory element used to represent the timing of the EKG recording and SHALL be provided either as a period or alternatively as a dateTime.

• effectivePeriod.start – Represents the exact start time of the EKG recording and is required if known.
• effectivePeriod.end – Represents the exact end time of the EKG recording and is required if known in combination with effectivePeriod.start.
• effectiveDateTime – Used only when the exact start time is unknown.

Required LOINC coding

This Observation contains the fixed code:

• code.coding:LOINC: code: 11524-6 system: http://loinc.org display: EKG study.

Resource references

This Observation references the Patient resource through the subject element and the author Organization through the performer element.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	MedComDocumentObservation	Measurements and simple assertions Constraints: obs-6, obs-7, dk-core-observation-mandatory-units
id	SOΣ	1..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment	S	1..1	(Complex)	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
extension		0..0		Extension Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension"
value[x]	S	1..1	Attachment	Value of extension
contentType	SOΣ	1..1	code	MIME type of the attached EKG recording. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Fixed Value: application/pdf Obligations Actor SHALL:in-narrative Producer of FHIR resources
data	S	1..1	base64Binary	Base64-encoded content of the EKG recording PDF/A document.
title	SOΣ	1..1	string	Label to display in place of the data Required Pattern: Elektrokardiogram-12-aflednings Obligations Actor SHALL:in-narrative Producer of FHIR resources
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Globally unique, stable identifier for this resource. The same identifier SHALL be used when this resource is recreated from the same source data.
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
status	?!SOΣ	1..1	code	Status MUST be final. Binding: MedComCoreObservationStatus (required) Required Pattern: final
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LOINC	SΣ	1..1	Coding	LOINC code for the observation
system	SOΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org Obligations Actor SHALL:in-narrative Producer of FHIR resources
code	SOΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6 Obligations Actor SHALL:in-narrative Producer of FHIR resources
display	SOΣ	1..1	string	Representation defined by the system Fixed Value: EKG study Obligations Actor SHALL:in-narrative Producer of FHIR resources
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://npu-terminology.org
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:SKS	Σ	0..1	Coding	SKS code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
code	Σ	1..1	code	Symbol in syntax defined by the system
subject	SOΣ	1..1	Reference(MedComDocumentPatient) {b}	Who and/or what the observation is about
Slices for effective[x]	SΣ	1..1		The time or time period of the EKG recording. Slice: Unordered, Closed by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectiveDateTime	SOΣC	0..1	dateTime	The time of the EKG recording. Use this if effectivePeriod.start is unknown. Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]:effectivePeriod	SΣ	0..1	Period	The date and time of the observation.
start	SOΣC	1..1	dateTime	The start time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
end	SOΣC	0..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
performer	SOΣ	1..1	Reference(MedComDocumentOrganization)	Who is responsible for the observation
Slices for value[x]	ΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
note	S	0..1	Annotation	Free-text note, used to document relevant measurement-related remarks. Line breaks in FHIR string values must be represented as escaped newline characters \n in JSON and either as a literal newline in the element text or as the character reference &#xA; in XML.
text	SOΣ	1..1	markdown	The annotation - text content (as markdown) Obligations Actor SHALL:in-narrative Producer of FHIR resources Max Length:1024
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.text.status	Base	required	NarrativeStatus	📍4.0.1	FHIR Std.
Observation.extension:valueAttachment.​value[x].contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
Observation.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Observation.status	Base	required	MedComCoreObservationStatus	📦1.8.2	DK MedCom Terminology v2.0
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dk-core-observation-mandatory-units	error	Observation	If value is specified then unit and/or code must be specified	value.ofType(Quantity).value.exists() implies value.ofType(Quantity).unit.exists() or value.ofType(Quantity).code.exists()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
medcom-datetime-has-time-offset-zulu	error	Observation.effective[x]:effectiveDateTime, Observation.effective[x]:effectivePeriod.start, Observation.effective[x]:effectivePeriod.end	dateTime must include date, time, and time zone.	$this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
txt-1	error	Observation.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	Observation.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

