Onconova Implementation Guide - Local Development build (v0.2.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: Comorbidities Profile

A profile representing comorbidities for a cancer patient, i.e. other health conditions that exist alongside the primary cancer diagnosis. Supports existing comorbidity panels such as the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) with comorbidity indexes.

The profile constrains the mCODE Comorbidities profile to ensure consistent use of ICD-10 codes for documenting comorbid conditions, and to link the comorbidity information to the Onconova primary cancer condition profile.

Conformance:

Observation resources representing a generic or panel comorbidities assessment in the scope of Onconova SHALL conform to this profile. Any resource intended to conform to this profile SHOULD populate meta.profile accordingly.

Usages:

• CapabilityStatements using this Profile: Onconova FHIR REST Server Capability Statement
• 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.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Comorbidities	assessment observation Constraints: obs-6, obs-7, com-1, com-req-1, com-req-2, com-req-3
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comorbidConditionPresent	S	0..*	(Complex)	Related Condition Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition"
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
extension:comorbidConditionAbsent	S	0..*	(Complex)	Related Condition Absent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent"
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Not used in this profile
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Not used in this profile
status	?!SΣ	1..1	code	Not used in this profile Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code	SΣ	1..1	CodeableConcept	(USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 398192003
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(Cancer Patient Profile)	(USCDI) Who and/or what the observation is about Obligations Actor SHALL:populate & SHALL:populate Creator (Onconova)Creator (Onconova) SHOULD:persist & SHOULD:persist Consumer (Onconova)Consumer (Onconova)
focus	SOΣ	1..1	Reference(Primary Cancer Condition Profile)	The Index Condition Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
encounter	Σ	0..1	Reference(Encounter)	Not used in this profile
effective[x]	SΣ	1..1	dateTime S	(USCDI) Clinically relevant time/time-period for observation
issued	Σ	0..1	instant	Not used in this profile
performer	SΣ	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	Not used in this profile
value[x]	SOΣC	0..1	Quantity S	Comorbidity Index Score Obligations Actor SHOULD:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
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 Required Pattern: 1
interpretation		0..*	CodeableConcept	Not used in this profile Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
method	O	0..1	CodeableConcept	Comorbidity framework used. Binding: Comorbidity Panels Value Set (required) Obligations Actor SHALL:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
referenceRange	C	0..*	BackboneElement	Not used in this profile Constraints: obs-3
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
derivedFrom	Σ	0..*	Reference(Observation | US Core DocumentReference Profile | US Core QuestionnaireResponse Profile | ImagingStudy | Media | MolecularSequence)	Not used in this profile
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.extension:comorbidConditionPresent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.extension:comorbidConditionAbsent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.category:us-core	Base	required	US Core Simple Observation Category	📦6.1.0	US Core v6.1
Observation.code	Base	preferred	LOINC Codes	📦4.0.1	FHIR Std.
Observation.value[x].​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.interpretation	Base	extensible	Observation Interpretation Codes	📦4.0.1	FHIR Std.
Observation.method	Base	required	Comorbidity Panels Value Set	📦0.2.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
com-1	error	Observation	If an index score is provided, then the comorbidity panel method must also be provided.	valueQuantity.exists() implies method.exists()
com-req-1	error	Observation	The subject element is required and must be provided.	subject.exists()
com-req-2	error	Observation	The effectiveDateTime element is required and must be provided.	effectiveDateTime.exists() and effectiveDateTime.hasValue()
com-req-3	error	Observation	The focus element is required and must be provided.	focus.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()
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()

