CIBMTR Reporting Implementation Guide
0.1.11 - Trial Use 1

This page is part of the CIBMTR Reporting Implementation Guide (v0.1.11: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: CIBMTR Vital Signs Results Profile (US Core)

Official URL: http://fhir.nmdp.org/ig/cibmtr-reporting/StructureDefinition/cibmtr-vital-signs Version: 0.1.11
Draft as of 2026-06-25 Computable Name: CIBMTRVitalSignsVariables

Overview

The CIBMTR Vital Signs Profile inherits from the US Core Vital Signs Profile, which in turn inherits from the base FHIR Observation resource. This profile constrains the representation, coding, and usage of vital sign observations to support consistent reporting and downstream use in CIBMTR data collection and analysis workflows.

This profile establishes minimum expectations for representing vital sign measurements (e.g., body height, body weight) recorded for a patient and submitted to the CIBMTR FHIR server. It specifies the required elements, extensions, and identifier slices, and defines how they SHALL be used to support standardized reporting to CIBMTR.

Mandatory and Must Support Data Elements

The following data elements must always be present (Must Have) or must be supported if the data is present in the sending system (Must Support).

Each Vital Signs Observation Must Have:

  • security label
  • status
  • code identifying the vital sign being measured
  • patient reference (subject)
  • clinically relevant time

Each Vital Signs Observation Must Support:

  • performer
  • result value
  • reason if the value is absent
  • component results

Profile-specific Implementation Guidance (CIBMTR)

Security label requirement (meta.security)
The CIBMTR vital signs profile requires a meta.security label identifying the Transplant Center context (e.g., rc_<CCN>). This security tag is used as part of the query pattern for searching and for access scoping.

subject
The subject element is mandatory and must contain a reference to a Patient resource identifying the individual whose vital signs are being recorded.

code
The code element identifies the vital sign being measured. Vital sign codes are typically represented using LOINC codes or CIBMTR-defined laboratory ValueSets where applicable.

Usages:

  • This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* USCoreVitalSignsProfile(8.0.0) US Core Vital Signs Profile
Constraints: obs-6, obs-7, vs-2
... meta Σ 0..1 Meta Metadata about the resource
.... Slices for security Σ 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
..... security:TransplantCenter SΣ 1..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... code ΣC 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
... code SΣ 1..1 CodeableConcept Coded vital sign result type
Binding: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion (extensible)
... subject SΣ 1..1 Reference(US Core Patient Profile(8.0.0)) Who and/or what the observation is about
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
Constraints: vs-1
.... effectiveDateTime dateTime S
.... effectivePeriod Period
... performer SΣ 0..* Reference(US Core Practitioner Profile(8.0.0) | US Core Organization Profile(8.0.0) | US Core Patient Profile(8.0.0) | PractitionerRole | US Core CareTeam Profile(8.0.0) | US Core RelatedPerson Profile(8.0.0)) Who is responsible for the observation
... value[x] SΣC 0..1 Quantity S Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... component SΣC 0..* BackboneElement Component observations
Constraints: vs-3
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Coded vital sign result type
Binding: Vital Sign Result Type . (extensible): Vital sign result types
.... value[x] SΣC 0..1 Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
..... valueQuantity Quantity S
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Observation.meta.security:TransplantCenter Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Observation.status Base required ObservationStatus 📍4.0.1 FHIR Std.
Observation.category Base preferred Observation Category Codes 📦4.0.1 FHIR Std.
Observation.category:VSCat Base preferred Observation Category Codes 📦4.0.1 FHIR Std.
Observation.code Base extensible https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion Not State Unknown
Observation.value[x] Base extensible Vital Signs Units 📍4.0.1 FHIR Std.
Observation.dataAbsentReason Base extensible DataAbsentReason 📦4.0.1 FHIR Std.
Observation.component.​code Base extensible Vital Sign Result Type . 📦20240322 VSAC v0.23
Observation.component.​value[x] Base extensible Vital Signs Units 📍4.0.1 FHIR Std.
Observation.component.​dataAbsentReason Base extensible DataAbsentReason 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Observation If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Observation If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Observation If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Observation If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Observation A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
obs-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()
sec-rc error Observation.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
vs-1 error Observation.effective[x] if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day $this is dateTime implies $this.toString().length() >= 10
vs-2 error Observation If there is no component or hasMember element then either a value[x] or a data absent reason must be present. (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3 error Observation.component If there is no a value a data absent reason must be present value.exists() or dataAbsentReason.exists()

