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Resource Profile: Smoking Status Observation

This StructureDefinition contains the maps for VistA file V HEALTH FACTORS (9000010.23) to us-core-smokingstatus.

Usage:

• CapabilityStatements using this Resource Profile: Lighthouse Clinical Health API and Lighthouse Patient Health API
• This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

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

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

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSmokingStatusProfile(5.0.1)	Measurements and simple assertions This profile also complies with the profiles US Core Smoking Status Observation Profile (6.1.0) and US Core Smoking Status Observation Profile (7.0.0) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	Σ	0..*	Identifier	Business Identifier for observation ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: http://va.gov/identifiers/$Sta3n/9000010.23
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: US Core Status for Smoking Status Observation (required) ele-1: All FHIR elements must have a @value or children Required Pattern: final
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
code	SΣC	1..1	CodeableConcept	Smoking Status Binding: US Core Smoking Status Observation Codes (extensible) ele-1: All FHIR elements must have a @value or children sso-24-1244: If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 sso-24-1862: If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record
subject	SΣ	1..1	Reference(Patient)	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
encounter	SΣ	0..1	Reference(Encounter: Outpatient)	Healthcare event during which this observation is made ele-1: All FHIR elements must have a @value or children
Slices for effective[x]	Σ	1..1	dateTime	Clinically relevant time/time-period for observation Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
effective[x]:effectiveDateTime	SΣ	1..1	dateTime	Clinically relevant time/time-period for observation ele-1: All FHIR elements must have a @value or children
performer	SΣ	0..*	Reference(Practitioner)	Who is responsible for the observation ele-1: All FHIR elements must have a @value or children
Slices for value[x]	ΣC	1..1	CodeableConcept	Actual result Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
value[x]:valueCodeableConcept	SΣC	1..1	CodeableConcept	Coded Responses from Smoking Status Value Set Binding: SmokingStatus FHIR (required): see mapping VF_SmokingStatus ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
note		0..*	Annotation	Comments about the observation ele-1: All FHIR elements must have a @value or children
text	SΣ	1..1	markdown	The annotation - text content (as markdown) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Observation.status	required	Pattern: final http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern: social-history http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	extensible	USCoreSmokingStatusObservationCodes http://hl7.org/fhir/us/core/ValueSet/us-core-smoking-status-observation-codes
Observation.value[x]:valueCodeableConcept	required	SmokingStatus http://va.gov/fhir/ValueSet/SmokingStatus from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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()
sso-24-1244	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 : true
sso-24-1862	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record : true

This structure is derived from USCoreSmokingStatusProfile

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	USCoreSmokingStatusProfile(5.0.1)	Measurements and simple assertions This profile also complies with the profiles US Core Smoking Status Observation Profile (6.1.0) and US Core Smoking Status Observation Profile (7.0.0)
identifier
system	S	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/9000010.23
value	S	0..1	string	The value that is unique
status		1..1	code	registered | preliminary | final | amended + Required Pattern: final
Slices for category				Content/Rules for all slices
category:SocialHistory		1..1	CodeableConcept	Classification of type of observation
code	C	1..1	CodeableConcept	Smoking Status sso-24-1244: If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 sso-24-1862: If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record
subject		1..1	Reference(Patient)	Who and/or what the observation is about
encounter	S	0..1	Reference(Encounter: Outpatient)	Healthcare event during which this observation is made
Slices for effective[x]				Content/Rules for all slices
effective[x]:effectiveDateTime		1..1	dateTime	Clinically relevant time/time-period for observation
performer	S	0..*	Reference(Practitioner)	Who is responsible for the observation
Slices for value[x]				Content/Rules for all slices
value[x]:valueCodeableConcept		1..1	CodeableConcept	Coded Responses from Smoking Status Value Set Binding: SmokingStatus FHIR (required): see mapping VF_SmokingStatus
text	S	0..1	string	Plain text representation of the concept
note
text	S	1..1	markdown	The annotation - text content (as markdown)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.value[x]:valueCodeableConcept	required	SmokingStatus http://va.gov/fhir/ValueSet/SmokingStatus from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
sso-24-1244	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 : true
sso-24-1862	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record : true