This structure is derived from MedComDocumentObservation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	MedComDocumentObservation	Measurements and simple assertions
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:valueAttachment	S	1..1	MedComObservationValueAttachmentExtension	Observation value as attachment.
url	S	1..1	uri	identifies the meaning of the extension
value[x]	S	1..1	Attachment	Value of extension
contentType	SO	1..1	code	MIME type of the attached EKG recording. Fixed Value: application/pdf Obligations Actor SHALL:in-narrative Producer of FHIR resources
data	S	1..1	base64Binary	Base64-encoded content of the EKG recording PDF/A document.
title	SO	1..1	string	Label to display in place of the data Required Pattern: Elektrokardiogram-12-aflednings Obligations Actor SHALL:in-narrative Producer of FHIR resources
status		1..1	code	Status MUST be final. Required Pattern: final
code
coding		1..*	Coding	Code defined by a terminology system
Slices for coding				Content/Rules for all slices
coding:LOINC	S	1..1	Coding	LOINC code for the observation
system	SO	1..1	uri	Identity of the terminology system Obligations Actor SHALL:in-narrative Producer of FHIR resources
code	SO	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6 Obligations Actor SHALL:in-narrative Producer of FHIR resources
display	SO	1..1	string	Representation defined by the system Fixed Value: EKG study Obligations Actor SHALL:in-narrative Producer of FHIR resources
Slices for effective[x]	S	1..1		The time or time period of the EKG recording. Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectiveDateTime	SOC	0..1	dateTime	The time of the EKG recording. Use this if effectivePeriod.start is unknown. Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]:effectivePeriod	S	0..1	Period	The date and time of the observation.
start	SOC	1..1	dateTime	The start time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
end	SOC	0..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
performer		1..1	Reference(MedComDocumentOrganization)	Who is responsible for the observation
note	S	0..1	Annotation	Free-text note, used to document relevant measurement-related remarks. Line breaks in FHIR string values must be represented as escaped newline characters \n in JSON and either as a literal newline in the element text or as the character reference 
 in XML.
text	SO	1..1	markdown	The annotation - text content (as markdown) Obligations Actor SHALL:in-narrative Producer of FHIR resources Max Length:1024
Documentation for this format