This structure is derived from Comorbidities

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Comorbidities	assessment observation Constraints: com-1, com-req-1, com-req-2, com-req-3
Slices for extension				Content/Rules for all slices
extension:comorbidConditionPresent		0..*	RelatedCondition	Related Condition Extension
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
extension:comorbidConditionAbsent		0..*	RelatedConditionAbsent	Related Condition Absent Extension
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
basedOn		0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Not used in this profile
partOf		0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Not used in this profile
status		1..1	code	Not used in this profile
subject	O	1..1	Reference(Cancer Patient Profile)	(USCDI) Who and/or what the observation is about Obligations Actor SHALL:populate & SHALL:populate Creator (Onconova)Creator (Onconova) SHOULD:persist & SHOULD:persist Consumer (Onconova)Consumer (Onconova)
focus	O	1..1	Reference(Primary Cancer Condition Profile)	The Index Condition Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
encounter		0..1	Reference(Encounter)	Not used in this profile
effective[x]		1..1	dateTime	(USCDI) Clinically relevant time/time-period for observation
issued		0..1	instant	Not used in this profile
performer		0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	Not used in this profile
value[x]	O	0..1	Quantity	Comorbidity Index Score Obligations Actor SHOULD:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
unit		0..1	string	Unit representation Required Pattern: 1
interpretation		0..*	CodeableConcept	Not used in this profile
method	O	0..1	CodeableConcept	Comorbidity framework used. Binding: Comorbidity Panels Value Set (required) Obligations Actor SHALL:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
referenceRange		0..*	BackboneElement	Not used in this profile
derivedFrom		0..*	Reference(Observation | US Core DocumentReference Profile | US Core QuestionnaireResponse Profile | ImagingStudy | Media | MolecularSequence)	Not used in this profile
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Observation.extension:comorbidConditionPresent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.extension:comorbidConditionAbsent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.method	Base	required	Comorbidity Panels Value Set	📦0.2.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
com-1	error	Observation	If an index score is provided, then the comorbidity panel method must also be provided.	valueQuantity.exists() implies method.exists()
com-req-1	error	Observation	The subject element is required and must be provided.	subject.exists()
com-req-2	error	Observation	The effectiveDateTime element is required and must be provided.	effectiveDateTime.exists() and effectiveDateTime.hasValue()
com-req-3	error	Observation	The focus element is required and must be provided.	focus.exists()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Comorbidities	assessment observation Constraints: obs-6, obs-7, com-1, com-req-1, com-req-2, com-req-3
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comorbidConditionPresent	S	0..*	(Complex)	Related Condition Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition"
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
extension:comorbidConditionAbsent	S	0..*	(Complex)	Related Condition Absent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent"
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
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)	Not used in this profile
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Not used in this profile
status	?!SΣ	1..1	code	Not used in this profile Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code	SΣ	1..1	CodeableConcept	(USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 398192003
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(Cancer Patient Profile)	(USCDI) Who and/or what the observation is about Obligations Actor SHALL:populate & SHALL:populate Creator (Onconova)Creator (Onconova) SHOULD:persist & SHOULD:persist Consumer (Onconova)Consumer (Onconova)
focus	SOΣ	1..1	Reference(Primary Cancer Condition Profile)	The Index Condition Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
encounter	Σ	0..1	Reference(Encounter)	Not used in this profile
effective[x]	SΣ	1..1	dateTime S	(USCDI) Clinically relevant time/time-period for observation
issued	Σ	0..1	instant	Not used in this profile
performer	SΣ	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	Not used in this profile
value[x]	SOΣC	0..1	Quantity S	Comorbidity Index Score Obligations Actor SHOULD:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
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 Required Pattern: 1
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	Not used in this profile Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Not used in this profile Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method	O	0..1	CodeableConcept	Comorbidity framework used. Binding: Comorbidity Panels Value Set (required) Obligations Actor SHALL:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
specimen		0..1	Reference(Specimen)	Not used in this profile
device		0..1	Reference(Device | DeviceMetric)	Not used in this profile
referenceRange	C	0..*	BackboneElement	Not used in this profile 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(Observation | QuestionnaireResponse | MolecularSequence)	Not used in this profile
derivedFrom	Σ	0..*	Reference(Observation | US Core DocumentReference Profile | US Core QuestionnaireResponse Profile | ImagingStudy | Media | MolecularSequence)	Not used in this profile
component	Σ	0..*	BackboneElement	Not used in this profile
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.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
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.extension:comorbidConditionPresent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.extension:comorbidConditionAbsent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.category:us-core	Base	required	US Core Simple Observation Category	📦6.1.0	US Core v6.1
Observation.code	Base	preferred	LOINC Codes	📦4.0.1	FHIR Std.
Observation.value[x].​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	required	Comorbidity Panels Value Set	📦0.2.0	This IG
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.​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
com-1	error	Observation	If an index score is provided, then the comorbidity panel method must also be provided.	valueQuantity.exists() implies method.exists()
com-req-1	error	Observation	The subject element is required and must be provided.	subject.exists()
com-req-2	error	Observation	The effectiveDateTime element is required and must be provided.	effectiveDateTime.exists() and effectiveDateTime.hasValue()
com-req-3	error	Observation	The focus element is required and must be provided.	focus.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()
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()

This structure is derived from Comorbidities

Summary

Mandatory: 2 elements

Structures

This structure refers to these other structures:

• Cancer Patient Profile (http://onconova.github.io/fhir/StructureDefinition/onconova-cancer-patient)
• Primary Cancer Condition Profile (http://onconova.github.io/fhir/StructureDefinition/onconova-primary-cancer-condition)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Comorbidities	assessment observation Constraints: obs-6, obs-7, com-1, com-req-1, com-req-2, com-req-3
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comorbidConditionPresent	S	0..*	(Complex)	Related Condition Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition"
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
extension:comorbidConditionAbsent	S	0..*	(Complex)	Related Condition Absent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent"
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Not used in this profile
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Not used in this profile
status	?!SΣ	1..1	code	Not used in this profile Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code	SΣ	1..1	CodeableConcept	(USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 398192003
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(Cancer Patient Profile)	(USCDI) Who and/or what the observation is about Obligations Actor SHALL:populate & SHALL:populate Creator (Onconova)Creator (Onconova) SHOULD:persist & SHOULD:persist Consumer (Onconova)Consumer (Onconova)
focus	SOΣ	1..1	Reference(Primary Cancer Condition Profile)	The Index Condition Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
encounter	Σ	0..1	Reference(Encounter)	Not used in this profile
effective[x]	SΣ	1..1	dateTime S	(USCDI) Clinically relevant time/time-period for observation
issued	Σ	0..1	instant	Not used in this profile
performer	SΣ	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	Not used in this profile
value[x]	SOΣC	0..1	Quantity S	Comorbidity Index Score Obligations Actor SHOULD:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
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 Required Pattern: 1
interpretation		0..*	CodeableConcept	Not used in this profile Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
method	O	0..1	CodeableConcept	Comorbidity framework used. Binding: Comorbidity Panels Value Set (required) Obligations Actor SHALL:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
referenceRange	C	0..*	BackboneElement	Not used in this profile Constraints: obs-3
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
derivedFrom	Σ	0..*	Reference(Observation | US Core DocumentReference Profile | US Core QuestionnaireResponse Profile | ImagingStudy | Media | MolecularSequence)	Not used in this profile
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.extension:comorbidConditionPresent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.extension:comorbidConditionAbsent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.category:us-core	Base	required	US Core Simple Observation Category	📦6.1.0	US Core v6.1
Observation.code	Base	preferred	LOINC Codes	📦4.0.1	FHIR Std.
Observation.value[x].​comparator	Base	required	QuantityComparator	📍4.0.1	FHIR Std.
Observation.interpretation	Base	extensible	Observation Interpretation Codes	📦4.0.1	FHIR Std.
Observation.method	Base	required	Comorbidity Panels Value Set	📦0.2.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
com-1	error	Observation	If an index score is provided, then the comorbidity panel method must also be provided.	valueQuantity.exists() implies method.exists()
com-req-1	error	Observation	The subject element is required and must be provided.	subject.exists()
com-req-2	error	Observation	The effectiveDateTime element is required and must be provided.	effectiveDateTime.exists() and effectiveDateTime.hasValue()
com-req-3	error	Observation	The focus element is required and must be provided.	focus.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()
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()

