SHINNYHRSN - Local Development build (v1.5.3) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: SHINNY Observation Screening Response Profile

• SHINNY HRSN: Needed for Screenings. Include in the Screening bundles and when needed as a referrence, include in Service Request, Task, and Assessment bundles.
• Profiled off of the SDOHCC Observation Screening Response: Profile for observations that represent question and answer pairs from Social Determinants of Health (SDOH) screening instruments.

Usage:

• Examples for this Resource Profile: Observation/AHCScreeningGroup96777-8, Observation/AlcoholUse68517-2, Observation/AssessmentResponseQuestionGrouper1, Observation/AssessmentResponseQuestionGrouper2... Show 35 more, Observation/Disability69858-9, Observation/Disability69861-3, Observation/DrugUse68524-8, Observation/Education96782-8, Observation/EmploymentStatus96780-2, Observation/FinancialInsecurity76513-1, Observation/FoodInsecurity88122-7, Observation/FoodInsecurity88123-5, Observation/HousingInstability71802-3, Observation/InadequateHousing96778-6, Observation/InadequateHousing96778-6Components, Observation/InterpersonalSafety95614-4, Observation/InterpersonalSafety95615-1, Observation/InterpersonalSafety95616-9, Observation/InterpersonalSafety95617-7, Observation/InterpersonalSafety95618-5, Observation/InterpersonalSafety95618-5Declined, Observation/LanguageFinding97027-7, Observation/MentalState44250-9, Observation/MentalState44255-8, Observation/MentalStateScore, Observation/NYSAHCHRSNScreeningGroup, Observation/NYSAHCHRSNScreeningGroupDeclinedAnswer, Observation/PhysicalActivity68516-4, Observation/PhysicalActivity89555-7, Observation/PhysicalActivityWeekly, Observation/SocialConnection96781-0, Observation/SocialHistory93159-2, Observation/Stress93038-8, Observation/SubstanceUse95530-2, Observation/SupplementalGroup97023-6, Observation/TobaccoUse96842-0, Observation/TransportationInsecurity93030-5, Observation/TransportationInsecurity93030-5Unknown and Observation/UtilityInsecurity96779-4

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
Observation	C	0..*	SDOHCCObservationScreeningResponse	SDOH screening questionnaire observations dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present Observation-PerformerOrganizationScreening: All grouper screening observations must include a performer that references an organization. SHINNYScreeningHousingComponent: All housing adequacy questions with code 96778-6, with a response value, require values as components.
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred) ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣ	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required) ele-1: All FHIR elements must have a @value or children
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories. ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access LOINCCodes Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status LOINCCodes Required Observation.category = sdoh-category-unspecified ele-1: All FHIR elements must have a @value or children
coding	SΣ	1..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
display	Σ	0..1	string	If present, this MUST match the long description name provided by the source system ele-1: All FHIR elements must have a @value or children
text	Σ	0..1	string	This is the human readable question that is presented to the patient and should be present ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
encounter	SΣ	1..1	Reference(Encounter)	Healthcare event during which this observation is made ele-1: All FHIR elements must have a @value or children
effective[x]	SΣ	1..1		Clinically relevant time/time-period for observation ele-1: All FHIR elements must have a @value or children
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SΣ	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation ele-1: All FHIR elements must have a @value or children
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueCodeableConcept	ΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability VSAC 2.16.840.1.113762.1.4.1196.178 Extensible Observation.category = inadequate-housing Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments Answers Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments Answers Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments Answers Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified ele-1: All FHIR elements must have a @value or children
text	Σ	0..1	string	This is the human readable answer that is presented to the patient and MUST be present ele-1: All FHIR elements must have a @value or children
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set. ele-1: All FHIR elements must have a @value or children
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing. ele-1: All FHIR elements must have a @value or children
Slices for hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument ele-1: All FHIR elements must have a @value or children
Slices for derivedFrom	SΣ	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS from this IG
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern: social-history http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:Survey	preferred	Pattern: survey http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationScreening	error	Observation	All grouper screening observations must include a performer that references an organization. : hasMember.exists() implies (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
SHINNYScreeningHousingComponent	error	Observation	All housing adequacy questions with code 96778-6, with a response value, require values as components. : where(code.coding.code contains '96778-6').exists() and dataAbsentReason.empty() and component.dataAbsentReason.empty() implies component.select(code.coding).where(code = '96778-6') and component.select(value).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-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 SDOHCCObservationScreeningResponse