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSmokingStatusProfile(5.0.1)	Measurements and simple assertions This profile also complies with the profiles US Core Smoking Status Observation Profile (6.1.0) and US Core Smoking Status Observation Profile (7.0.0) obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/9000010.23
value	SΣ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: US Core Status for Smoking Status Observation (required) Required Pattern: final
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$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
code	SΣC	1..1	CodeableConcept	Smoking Status Binding: US Core Smoking Status Observation Codes (extensible) sso-24-1244: If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 sso-24-1862: If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record
subject	SΣ	1..1	Reference(Patient)	Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	SΣ	0..1	Reference(Encounter: Outpatient)	Healthcare event during which this observation is made
Slices for effective[x]	Σ	1..1	dateTime	Clinically relevant time/time-period for observation Slice: Unordered, Closed by type:$this
effective[x]:effectiveDateTime	SΣ	1..1	dateTime	Clinically relevant time/time-period for observation
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(Practitioner)	Who is responsible for the observation
Slices for value[x]	ΣC	1..1	CodeableConcept	Actual result Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	SΣC	1..1	CodeableConcept	Coded Responses from Smoking Status Value Set Binding: SmokingStatus FHIR (required): see mapping VF_SmokingStatus
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
text	SΣ	0..1	string	Plain text representation of the concept
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
author[x]	Σ	0..1		Individual responsible for the annotation
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
time	Σ	0..1	dateTime	When the annotation was made
text	SΣ	1..1	markdown	The annotation - text content (as markdown)
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
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	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Observation.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Observation.status	required	Pattern: final http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern: social-history http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	extensible	USCoreSmokingStatusObservationCodes http://hl7.org/fhir/us/core/ValueSet/us-core-smoking-status-observation-codes
Observation.value[x]:valueCodeableConcept	required	SmokingStatus http://va.gov/fhir/ValueSet/SmokingStatus from this IG
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.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site 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
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()
sso-24-1244	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 : true
sso-24-1862	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record : true

This structure is derived from USCoreSmokingStatusProfile

Summary

Must-Support: 6 elements

Structures

This structure refers to these other structures:

• Patient (http://va.gov/fhir/StructureDefinition/Patient)
• Encounter: Outpatient (http://va.gov/fhir/StructureDefinition/EncounterOutpatient)
• Practitioner (http://va.gov/fhir/StructureDefinition/Practitioner)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSmokingStatusProfile(5.0.1)	Measurements and simple assertions This profile also complies with the profiles US Core Smoking Status Observation Profile (6.1.0) and US Core Smoking Status Observation Profile (7.0.0) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	Σ	0..*	Identifier	Business Identifier for observation ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: http://va.gov/identifiers/$Sta3n/9000010.23
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: US Core Status for Smoking Status Observation (required) ele-1: All FHIR elements must have a @value or children Required Pattern: final
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
code	SΣC	1..1	CodeableConcept	Smoking Status Binding: US Core Smoking Status Observation Codes (extensible) ele-1: All FHIR elements must have a @value or children sso-24-1244: If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 sso-24-1862: If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record
subject	SΣ	1..1	Reference(Patient)	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
encounter	SΣ	0..1	Reference(Encounter: Outpatient)	Healthcare event during which this observation is made ele-1: All FHIR elements must have a @value or children
Slices for effective[x]	Σ	1..1	dateTime	Clinically relevant time/time-period for observation Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
effective[x]:effectiveDateTime	SΣ	1..1	dateTime	Clinically relevant time/time-period for observation ele-1: All FHIR elements must have a @value or children
performer	SΣ	0..*	Reference(Practitioner)	Who is responsible for the observation ele-1: All FHIR elements must have a @value or children
Slices for value[x]	ΣC	1..1	CodeableConcept	Actual result Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
value[x]:valueCodeableConcept	SΣC	1..1	CodeableConcept	Coded Responses from Smoking Status Value Set Binding: SmokingStatus FHIR (required): see mapping VF_SmokingStatus ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
note		0..*	Annotation	Comments about the observation ele-1: All FHIR elements must have a @value or children
text	SΣ	1..1	markdown	The annotation - text content (as markdown) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Observation.status	required	Pattern: final http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern: social-history http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	extensible	USCoreSmokingStatusObservationCodes http://hl7.org/fhir/us/core/ValueSet/us-core-smoking-status-observation-codes
Observation.value[x]:valueCodeableConcept	required	SmokingStatus http://va.gov/fhir/ValueSet/SmokingStatus from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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()
sso-24-1244	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 : true
sso-24-1862	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record : true