Differential View

This structure is derived from Comorbidities

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Comorbidities	assessment observation Constraints: com-1, com-req-1, com-req-2, com-req-3
Slices for extension				Content/Rules for all slices
extension:comorbidConditionPresent		0..*	RelatedCondition	Related Condition Extension
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
extension:comorbidConditionAbsent		0..*	RelatedConditionAbsent	Related Condition Absent Extension
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
basedOn		0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Not used in this profile
partOf		0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Not used in this profile
status		1..1	code	Not used in this profile
subject	O	1..1	Reference(Cancer Patient Profile)	(USCDI) Who and/or what the observation is about Obligations Actor SHALL:populate & SHALL:populate Creator (Onconova)Creator (Onconova) SHOULD:persist & SHOULD:persist Consumer (Onconova)Consumer (Onconova)
focus	O	1..1	Reference(Primary Cancer Condition Profile)	The Index Condition Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
encounter		0..1	Reference(Encounter)	Not used in this profile
effective[x]		1..1	dateTime	(USCDI) Clinically relevant time/time-period for observation
issued		0..1	instant	Not used in this profile
performer		0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	Not used in this profile
value[x]	O	0..1	Quantity	Comorbidity Index Score Obligations Actor SHOULD:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
unit		0..1	string	Unit representation Required Pattern: 1
interpretation		0..*	CodeableConcept	Not used in this profile
method	O	0..1	CodeableConcept	Comorbidity framework used. Binding: Comorbidity Panels Value Set (required) Obligations Actor SHALL:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
referenceRange		0..*	BackboneElement	Not used in this profile
derivedFrom		0..*	Reference(Observation | US Core DocumentReference Profile | US Core QuestionnaireResponse Profile | ImagingStudy | Media | MolecularSequence)	Not used in this profile
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Observation.extension:comorbidConditionPresent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.extension:comorbidConditionAbsent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.method	Base	required	Comorbidity Panels Value Set	📦0.2.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
com-1	error	Observation	If an index score is provided, then the comorbidity panel method must also be provided.	valueQuantity.exists() implies method.exists()
com-req-1	error	Observation	The subject element is required and must be provided.	subject.exists()
com-req-2	error	Observation	The effectiveDateTime element is required and must be provided.	effectiveDateTime.exists() and effectiveDateTime.hasValue()
com-req-3	error	Observation	The focus element is required and must be provided.	focus.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Comorbidities	assessment observation Constraints: obs-6, obs-7, com-1, com-req-1, com-req-2, com-req-3
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comorbidConditionPresent	S	0..*	(Complex)	Related Condition Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition"
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
extension:comorbidConditionAbsent	S	0..*	(Complex)	Related Condition Absent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-related-condition-absent"
value[x]	O	1..1	CodeableConcept	Value of extension Binding: ICD-10 Codes Value Set (required) Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
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)	Not used in this profile
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Not used in this profile
status	?!SΣ	1..1	code	Not used in this profile Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code	SΣ	1..1	CodeableConcept	(USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 398192003
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(Cancer Patient Profile)	(USCDI) Who and/or what the observation is about Obligations Actor SHALL:populate & SHALL:populate Creator (Onconova)Creator (Onconova) SHOULD:persist & SHOULD:persist Consumer (Onconova)Consumer (Onconova)
focus	SOΣ	1..1	Reference(Primary Cancer Condition Profile)	The Index Condition Obligations Actor SHALL:populate Creator (Onconova) SHOULD:persist Consumer (Onconova)
encounter	Σ	0..1	Reference(Encounter)	Not used in this profile
effective[x]	SΣ	1..1	dateTime S	(USCDI) Clinically relevant time/time-period for observation
issued	Σ	0..1	instant	Not used in this profile
performer	SΣ	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	Not used in this profile
value[x]	SOΣC	0..1	Quantity S	Comorbidity Index Score Obligations Actor SHOULD:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
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 Required Pattern: 1
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	Not used in this profile Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Not used in this profile Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method	O	0..1	CodeableConcept	Comorbidity framework used. Binding: Comorbidity Panels Value Set (required) Obligations Actor SHALL:populate-if-known Creator (Onconova) SHOULD:persist Consumer (Onconova)
specimen		0..1	Reference(Specimen)	Not used in this profile
device		0..1	Reference(Device | DeviceMetric)	Not used in this profile
referenceRange	C	0..*	BackboneElement	Not used in this profile 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(Observation | QuestionnaireResponse | MolecularSequence)	Not used in this profile
derivedFrom	Σ	0..*	Reference(Observation | US Core DocumentReference Profile | US Core QuestionnaireResponse Profile | ImagingStudy | Media | MolecularSequence)	Not used in this profile
component	Σ	0..*	BackboneElement	Not used in this profile
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.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
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.extension:comorbidConditionPresent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.extension:comorbidConditionAbsent.​value[x]	Base	required	ICD-10 Codes Value Set	📦0.2.0	This IG
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.category:us-core	Base	required	US Core Simple Observation Category	📦6.1.0	US Core v6.1
Observation.code	Base	preferred	LOINC Codes	📦4.0.1	FHIR Std.
Observation.value[x].​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	required	Comorbidity Panels Value Set	📦0.2.0	This IG
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.​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
com-1	error	Observation	If an index score is provided, then the comorbidity panel method must also be provided.	valueQuantity.exists() implies method.exists()
com-req-1	error	Observation	The subject element is required and must be provided.	subject.exists()
com-req-2	error	Observation	The effectiveDateTime element is required and must be provided.	effectiveDateTime.exists() and effectiveDateTime.hasValue()
com-req-3	error	Observation	The focus element is required and must be provided.	focus.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()
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()

This structure is derived from Comorbidities

Summary

Mandatory: 2 elements

Structures

This structure refers to these other structures:

• Cancer Patient Profile (http://onconova.github.io/fhir/StructureDefinition/onconova-cancer-patient)
• Primary Cancer Condition Profile (http://onconova.github.io/fhir/StructureDefinition/onconova-primary-cancer-condition)

Other representations of profile: CSV, Excel, Schematron