This structure is derived from USCoreVitalSignsProfile

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation 0..* USCoreVitalSignsProfile(8.0.0) US Core Vital Signs Profile
... meta
.... Slices for security 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
..... security:TransplantCenter S 1..1 Coding Security Labels applied to this resource
...... system 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... code C 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
... code 1..1 CodeableConcept Coded vital sign result type
Binding: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion (extensible)
... value[x] 0..1 Quantity Vital Signs Value

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Observation.code Base extensible https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion Not State Unknown

Constraints

Id Grade Path(s) Description Expression
sec-rc error Observation.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* USCoreVitalSignsProfile(8.0.0) US Core Vital Signs Profile
Constraints: obs-6, obs-7, vs-2
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... Slices for security Σ 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
..... security:TransplantCenter SΣ 1..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
...... 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://terminology.cibmtr.org/codesystem/transplant-center
...... version Σ 0..1 string Version of the system - if relevant
...... code ΣC 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... 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 BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for observation
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
... status ?!SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... 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 SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
...... 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
... code SΣ 1..1 CodeableConcept Coded vital sign result type
Binding: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion (extensible)
... subject SΣ 1..1 Reference(US Core Patient Profile(8.0.0)) 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
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
Constraints: vs-1
.... effectiveDateTime dateTime S
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer SΣ 0..* Reference(US Core Practitioner Profile(8.0.0) | US Core Organization Profile(8.0.0) | US Core Patient Profile(8.0.0) | PractitionerRole | US Core CareTeam Profile(8.0.0) | US Core RelatedPerson Profile(8.0.0)) Who is responsible for the observation
... value[x] SΣC 0..1 Quantity S Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... note 0..* Annotation Comments about the observation
... bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... 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 Low Range, if relevant
.... high C 0..1 SimpleQuantity 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(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Used when reporting vital signs panel components
... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Related measurements the observation is made from
... component SΣC 0..* BackboneElement Component observations
Constraints: vs-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
.... code SΣ 1..1 CodeableConcept Coded vital sign result type
Binding: Vital Sign Result Type . (extensible): Vital sign result types
.... value[x] SΣC 0..1 Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
..... valueQuantity Quantity S
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Observation.meta.security:TransplantCenter Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Observation.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
Observation.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Observation.status Base required ObservationStatus 📍4.0.1 FHIR Std.
Observation.category Base preferred Observation Category Codes 📦4.0.1 FHIR Std.
Observation.category:VSCat Base preferred Observation Category Codes 📦4.0.1 FHIR Std.
Observation.code Base extensible https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion Not State Unknown
Observation.value[x] Base extensible Vital Signs Units 📍4.0.1 FHIR Std.
Observation.dataAbsentReason Base extensible DataAbsentReason 📦4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📦4.0.1 FHIR Std.
Observation.bodySite Base example SNOMED CT Body Structures 📦4.0.1 FHIR Std.
Observation.method Base example Observation Methods 📦4.0.1 FHIR Std.
Observation.referenceRange.​type Base preferred Observation Reference Range Meaning Codes 📦4.0.1 FHIR Std.
Observation.referenceRange.​appliesTo Base example Observation Reference Range Applies To Codes 📦4.0.1 FHIR Std.
Observation.component.​code Base extensible Vital Sign Result Type . 📦20240322 VSAC v0.23
Observation.component.​value[x] Base extensible Vital Signs Units 📍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
dom-2 error Observation If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Observation If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Observation If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Observation If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Observation A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
obs-3 error Observation.referenceRange Must have at least a low or a high or text low.exists() or high.exists() or text.exists()
obs-6 error Observation dataAbsentReason SHALL only be present if Observation.value[x] is not present dataAbsentReason.empty() or value.empty()
obs-7 error Observation If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
sec-rc error Observation.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
vs-1 error Observation.effective[x] if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day $this is dateTime implies $this.toString().length() >= 10
vs-2 error Observation If there is no component or hasMember element then either a value[x] or a data absent reason must be present. (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3 error Observation.component If there is no a value a data absent reason must be present value.exists() or dataAbsentReason.exists()