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	SDOHCCObservationScreeningResponse	SDOH screening questionnaire observations Observation-PerformerOrganizationScreening: All grouper screening observations must include a performer that references an organization. SHINNYScreeningHousingComponent: All housing adequacy questions with code 96778-6, with a response value, require values as components.
id	S	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	S	1..1	SHINNYMeta	Metadata about the resource
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
code
coding	S	1..*	Coding	Code defined by a terminology system
display		0..1	string	If present, this MUST match the long description name provided by the source system
text		0..1	string	This is the human readable question that is presented to the patient and should be present
encounter	S	1..1	Reference(Encounter)	Healthcare event during which this observation is made
Slices for value[x]				Content/Rules for all slices
value[x]:valueCodeableConcept		0..1	CodeableConcept	Actual result
coding
display		0..1	string	This MUST match the long description name provided by the source system
text		0..1	string	This is the human readable answer that is presented to the patient and MUST be present
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationScreening	error	Observation	All grouper screening observations must include a performer that references an organization. : hasMember.exists() implies (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
SHINNYScreeningHousingComponent	error	Observation	All housing adequacy questions with code 96778-6, with a response value, require values as components. : where(code.coding.code contains '96778-6').exists() and dataAbsentReason.empty() and component.dataAbsentReason.empty() implies component.select(code.coding).where(code = '96778-6') and component.select(value).exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	SDOHCCObservationScreeningResponse	SDOH screening questionnaire observations obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present Observation-PerformerOrganizationScreening: All grouper screening observations must include a performer that references an organization. SHINNYScreeningHousingComponent: All housing adequacy questions with code 96778-6, with a response value, require values as components.
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	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: SHINNYLanguageVS (preferred)
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
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	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. 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://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
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
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. 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://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
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
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access LOINCCodes Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status LOINCCodes Required Observation.category = sdoh-category-unspecified
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	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	If present, this MUST match the long description name provided by the source system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	This is the human readable question that is presented to the patient and should be present
subject	SΣ	1..1	Reference(US Core Patient Profile)	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	SΣ	1..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Closed by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueCodeableConcept	ΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability VSAC 2.16.840.1.113762.1.4.1196.178 Extensible Observation.category = inadequate-housing Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments Answers Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments Answers Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments Answers Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	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	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	This MUST match the long description name provided by the source system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	This is the human readable answer that is presented to the patient and MUST be present
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
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
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
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
Slices for hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	SΣ	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
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	Conformance	ValueSet / Code	URI
Observation.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS from this IG
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern: social-history http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:Survey	preferred	Pattern: survey http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationScreening	error	Observation	All grouper screening observations must include a performer that references an organization. : hasMember.exists() implies (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
SHINNYScreeningHousingComponent	error	Observation	All housing adequacy questions with code 96778-6, with a response value, require values as components. : where(code.coding.code contains '96778-6').exists() and dataAbsentReason.empty() and component.dataAbsentReason.empty() implies component.select(code.coding).where(code = '96778-6') and component.select(value).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 SDOHCCObservationScreeningResponse

Summary

Mandatory: 4 elements
Must-Support: 4 elements

Structures

This structure refers to these other structures:

• SHINNYMeta (http://shinny.org/us/ny/hrsn/StructureDefinition/SHINNYMeta)

Extensions

This structure refers to these extensions:

• http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	SDOHCCObservationScreeningResponse	SDOH screening questionnaire observations dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present Observation-PerformerOrganizationScreening: All grouper screening observations must include a performer that references an organization. SHINNYScreeningHousingComponent: All housing adequacy questions with code 96778-6, with a response value, require values as components.
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred) ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣ	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required) ele-1: All FHIR elements must have a @value or children
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories. ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access LOINCCodes Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status LOINCCodes Required Observation.category = sdoh-category-unspecified ele-1: All FHIR elements must have a @value or children
coding	SΣ	1..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
display	Σ	0..1	string	If present, this MUST match the long description name provided by the source system ele-1: All FHIR elements must have a @value or children
text	Σ	0..1	string	This is the human readable question that is presented to the patient and should be present ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
encounter	SΣ	1..1	Reference(Encounter)	Healthcare event during which this observation is made ele-1: All FHIR elements must have a @value or children
effective[x]	SΣ	1..1		Clinically relevant time/time-period for observation ele-1: All FHIR elements must have a @value or children
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SΣ	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation ele-1: All FHIR elements must have a @value or children
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueCodeableConcept	ΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability VSAC 2.16.840.1.113762.1.4.1196.178 Extensible Observation.category = inadequate-housing Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments Answers Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments Answers Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments Answers Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified ele-1: All FHIR elements must have a @value or children
text	Σ	0..1	string	This is the human readable answer that is presented to the patient and MUST be present ele-1: All FHIR elements must have a @value or children
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set. ele-1: All FHIR elements must have a @value or children
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing. ele-1: All FHIR elements must have a @value or children
Slices for hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument ele-1: All FHIR elements must have a @value or children
Slices for derivedFrom	SΣ	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS from this IG
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern: social-history http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:Survey	preferred	Pattern: survey http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationScreening	error	Observation	All grouper screening observations must include a performer that references an organization. : hasMember.exists() implies (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
SHINNYScreeningHousingComponent	error	Observation	All housing adequacy questions with code 96778-6, with a response value, require values as components. : where(code.coding.code contains '96778-6').exists() and dataAbsentReason.empty() and component.dataAbsentReason.empty() implies component.select(code.coding).where(code = '96778-6') and component.select(value).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-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 SDOHCCObservationScreeningResponse