Constraints

Id	Grade	Path(s)	Description	Expression
medcom-datetime-has-time-offset-zulu	error	Observation.effective[x]:effectiveDateTime, Observation.effective[x]:effectivePeriod.start, Observation.effective[x]:effectivePeriod.end	dateTime must include date, time, and time zone.	$this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	MedComDocumentObservation	Measurements and simple assertions Constraints: obs-6, obs-7, dk-core-observation-mandatory-units
id	SOΣ	1..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment	S	1..1	(Complex)	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension"
value[x]	S	1..1	Attachment	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SOΣ	1..1	code	MIME type of the attached EKG recording. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Fixed Value: application/pdf Obligations Actor SHALL:in-narrative Producer of FHIR resources
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	1..1	base64Binary	Base64-encoded content of the EKG recording PDF/A document.
url	Σ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	SOΣ	1..1	string	Label to display in place of the data Required Pattern: Elektrokardiogram-12-aflednings Obligations Actor SHALL:in-narrative Producer of FHIR resources
creation	Σ	0..1	dateTime	Date attachment was first created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Globally unique, stable identifier for this resource. The same identifier SHALL be used when this resource is recreated from the same source data.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SOΣ	1..1	code	Status MUST be final. Binding: MedComCoreObservationStatus (required) Required Pattern: final
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LOINC	SΣ	1..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SOΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org Obligations Actor SHALL:in-narrative Producer of FHIR resources
version	Σ	0..1	string	Version of the system - if relevant
code	SOΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6 Obligations Actor SHALL:in-narrative Producer of FHIR resources
display	SOΣ	1..1	string	Representation defined by the system Fixed Value: EKG study Obligations Actor SHALL:in-narrative Producer of FHIR resources
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://npu-terminology.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(MedComDocumentPatient) {b}	Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
Slices for effective[x]	SΣ	1..1		The time or time period of the EKG recording. Slice: Unordered, Closed by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectiveDateTime	SOΣC	0..1	dateTime	The time of the EKG recording. Use this if effectivePeriod.start is unknown. Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]:effectivePeriod	SΣ	0..1	Period	The date and time of the observation.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SOΣC	1..1	dateTime	The start time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
end	SOΣC	0..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SOΣ	1..1	Reference(MedComDocumentOrganization)	Who is responsible for the observation
Slices for value[x]	ΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note	S	0..1	Annotation	Free-text note, used to document relevant measurement-related remarks. Line breaks in FHIR string values must be represented as escaped newline characters \n in JSON and either as a literal newline in the element text or as the character reference &#xA; in XML.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
author[x]	Σ	0..1		Individual responsible for the annotation
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
time	Σ	0..1	dateTime	When the annotation was made
text	SOΣ	1..1	markdown	The annotation - text content (as markdown) Obligations Actor SHALL:in-narrative Producer of FHIR resources Max Length:1024
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:SCTCode	Σ	0..1	Coding	Code defined by a terminology system Binding: DK TechniquesSCTCodes (example)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct|http://snomed.info/sct/554471000005108
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	The device used for the measurement. It is recommended that when information about the device is sent, it is contained in the same Bundle as the Observation the device measured.
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity(4.0.1)	Low Range, if relevant
high	C	0..1	SimpleQuantity(4.0.1)	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://npu-terminology.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Observation.text.status	Base	required	NarrativeStatus	📍4.0.1	FHIR Std.
Observation.extension:valueAttachment.​value[x].contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
Observation.extension:valueAttachment.​value[x].language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Observation.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Observation.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Observation.status	Base	required	MedComCoreObservationStatus	📦1.8.2	DK MedCom Terminology v2.0
Observation.category	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Observation.method	Base	example	Observation Methods	📍4.0.1	FHIR Std.
Observation.method.coding:SCTCode	Base	example	DK TechniquesSCTCodes	📦3.5.0	HL7 FHIR Implementation Guide: DK Core v3.5
Observation.referenceRange.​type	Base	preferred	Observation Reference Range Meaning Codes	📍4.0.1	FHIR Std.
Observation.referenceRange.​appliesTo	Base	example	Observation Reference Range Applies To Codes	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.component.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dk-core-observation-mandatory-units	error	Observation	If value is specified then unit and/or code must be specified	value.ofType(Quantity).value.exists() implies value.ofType(Quantity).unit.exists() or value.ofType(Quantity).code.exists()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
medcom-datetime-has-time-offset-zulu	error	Observation.effective[x]:effectiveDateTime, Observation.effective[x]:effectivePeriod.start, Observation.effective[x]:effectivePeriod.end	dateTime must include date, time, and time zone.	$this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text	low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
txt-1	error	Observation.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	Observation.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	MedComDocumentObservation	Measurements and simple assertions Constraints: obs-6, obs-7, dk-core-observation-mandatory-units
id	SOΣ	1..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment	S	1..1	(Complex)	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
extension		0..0		Extension Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension"
value[x]	S	1..1	Attachment	Value of extension
contentType	SOΣ	1..1	code	MIME type of the attached EKG recording. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Fixed Value: application/pdf Obligations Actor SHALL:in-narrative Producer of FHIR resources
data	S	1..1	base64Binary	Base64-encoded content of the EKG recording PDF/A document.
title	SOΣ	1..1	string	Label to display in place of the data Required Pattern: Elektrokardiogram-12-aflednings Obligations Actor SHALL:in-narrative Producer of FHIR resources
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Globally unique, stable identifier for this resource. The same identifier SHALL be used when this resource is recreated from the same source data.
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
status	?!SOΣ	1..1	code	Status MUST be final. Binding: MedComCoreObservationStatus (required) Required Pattern: final
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LOINC	SΣ	1..1	Coding	LOINC code for the observation
system	SOΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org Obligations Actor SHALL:in-narrative Producer of FHIR resources
code	SOΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6 Obligations Actor SHALL:in-narrative Producer of FHIR resources
display	SOΣ	1..1	string	Representation defined by the system Fixed Value: EKG study Obligations Actor SHALL:in-narrative Producer of FHIR resources
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://npu-terminology.org
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:SKS	Σ	0..1	Coding	SKS code for the observation
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
code	Σ	1..1	code	Symbol in syntax defined by the system
subject	SOΣ	1..1	Reference(MedComDocumentPatient) {b}	Who and/or what the observation is about
Slices for effective[x]	SΣ	1..1		The time or time period of the EKG recording. Slice: Unordered, Closed by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectiveDateTime	SOΣC	0..1	dateTime	The time of the EKG recording. Use this if effectivePeriod.start is unknown. Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]:effectivePeriod	SΣ	0..1	Period	The date and time of the observation.
start	SOΣC	1..1	dateTime	The start time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
end	SOΣC	0..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
performer	SOΣ	1..1	Reference(MedComDocumentOrganization)	Who is responsible for the observation
Slices for value[x]	ΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
note	S	0..1	Annotation	Free-text note, used to document relevant measurement-related remarks. Line breaks in FHIR string values must be represented as escaped newline characters \n in JSON and either as a literal newline in the element text or as the character reference &#xA; in XML.
text	SOΣ	1..1	markdown	The annotation - text content (as markdown) Obligations Actor SHALL:in-narrative Producer of FHIR resources Max Length:1024
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.text.status	Base	required	NarrativeStatus	📍4.0.1	FHIR Std.
Observation.extension:valueAttachment.​value[x].contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
Observation.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Observation.status	Base	required	MedComCoreObservationStatus	📦1.8.2	DK MedCom Terminology v2.0
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dk-core-observation-mandatory-units	error	Observation	If value is specified then unit and/or code must be specified	value.ofType(Quantity).value.exists() implies value.ofType(Quantity).unit.exists() or value.ofType(Quantity).code.exists()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
medcom-datetime-has-time-offset-zulu	error	Observation.effective[x]:effectiveDateTime, Observation.effective[x]:effectivePeriod.start, Observation.effective[x]:effectivePeriod.end	dateTime must include date, time, and time zone.	$this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
txt-1	error	Observation.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	Observation.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