This structure is derived from USCoreVitalSignsProfile

Summary

Mandatory: 0 element(4 nested mandatory elements)
Must-Support: 1 element

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Observation.meta.security

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* USCoreVitalSignsProfile(8.0.0) US Core Vital Signs Profile
Constraints: obs-6, obs-7, vs-2
... meta Σ 0..1 Meta Metadata about the resource
.... Slices for security Σ 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
..... security:TransplantCenter SΣ 1..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... code ΣC 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
... code SΣ 1..1 CodeableConcept Coded vital sign result type
Binding: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion (extensible)
... subject SΣ 1..1 Reference(US Core Patient Profile(8.0.0)) Who and/or what the observation is about
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
Constraints: vs-1
.... effectiveDateTime dateTime S
.... effectivePeriod Period
... performer SΣ 0..* Reference(US Core Practitioner Profile(8.0.0) | US Core Organization Profile(8.0.0) | US Core Patient Profile(8.0.0) | PractitionerRole | US Core CareTeam Profile(8.0.0) | US Core RelatedPerson Profile(8.0.0)) Who is responsible for the observation
... value[x] SΣC 0..1 Quantity S Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... component SΣC 0..* BackboneElement Component observations
Constraints: vs-3
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Coded vital sign result type
Binding: Vital Sign Result Type . (extensible): Vital sign result types
.... value[x] SΣC 0..1 Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
..... valueQuantity Quantity S
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Observation.meta.security:TransplantCenter Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Observation.status Base required ObservationStatus 📍4.0.1 FHIR Std.
Observation.category Base preferred Observation Category Codes 📦4.0.1 FHIR Std.
Observation.category:VSCat Base preferred Observation Category Codes 📦4.0.1 FHIR Std.
Observation.code Base extensible https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion Not State Unknown
Observation.value[x] Base extensible Vital Signs Units 📍4.0.1 FHIR Std.
Observation.dataAbsentReason Base extensible DataAbsentReason 📦4.0.1 FHIR Std.
Observation.component.​code Base extensible Vital Sign Result Type . 📦20240322 VSAC v0.23
Observation.component.​value[x] Base extensible Vital Signs Units 📍4.0.1 FHIR Std.
Observation.component.​dataAbsentReason Base extensible DataAbsentReason 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Observation If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Observation If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Observation If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Observation If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Observation A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
obs-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()
sec-rc error Observation.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
vs-1 error Observation.effective[x] if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day $this is dateTime implies $this.toString().length() >= 10
vs-2 error Observation If there is no component or hasMember element then either a value[x] or a data absent reason must be present. (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3 error Observation.component If there is no a value a data absent reason must be present value.exists() or dataAbsentReason.exists()

Differential View

This structure is derived from USCoreVitalSignsProfile

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation 0..* USCoreVitalSignsProfile(8.0.0) US Core Vital Signs Profile
... meta
.... Slices for security 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
..... security:TransplantCenter S 1..1 Coding Security Labels applied to this resource
...... system 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... code C 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
... code 1..1 CodeableConcept Coded vital sign result type
Binding: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion (extensible)
... value[x] 0..1 Quantity Vital Signs Value

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Observation.code Base extensible https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion Not State Unknown

