1.7.1 - release

SHINNYHRSN - Local Development build (v1.7.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Resource Profile: SHINNY Observation Screening Response Profile

Official URL: http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-screening-response | Version: 1.7.1
Active as of 2025-12-09 | Computable Name: SHINNYObservationScreeningResponse

- 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.

### Purpose

The SHINNY Observation Screening Response Profile inherits from the SDOH Clinical Care Observation Screening Response profile. This profile is intended to represent question-answer pairs from Social Determinants of Health (SDOH) assessment instruments.

### Usage

For a complete description of usage, please reference the details documented within the SDOH Clinical Care Implementation Guide

#### Language

Note that within the SHINNYLanguageVS value set there are two different links to language standards. Within the FHIR documentation, currently there is no way of navitaging directly to the complete list of "All Languages", which can be found here.

It's also important to note there are two language attributes within the patient resource. The "language" attribute within all resources describes the language of the FHIR IG itself. For the SHIN-NY IG, this should always be "en" for English. The communication.language is described as, "The language which can be used to communicate with the patient about his or her health." For this attribute, any of the languages found in the list of "All Languages", referenced above, can be used.

Usages:

- Examples for this Profile: Observation/ObservationResponseAlcoholUse68517-2, Observation/ObservationResponseDisability69858-9, Observation/ObservationResponseDisability69861-3, Observation/ObservationResponseDrugUse68524-8... Show 38 more, Observation/ObservationResponseEducation96782-8, Observation/ObservationResponseEmploymentStatus96780-2, Observation/ObservationResponseFinancialInsecurity76513-1, Observation/ObservationResponseFoodInsecurity88122-7, Observation/ObservationResponseFoodInsecurity88123-5, Observation/ObservationResponseHousingInstability71802-3, Observation/ObservationResponseInadequateHousing96778-6, Observation/ObservationResponseInadequateHousingWithComponents, Observation/ObservationResponseInterpersonalSafety95614-4, Observation/ObservationResponseInterpersonalSafety95614-4Declined, Observation/ObservationResponseInterpersonalSafety95615-1, Observation/ObservationResponseInterpersonalSafety95616-9, Observation/ObservationResponseInterpersonalSafety95617-7, Observation/ObservationResponseInterpersonalSafety95618-5, Observation/ObservationResponseInterpersonalSafety95618-5Declined, Observation/ObservationResponseLanguageFinding97027-7, Observation/ObservationResponseMainAHCScreeningGroup96777-8, Observation/ObservationResponseMentalState44250-9, Observation/ObservationResponseMentalState44255-8, Observation/ObservationResponseMentalStateScore, Observation/ObservationResponseNYSAHCHRSNScreeningGroup, Observation/ObservationResponseNYSAHCHRSNScreeningGroupDeclinedAnswer, Observation/ObservationResponseNYSAHCHRSNScreeningGroupUnknown, Observation/ObservationResponsePhysicalActivity68516-4, Observation/ObservationResponsePhysicalActivity89555-7, Observation/ObservationResponsePhysicalActivityWeekly, Observation/ObservationResponseQuestion1grouper, Observation/ObservationResponseQuestion2grouper, Observation/ObservationResponseSocialConnection96781-0, Observation/ObservationResponseSocialHistory93159-2, Observation/ObservationResponseStress93038-8, Observation/ObservationResponseSubstanceUse95530-2, Observation/ObservationResponseSupplementalGroup97023-6, Observation/ObservationResponseTobaccoUse96842-0, Observation/ObservationResponseTransportationInsecurity93030-5, Observation/ObservationResponseTransportationInsecurity93030-5NewNeed, Observation/ObservationResponseTransportationInsecurity93030-5Unknown and Observation/ObservationResponseUtilityInsecurity96779-4