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	SDOHCCObservationScreeningResponse	SDOH screening questionnaire observations Observation-PerformerOrganizationScreening: All grouper screening observations must include a performer that references an organization. SHINNYScreeningHousingComponent: All housing adequacy questions with code 96778-6, with a response value, require values as components.
id	S	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	S	1..1	SHINNYMeta	Metadata about the resource
language		0..1	code	Language of the resource content Binding: SHINNYLanguageVS (preferred)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
code
coding	S	1..*	Coding	Code defined by a terminology system
display		0..1	string	If present, this MUST match the long description name provided by the source system
text		0..1	string	This is the human readable question that is presented to the patient and should be present
encounter	S	1..1	Reference(Encounter)	Healthcare event during which this observation is made
Slices for value[x]				Content/Rules for all slices
value[x]:valueCodeableConcept		0..1	CodeableConcept	Actual result
coding
display		0..1	string	This MUST match the long description name provided by the source system
text		0..1	string	This is the human readable answer that is presented to the patient and MUST be present
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationScreening	error	Observation	All grouper screening observations must include a performer that references an organization. : hasMember.exists() implies (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
SHINNYScreeningHousingComponent	error	Observation	All housing adequacy questions with code 96778-6, with a response value, require values as components. : where(code.coding.code contains '96778-6').exists() and dataAbsentReason.empty() and component.dataAbsentReason.empty() implies component.select(code.coding).where(code = '96778-6') and component.select(value).exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	SDOHCCObservationScreeningResponse	SDOH screening questionnaire observations obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present Observation-PerformerOrganizationScreening: All grouper screening observations must include a performer that references an organization. SHINNYScreeningHousingComponent: All housing adequacy questions with code 96778-6, with a response value, require values as components.
id	SΣ	1..1	id	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	SΣ	1..1	SHINNYMeta	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: SHINNYLanguageVS (preferred)
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:screeninglanguage		0..*	CodeableConcept	SHINNY Observation Language URL: http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
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	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. 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://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
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
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. 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://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
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
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access LOINCCodes Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status LOINCCodes Required Observation.category = sdoh-category-unspecified
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	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	If present, this MUST match the long description name provided by the source system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	This is the human readable question that is presented to the patient and should be present
subject	SΣ	1..1	Reference(US Core Patient Profile)	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	SΣ	1..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Closed by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueCodeableConcept	ΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability VSAC 2.16.840.1.113762.1.4.1196.178 Extensible Observation.category = inadequate-housing Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments Answers Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments Answers Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments Answers Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	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	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	This MUST match the long description name provided by the source system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	This is the human readable answer that is presented to the patient and MUST be present
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
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
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
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
Slices for hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	SΣ	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
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	Conformance	ValueSet / Code	URI
Observation.language	preferred	SHINNYLanguageVS http://shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS from this IG
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern: social-history http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:Survey	preferred	Pattern: survey http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
Observation-PerformerOrganizationScreening	error	Observation	All grouper screening observations must include a performer that references an organization. : hasMember.exists() implies (performer.reference.where ($this.contains ('Organization')).count() > 0 or performer.type.where ($this.contains ('Organization')).count() > 0)
SHINNYScreeningHousingComponent	error	Observation	All housing adequacy questions with code 96778-6, with a response value, require values as components. : where(code.coding.code contains '96778-6').exists() and dataAbsentReason.empty() and component.dataAbsentReason.empty() implies component.select(code.coding).where(code = '96778-6') and component.select(value).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 SDOHCCObservationScreeningResponse

Summary

Mandatory: 4 elements
Must-Support: 4 elements

Structures

This structure refers to these other structures:

• SHINNYMeta (http://shinny.org/us/ny/hrsn/StructureDefinition/SHINNYMeta)

Extensions

This structure refers to these extensions:

• http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language