Differential View

This structure is derived from MedComDocumentObservation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	MedComDocumentObservation	Measurements and simple assertions
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:valueAttachment	S	1..1	MedComObservationValueAttachmentExtension	Observation value as attachment.
url	S	1..1	uri	identifies the meaning of the extension
value[x]	S	1..1	Attachment	Value of extension
contentType	SO	1..1	code	MIME type of the attached EKG recording. Fixed Value: application/pdf Obligations Actor SHALL:in-narrative Producer of FHIR resources
data	S	1..1	base64Binary	Base64-encoded content of the EKG recording PDF/A document.
title	SO	1..1	string	Label to display in place of the data Required Pattern: Elektrokardiogram-12-aflednings Obligations Actor SHALL:in-narrative Producer of FHIR resources
status		1..1	code	Status MUST be final. Required Pattern: final
code
coding		1..*	Coding	Code defined by a terminology system
Slices for coding				Content/Rules for all slices
coding:LOINC	S	1..1	Coding	LOINC code for the observation
system	SO	1..1	uri	Identity of the terminology system Obligations Actor SHALL:in-narrative Producer of FHIR resources
code	SO	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6 Obligations Actor SHALL:in-narrative Producer of FHIR resources
display	SO	1..1	string	Representation defined by the system Fixed Value: EKG study Obligations Actor SHALL:in-narrative Producer of FHIR resources
Slices for effective[x]	S	1..1		The time or time period of the EKG recording. Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectiveDateTime	SOC	0..1	dateTime	The time of the EKG recording. Use this if effectivePeriod.start is unknown. Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]:effectivePeriod	S	0..1	Period	The date and time of the observation.
start	SOC	1..1	dateTime	The start time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
end	SOC	0..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
performer		1..1	Reference(MedComDocumentOrganization)	Who is responsible for the observation
note	S	0..1	Annotation	Free-text note, used to document relevant measurement-related remarks. Line breaks in FHIR string values must be represented as escaped newline characters \n in JSON and either as a literal newline in the element text or as the character reference 
 in XML.
text	SO	1..1	markdown	The annotation - text content (as markdown) Obligations Actor SHALL:in-narrative Producer of FHIR resources Max Length:1024
Documentation for this format