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..* | SDOHCCObservationScreeningResponse | SDOH screening questionnaire observations Constraints: obs-6, obs-7, Observation-PerformerOrganizationScreening, SHINNYScreeningHousingComponent
id | S Σ | 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 Σ | 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)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:screeninglanguage |  | 0..* | CodeableConcept | SHINNY Observation Language URL: http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category |  | 3..* | 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 | 1..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
category:SNOMED | S | 0..* | CodeableConcept | SNOMED CT codes associated with SDOH category. Binding: SHINNYSNOMEDSDOHCategory (required): SNOMED codes descirbing a specific SDOH category when that category is not locally defined.
code | S Σ | 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 | SDOHCCObservationScreeningResponse#`Observation.category` = digital-access
LOINCCodes | Required | SDOHCCObservationScreeningResponse#`Observation.category` = digital-literacy
Less Than High School Education Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = educational-attainment
Elder Abuse Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = elder-abuse
Unemployment Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = employment-status
Financial Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = financial-insecurity
Food Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = food-insecurity
Health Insurance Coverage Status Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = health-insurance-coverage-status
Homelessness Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = homelessness
Housing Instability Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = housing-instability
Inadequate Housing Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = inadequate-housing
Intimate Partner Violence Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = intimate-partner-violence
Material Hardship Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = material-hardship
Medical Cost Burden Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = medical-cost-burden
Health Literacy Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = personal-health-literacy
Social Connection Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = social-connection
Stress Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = stress
Transportation Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = transportation-insecurity
Utility Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = utility-insecurity
Veteran Status Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = veteran-status
LOINCCodes | Required | SDOHCCObservationScreeningResponse#`Observation.category` = sdoh-category-unspecified
coding | S Σ | 1..* | Coding | Code defined by a terminology system
display | Σ | 0..1 | string | If present, this MUST match the long description name provided by the source system
text | Σ | 0..1 | string | This is the human readable question that is presented to the patient and should be present
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
encounter | S Σ | 1..1 | Reference(Encounter) | Healthcare event during which this observation is made
effective[x] | S Σ | 1..1 |  | Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
performer | S Σ | 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] | S Σ C | 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 | Σ C | 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 | SDOHCCObservationScreeningResponse#`Observation.category` = digital-access
LOINCCodes | Preferred | SDOHCCObservationScreeningResponse#`Observation.category` = digital-literacy
Less Than High School Education Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = educational-attainment
Elder Abuse Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = elder-abuse
Unemployment Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = employment-status
Financial Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = financial-insecurity
Food Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = food-insecurity
Health Insurance Coverage Status Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = health-insurance-coverage-status
Homelessness Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = homelessness
Housing Instability Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = housing-instability
VSAC 2.16.840.1.113762.1.4.1196.178 | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = inadequate-housing
Intimate Partner Violence Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = intimate-partner-violence
Material Hardship Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = material-hardship
Medical Cost Burden Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = medical-cost-burden
Health Literacy Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = personal-health-literacy
Social Connection Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = social-connection
Stress Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = stress
Transportation Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = transportation-insecurity
Utility Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = utility-insecurity
Veteran Status Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = veteran-status
LOINCCodes | Preferred | SDOHCCObservationScreeningResponse#`Observation.category` = sdoh-category-unspecified
text | Σ | 0..1 | string | This is the human readable answer that is presented to the patient and MUST be present
value[x]:valueQuantity | Σ C | 0..1 | Quantity | Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Slices for hasMember | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember | S Σ | 0..* | Reference(SDOHCC Observation Screening Response) | For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom | S Σ | 0..* | Reference(DocumentReference | QuestionnaireResponse | Observation) | Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom | S Σ | 0..* | Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response) | Related questionnaire responses or observations that the observation is made from
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Observation.language | preferred | SHINNYLanguageVS `http://test.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 Value: social-history `http://hl7.org/fhir/ValueSet/observation-category` From the FHIR Standard
Observation.category:Survey | preferred | Pattern Value: 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.category:SNOMED | required | SHINNYSNOMEDSDOHCategory(a valid code from SNOMED CT) `http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYSNOMEDSDOHCategory` From this IG
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 Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | SDOHCCObservationScreeningResponse | SDOH screening questionnaire observations Constraints: Observation-PerformerOrganizationScreening, SHINNYScreeningHousingComponent
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://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
category |  | 3..* | CodeableConcept | Classification of type of observation