Constraints

Id Grade Path(s) Description Expression
sec-rc error Observation.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* USCoreVitalSignsProfile(8.0.0) US Core Vital Signs Profile
Constraints: obs-6, obs-7, vs-2
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... Slices for security Σ 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
..... security:TransplantCenter SΣ 1..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
...... 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://terminology.cibmtr.org/codesystem/transplant-center
...... version Σ 0..1 string Version of the system - if relevant
...... code ΣC 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... 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 BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for observation
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
... status ?!SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... 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 SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
...... 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
... code SΣ 1..1 CodeableConcept Coded vital sign result type
Binding: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion (extensible)
... subject SΣ 1..1 Reference(US Core Patient Profile(8.0.0)) 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
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
Constraints: vs-1
.... effectiveDateTime dateTime S
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer SΣ 0..* Reference(US Core Practitioner Profile(8.0.0) | US Core Organization Profile(8.0.0) | US Core Patient Profile(8.0.0) | PractitionerRole | US Core CareTeam Profile(8.0.0) | US Core RelatedPerson Profile(8.0.0)) Who is responsible for the observation
... value[x] SΣC 0..1 Quantity S Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... note 0..* Annotation Comments about the observation
... bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... 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 Low Range, if relevant
.... high C 0..1 SimpleQuantity 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(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Used when reporting vital signs panel components
... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Related measurements the observation is made from
... component SΣC 0..* BackboneElement Component observations
Constraints: vs-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
.... code SΣ 1..1 CodeableConcept Coded vital sign result type
Binding: Vital Sign Result Type . (extensible): Vital sign result types
.... value[x] SΣC 0..1 Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
..... valueQuantity Quantity S
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Observation.meta.security:TransplantCenter Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Observation.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
Observation.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Observation.status Base required ObservationStatus 📍4.0.1 FHIR Std.
Observation.category Base preferred Observation Category Codes 📦4.0.1 FHIR Std.
Observation.category:VSCat Base preferred Observation Category Codes 📦4.0.1 FHIR Std.
Observation.code Base extensible https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1295.1/expansion Not State Unknown
Observation.value[x] Base extensible Vital Signs Units 📍4.0.1 FHIR Std.
Observation.dataAbsentReason Base extensible DataAbsentReason 📦4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📦4.0.1 FHIR Std.
Observation.bodySite Base example SNOMED CT Body Structures 📦4.0.1 FHIR Std.
Observation.method Base example Observation Methods 📦4.0.1 FHIR Std.
Observation.referenceRange.​type Base preferred Observation Reference Range Meaning Codes 📦4.0.1 FHIR Std.
Observation.referenceRange.​appliesTo Base example Observation Reference Range Applies To Codes 📦4.0.1 FHIR Std.
Observation.component.​code Base extensible Vital Sign Result Type . 📦20240322 VSAC v0.23
Observation.component.​value[x] Base extensible Vital Signs Units 📍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
dom-2 error Observation If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Observation If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Observation If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Observation If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Observation A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
obs-3 error Observation.referenceRange Must have at least a low or a high or text low.exists() or high.exists() or text.exists()
obs-6 error Observation dataAbsentReason SHALL only be present if Observation.value[x] is not present dataAbsentReason.empty() or value.empty()
obs-7 error Observation If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
sec-rc error Observation.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
vs-1 error Observation.effective[x] if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day $this is dateTime implies $this.toString().length() >= 10
vs-2 error Observation If there is no component or hasMember element then either a value[x] or a data absent reason must be present. (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3 error Observation.component If there is no a value a data absent reason must be present value.exists() or dataAbsentReason.exists()

This structure is derived from USCoreVitalSignsProfile

Summary

Mandatory: 0 element(4 nested mandatory elements)
Must-Support: 1 element

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Observation.meta.security

 

Other representations of profile: CSV, Excel, Schematron

Notes:

valueQuantity

Vital Signs values can be reported in many forms. CIBMTR currently supports only "valueQuantity" and does not support other value[x] data types (e.g., valueString, valueCodeableConcept).

Vital sign values SHALL be reported using UCUM units as defined by the US Core Vital Signs profile. Client systems SHALL ensure that numeric values and units are aligned to avoid misinterpretation or validation errors.

Example: valueQuantity using UCUM units

"valueQuantity" : {
    "value" : 65.899999999999991,
    "unit" : "in",
    "system" : "http://unitsofmeasure.org",
    "code" : "[in_i]"
}

Special rules:

  • One code in observation.code must have a fixed Observation.code.coding.code provided in the FHIR core specification vital signs table. For example, the fixed code 8302-2 is required in body height fhir data,

  • Each vital signs Observation SHALL include a LOINC code in Observation.code.coding.code that corresponds to one of the fixed codes defined in the FHIR core Vital Signs table. The required LOINC code identifies the type of vital sign being reported.

    For example, a Body Height observation SHALL include the fixed LOINC code 8302-2:

"coding" : [{
      "system" : "http://loinc.org",
      "code" : "8302-2", 
      "display" : "Body height"
    }]

  • An Observation MAY include additional codes in Observation.code.coding that further qualify, translate, or map to the primary vital sign code. Examples include:

    -a local system-specific code -a more specific LOINC code in addition to the fixed code

    For example, a Body Weight observation may include both the fixed code 29463-7 (Body weight) and a more specific code such as 3141-9 (Body weight Measured):

"coding" : [
    {"system":"http://loinc.org",
     "code":"29463-7",
     "display":"Body weight"},

    {"system":"http://loinc.org",
     "code":"3141-9",
     "display":"Body weight Measured"}
    ]

A code system value SHOULD be supplied for each additional code.

  • The observations MAY have component observations. For example, to qualify the vital sign observation, 8310-5 - Body temperature, 8327-9 - Body temperature measurement site (oral, forehead, rectal, etc.) may be used as a component observation. The FHIR core specification vital signs table provides several of these.
  • An Observation MAY include component observations to further qualify the measurement. For example, to qualify the vital sign observation, 8310-5 - Body temperature, 8327-9 - Body temperature measurement site (oral, forehead, rectal, etc.) may be used as a component observation. The FHIR core specification vital signs table provides several of these.