Constraints

Id	Grade	Path(s)	Description	Expression
medcom-datetime-has-time-offset-zulu	error	Observation.effective[x]:effectiveDateTime, Observation.effective[x]:effectivePeriod.start, Observation.effective[x]:effectivePeriod.end	dateTime must include date, time, and time zone.	$this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	MedComDocumentObservation	Measurements and simple assertions Constraints: obs-6, obs-7, dk-core-observation-mandatory-units
id	SOΣ	1..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:valueAttachment	S	1..1	(Complex)	Observation value as attachment. URL: http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://medcomfhir.dk/ig/core/StructureDefinition/medcom-observation-value-attachment-extension"
value[x]	S	1..1	Attachment	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SOΣ	1..1	code	MIME type of the attached EKG recording. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Fixed Value: application/pdf Obligations Actor SHALL:in-narrative Producer of FHIR resources
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	1..1	base64Binary	Base64-encoded content of the EKG recording PDF/A document.
url	Σ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	SOΣ	1..1	string	Label to display in place of the data Required Pattern: Elektrokardiogram-12-aflednings Obligations Actor SHALL:in-narrative Producer of FHIR resources
creation	Σ	0..1	dateTime	Date attachment was first created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Globally unique, stable identifier for this resource. The same identifier SHALL be used when this resource is recreated from the same source data.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SOΣ	1..1	code	Status MUST be final. Binding: MedComCoreObservationStatus (required) Required Pattern: final
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LOINC	SΣ	1..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SOΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org Obligations Actor SHALL:in-narrative Producer of FHIR resources
version	Σ	0..1	string	Version of the system - if relevant
code	SOΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6 Obligations Actor SHALL:in-narrative Producer of FHIR resources
display	SOΣ	1..1	string	Representation defined by the system Fixed Value: EKG study Obligations Actor SHALL:in-narrative Producer of FHIR resources
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://npu-terminology.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(MedComDocumentPatient) {b}	Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
Slices for effective[x]	SΣ	1..1		The time or time period of the EKG recording. Slice: Unordered, Closed by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectiveDateTime	SOΣC	0..1	dateTime	The time of the EKG recording. Use this if effectivePeriod.start is unknown. Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
effective[x]:effectivePeriod	SΣ	0..1	Period	The date and time of the observation.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SOΣC	1..1	dateTime	The start time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
end	SOΣC	0..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu Obligations Actor SHALL:in-narrative Producer of FHIR resources
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SOΣ	1..1	Reference(MedComDocumentOrganization)	Who is responsible for the observation
Slices for value[x]	ΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note	S	0..1	Annotation	Free-text note, used to document relevant measurement-related remarks. Line breaks in FHIR string values must be represented as escaped newline characters \n in JSON and either as a literal newline in the element text or as the character reference &#xA; in XML.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
author[x]	Σ	0..1		Individual responsible for the annotation
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
time	Σ	0..1	dateTime	When the annotation was made
text	SOΣ	1..1	markdown	The annotation - text content (as markdown) Obligations Actor SHALL:in-narrative Producer of FHIR resources Max Length:1024
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:SCTCode	Σ	0..1	Coding	Code defined by a terminology system Binding: DK TechniquesSCTCodes (example)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct|http://snomed.info/sct/554471000005108
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	The device used for the measurement. It is recommended that when information about the device is sent, it is contained in the same Bundle as the Observation the device measured.
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity(4.0.1)	Low Range, if relevant
high	C	0..1	SimpleQuantity(4.0.1)	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://npu-terminology.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Observation.text.status	Base	required	NarrativeStatus	📍4.0.1	FHIR Std.
Observation.extension:valueAttachment.​value[x].contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
Observation.extension:valueAttachment.​value[x].language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Observation.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Observation.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Observation.status	Base	required	MedComCoreObservationStatus	📦1.8.2	DK MedCom Terminology v2.0
Observation.category	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Observation.method	Base	example	Observation Methods	📍4.0.1	FHIR Std.
Observation.method.coding:SCTCode	Base	example	DK TechniquesSCTCodes	📦3.5.0	HL7 FHIR Implementation Guide: DK Core v3.5
Observation.referenceRange.​type	Base	preferred	Observation Reference Range Meaning Codes	📍4.0.1	FHIR Std.
Observation.referenceRange.​appliesTo	Base	example	Observation Reference Range Applies To Codes	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.component.​value[x]:valueQuantity.​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.component.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dk-core-observation-mandatory-units	error	Observation	If value is specified then unit and/or code must be specified	value.ofType(Quantity).value.exists() implies value.ofType(Quantity).unit.exists() or value.ofType(Quantity).code.exists()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
medcom-datetime-has-time-offset-zulu	error	Observation.effective[x]:effectiveDateTime, Observation.effective[x]:effectivePeriod.start, Observation.effective[x]:effectivePeriod.end	dateTime must include date, time, and time zone.	$this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text	low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
txt-1	error	Observation.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	Observation.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

This structure is derived from MedComDocumentObservation

Summary

Mandatory: 10 elements(1 nested mandatory element)
Must-Support: 17 elements
Fixed: 3 elements

Structures

This structure refers to these other structures:

• MedComDocumentOrganization (http://medcomfhir.dk/ig/document/StructureDefinition/medcom-document-organization)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Observation.effective[x]