Slices for category |  |  |  | Content/Rules for all slices
category:SDOH |  | 1..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity
category:SNOMED | S | 0..* | CodeableConcept | SNOMED CT codes associated with SDOH category. Binding: SHINNYSNOMEDSDOHCategory (required): SNOMED codes descirbing a specific SDOH category when that category is not locally defined.
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://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS` From this IG
Observation.category:SNOMED | required | SHINNYSNOMEDSDOHCategory(a valid code from SNOMED CT) `http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYSNOMEDSDOHCategory` 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 Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | SDOHCCObservationScreeningResponse | SDOH screening questionnaire observations Constraints: obs-6, obs-7, Observation-PerformerOrganizationScreening, SHINNYScreeningHousingComponent
id | S Σ | 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 Σ | 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 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 |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:screeninglanguage |  | 0..* | CodeableConcept | SHINNY Observation Language URL: http://test.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 | ?!S Σ | 1..1 | code | final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category |  | 3..* | 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 | 1..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
category:SNOMED | S | 0..* | CodeableConcept | SNOMED CT codes associated with SDOH category. Binding: SHINNYSNOMEDSDOHCategory (required): SNOMED codes descirbing a specific SDOH category when that category is not locally defined.
code | S Σ | 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 | SDOHCCObservationScreeningResponse#`Observation.category` = digital-access
LOINCCodes | Required | SDOHCCObservationScreeningResponse#`Observation.category` = digital-literacy
Less Than High School Education Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = educational-attainment
Elder Abuse Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = elder-abuse
Unemployment Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = employment-status
Financial Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = financial-insecurity
Food Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = food-insecurity
Health Insurance Coverage Status Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = health-insurance-coverage-status
Homelessness Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = homelessness
Housing Instability Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = housing-instability
Inadequate Housing Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = inadequate-housing
Intimate Partner Violence Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = intimate-partner-violence
Material Hardship Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = material-hardship
Medical Cost Burden Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = medical-cost-burden
Health Literacy Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = personal-health-literacy
Social Connection Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = social-connection
Stress Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = stress
Transportation Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = transportation-insecurity
Utility Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = utility-insecurity
Veteran Status Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = veteran-status
LOINCCodes | Required | SDOHCCObservationScreeningResponse#`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 | S Σ | 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 | S Σ | 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 | S Σ | 1..1 | Reference(Encounter) | Healthcare event during which this observation is made
effective[x] | S Σ | 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 | S Σ | 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] | S Σ C | 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 | Σ C | 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 | SDOHCCObservationScreeningResponse#`Observation.category` = digital-access
LOINCCodes | Preferred | SDOHCCObservationScreeningResponse#`Observation.category` = digital-literacy
Less Than High School Education Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = educational-attainment
Elder Abuse Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = elder-abuse
Unemployment Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = employment-status
Financial Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = financial-insecurity
Food Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = food-insecurity
Health Insurance Coverage Status Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = health-insurance-coverage-status
Homelessness Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = homelessness
Housing Instability Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = housing-instability
VSAC 2.16.840.1.113762.1.4.1196.178 | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = inadequate-housing
Intimate Partner Violence Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = intimate-partner-violence
Material Hardship Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = material-hardship
Medical Cost Burden Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = medical-cost-burden
Health Literacy Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = personal-health-literacy
Social Connection Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = social-connection
Stress Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = stress
Transportation Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = transportation-insecurity
Utility Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = utility-insecurity
Veteran Status Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = veteran-status
LOINCCodes | Preferred | SDOHCCObservationScreeningResponse#`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 | Σ C | 0..1 | Quantity | Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note |  | 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 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
Slices for hasMember | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember | S Σ | 0..* | Reference(SDOHCC Observation Screening Response) | For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom | S Σ | 0..* | Reference(DocumentReference | QuestionnaireResponse | Observation) | Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom | S Σ | 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://test.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 Value: social-history `http://hl7.org/fhir/ValueSet/observation-category` From the FHIR Standard
Observation.category:Survey | preferred | Pattern Value: 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.category:SNOMED | required | SHINNYSNOMEDSDOHCategory(a valid code from SNOMED CT) `http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYSNOMEDSDOHCategory` From this IG
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: 5 elements
Must-Support: 5 elements

Structures

This structure refers to these other structures:

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

Extensions

This structure refers to these extensions:

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

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | SDOHCCObservationScreeningResponse | SDOH screening questionnaire observations Constraints: obs-6, obs-7, Observation-PerformerOrganizationScreening, SHINNYScreeningHousingComponent
id | S Σ | 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 Σ | 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)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:screeninglanguage |  | 0..* | CodeableConcept | SHINNY Observation Language URL: http://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category |  | 3..* | 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 | 1..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
category:SNOMED | S | 0..* | CodeableConcept | SNOMED CT codes associated with SDOH category. Binding: SHINNYSNOMEDSDOHCategory (required): SNOMED codes descirbing a specific SDOH category when that category is not locally defined.
code | S Σ | 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 | SDOHCCObservationScreeningResponse#`Observation.category` = digital-access
LOINCCodes | Required | SDOHCCObservationScreeningResponse#`Observation.category` = digital-literacy
Less Than High School Education Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = educational-attainment
Elder Abuse Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = elder-abuse
Unemployment Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = employment-status
Financial Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = financial-insecurity
Food Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = food-insecurity
Health Insurance Coverage Status Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = health-insurance-coverage-status
Homelessness Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = homelessness
Housing Instability Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = housing-instability
Inadequate Housing Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = inadequate-housing
Intimate Partner Violence Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = intimate-partner-violence
Material Hardship Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = material-hardship
Medical Cost Burden Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = medical-cost-burden
Health Literacy Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = personal-health-literacy
Social Connection Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = social-connection
Stress Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = stress
Transportation Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = transportation-insecurity
Utility Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = utility-insecurity
Veteran Status Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = veteran-status
LOINCCodes | Required | SDOHCCObservationScreeningResponse#`Observation.category` = sdoh-category-unspecified
coding | S Σ | 1..* | Coding | Code defined by a terminology system
display | Σ | 0..1 | string | If present, this MUST match the long description name provided by the source system
text | Σ | 0..1 | string | This is the human readable question that is presented to the patient and should be present
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
encounter | S Σ | 1..1 | Reference(Encounter) | Healthcare event during which this observation is made
effective[x] | S Σ | 1..1 |  | Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
performer | S Σ | 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] | S Σ C | 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 | Σ C | 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 | SDOHCCObservationScreeningResponse#`Observation.category` = digital-access
LOINCCodes | Preferred | SDOHCCObservationScreeningResponse#`Observation.category` = digital-literacy
Less Than High School Education Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = educational-attainment
Elder Abuse Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = elder-abuse
Unemployment Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = employment-status
Financial Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = financial-insecurity
Food Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = food-insecurity
Health Insurance Coverage Status Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = health-insurance-coverage-status
Homelessness Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = homelessness
Housing Instability Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = housing-instability
VSAC 2.16.840.1.113762.1.4.1196.178 | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = inadequate-housing
Intimate Partner Violence Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = intimate-partner-violence
Material Hardship Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = material-hardship
Medical Cost Burden Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = medical-cost-burden
Health Literacy Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = personal-health-literacy
Social Connection Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = social-connection
Stress Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = stress
Transportation Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = transportation-insecurity
Utility Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = utility-insecurity
Veteran Status Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = veteran-status
LOINCCodes | Preferred | SDOHCCObservationScreeningResponse#`Observation.category` = sdoh-category-unspecified
text | Σ | 0..1 | string | This is the human readable answer that is presented to the patient and MUST be present
value[x]:valueQuantity | Σ C | 0..1 | Quantity | Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Slices for hasMember | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember | S Σ | 0..* | Reference(SDOHCC Observation Screening Response) | For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom | S Σ | 0..* | Reference(DocumentReference | QuestionnaireResponse | Observation) | Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom | S Σ | 0..* | Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response) | Related questionnaire responses or observations that the observation is made from
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Observation.language | preferred | SHINNYLanguageVS `http://test.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 Value: social-history `http://hl7.org/fhir/ValueSet/observation-category` From the FHIR Standard
Observation.category:Survey | preferred | Pattern Value: 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.category:SNOMED | required | SHINNYSNOMEDSDOHCategory(a valid code from SNOMED CT) `http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYSNOMEDSDOHCategory` From this IG
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 Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | SDOHCCObservationScreeningResponse | SDOH screening questionnaire observations Constraints: Observation-PerformerOrganizationScreening, SHINNYScreeningHousingComponent
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://test.shinny.org/us/ny/hrsn/StructureDefinition/shinny-observation-language Binding: SHINNYLanguageVS (preferred): ObservationLanguage
category |  | 3..* | CodeableConcept | Classification of type of observation
Slices for category |  |  |  | Content/Rules for all slices
category:SDOH |  | 1..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity
category:SNOMED | S | 0..* | CodeableConcept | SNOMED CT codes associated with SDOH category. Binding: SHINNYSNOMEDSDOHCategory (required): SNOMED codes descirbing a specific SDOH category when that category is not locally defined.
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://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS` From this IG
Observation.category:SNOMED | required | SHINNYSNOMEDSDOHCategory(a valid code from SNOMED CT) `http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYSNOMEDSDOHCategory` 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 Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | SDOHCCObservationScreeningResponse | SDOH screening questionnaire observations Constraints: obs-6, obs-7, Observation-PerformerOrganizationScreening, SHINNYScreeningHousingComponent
id | S Σ | 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 Σ | 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 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 |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:screeninglanguage |  | 0..* | CodeableConcept | SHINNY Observation Language URL: http://test.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 | ?!S Σ | 1..1 | code | final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category |  | 3..* | 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 | 1..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
category:SNOMED | S | 0..* | CodeableConcept | SNOMED CT codes associated with SDOH category. Binding: SHINNYSNOMEDSDOHCategory (required): SNOMED codes descirbing a specific SDOH category when that category is not locally defined.
code | S Σ | 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 | SDOHCCObservationScreeningResponse#`Observation.category` = digital-access
LOINCCodes | Required | SDOHCCObservationScreeningResponse#`Observation.category` = digital-literacy
Less Than High School Education Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = educational-attainment
Elder Abuse Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = elder-abuse
Unemployment Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = employment-status
Financial Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = financial-insecurity
Food Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = food-insecurity
Health Insurance Coverage Status Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = health-insurance-coverage-status
Homelessness Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = homelessness
Housing Instability Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = housing-instability
Inadequate Housing Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = inadequate-housing
Intimate Partner Violence Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = intimate-partner-violence
Material Hardship Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = material-hardship
Medical Cost Burden Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = medical-cost-burden
Health Literacy Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = personal-health-literacy
Social Connection Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = social-connection
Stress Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = stress
Transportation Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = transportation-insecurity
Utility Insecurity Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = utility-insecurity
Veteran Status Screening Assessments And Questions | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = veteran-status
LOINCCodes | Required | SDOHCCObservationScreeningResponse#`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 | S Σ | 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 | S Σ | 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 | S Σ | 1..1 | Reference(Encounter) | Healthcare event during which this observation is made
effective[x] | S Σ | 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 | S Σ | 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] | S Σ C | 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 | Σ C | 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 | SDOHCCObservationScreeningResponse#`Observation.category` = digital-access
LOINCCodes | Preferred | SDOHCCObservationScreeningResponse#`Observation.category` = digital-literacy
Less Than High School Education Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = educational-attainment
Elder Abuse Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = elder-abuse
Unemployment Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = employment-status
Financial Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = financial-insecurity
Food Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = food-insecurity
Health Insurance Coverage Status Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = health-insurance-coverage-status
Homelessness Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = homelessness
Housing Instability Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = housing-instability
VSAC 2.16.840.1.113762.1.4.1196.178 | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = inadequate-housing
Intimate Partner Violence Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = intimate-partner-violence
Material Hardship Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = material-hardship
Medical Cost Burden Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = medical-cost-burden
Health Literacy Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = personal-health-literacy
Social Connection Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = social-connection
Stress Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = stress
Transportation Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = transportation-insecurity
Utility Insecurity Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = utility-insecurity
Veteran Status Screening Assessments Answers | Extensible | SDOHCCObservationScreeningResponse#`Observation.category` = veteran-status
LOINCCodes | Preferred | SDOHCCObservationScreeningResponse#`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 | Σ C | 0..1 | Quantity | Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note |  | 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 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
Slices for hasMember | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember | S Σ | 0..* | Reference(SDOHCC Observation Screening Response) | For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom | S Σ | 0..* | Reference(DocumentReference | QuestionnaireResponse | Observation) | Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom | S Σ | 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://test.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 Value: social-history `http://hl7.org/fhir/ValueSet/observation-category` From the FHIR Standard
Observation.category:Survey | preferred | Pattern Value: 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.category:SNOMED | required | SHINNYSNOMEDSDOHCategory(a valid code from SNOMED CT) `http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYSNOMEDSDOHCategory` From this IG
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: 5 elements
Must-Support: 5 elements

Structures

This structure refers to these other structures:

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

Extensions

This structure refers to these extensions:

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

Other representations of profile: CSV, Excel, Schematron