Differential View

This structure is derived from USCoreSmokingStatusProfile

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	USCoreSmokingStatusProfile(5.0.1)	Measurements and simple assertions This profile also complies with the profiles US Core Smoking Status Observation Profile (6.1.0) and US Core Smoking Status Observation Profile (7.0.0)
identifier
system	S	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/9000010.23
value	S	0..1	string	The value that is unique
status		1..1	code	registered | preliminary | final | amended + Required Pattern: final
Slices for category				Content/Rules for all slices
category:SocialHistory		1..1	CodeableConcept	Classification of type of observation
code	C	1..1	CodeableConcept	Smoking Status sso-24-1244: If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 sso-24-1862: If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record
subject		1..1	Reference(Patient)	Who and/or what the observation is about
encounter	S	0..1	Reference(Encounter: Outpatient)	Healthcare event during which this observation is made
Slices for effective[x]				Content/Rules for all slices
effective[x]:effectiveDateTime		1..1	dateTime	Clinically relevant time/time-period for observation
performer	S	0..*	Reference(Practitioner)	Who is responsible for the observation
Slices for value[x]				Content/Rules for all slices
value[x]:valueCodeableConcept		1..1	CodeableConcept	Coded Responses from Smoking Status Value Set Binding: SmokingStatus FHIR (required): see mapping VF_SmokingStatus
text	S	0..1	string	Plain text representation of the concept
note
text	S	1..1	markdown	The annotation - text content (as markdown)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.value[x]:valueCodeableConcept	required	SmokingStatus http://va.gov/fhir/ValueSet/SmokingStatus from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
sso-24-1244	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 : true
sso-24-1862	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record : true

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSmokingStatusProfile(5.0.1)	Measurements and simple assertions This profile also complies with the profiles US Core Smoking Status Observation Profile (6.1.0) and US Core Smoking Status Observation Profile (7.0.0) obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/9000010.23
value	SΣ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: US Core Status for Smoking Status Observation (required) Required Pattern: final
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$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
code	SΣC	1..1	CodeableConcept	Smoking Status Binding: US Core Smoking Status Observation Codes (extensible) sso-24-1244: If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 sso-24-1862: If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record
subject	SΣ	1..1	Reference(Patient)	Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	SΣ	0..1	Reference(Encounter: Outpatient)	Healthcare event during which this observation is made
Slices for effective[x]	Σ	1..1	dateTime	Clinically relevant time/time-period for observation Slice: Unordered, Closed by type:$this
effective[x]:effectiveDateTime	SΣ	1..1	dateTime	Clinically relevant time/time-period for observation
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(Practitioner)	Who is responsible for the observation
Slices for value[x]	ΣC	1..1	CodeableConcept	Actual result Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	SΣC	1..1	CodeableConcept	Coded Responses from Smoking Status Value Set Binding: SmokingStatus FHIR (required): see mapping VF_SmokingStatus
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
text	SΣ	0..1	string	Plain text representation of the concept
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
author[x]	Σ	0..1		Individual responsible for the annotation
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
time	Σ	0..1	dateTime	When the annotation was made
text	SΣ	1..1	markdown	The annotation - text content (as markdown)
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
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	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Observation.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Observation.status	required	Pattern: final http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:SocialHistory	preferred	Pattern: social-history http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	extensible	USCoreSmokingStatusObservationCodes http://hl7.org/fhir/us/core/ValueSet/us-core-smoking-status-observation-codes
Observation.value[x]:valueCodeableConcept	required	SmokingStatus http://va.gov/fhir/ValueSet/SmokingStatus from this IG
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.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site 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
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()
sso-24-1244	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is TOBACCO [C] then fixed value http://loinc.org#72166-2 : true
sso-24-1862	warning	Observation.code	If (9000010.23-.01 > 9999999.64-.03) is Not TOBACCO [C] then exclude record : true

This structure is derived from USCoreSmokingStatusProfile

Summary

Must-Support: 6 elements

Structures

This structure refers to these other structures:

• Patient (http://va.gov/fhir/StructureDefinition/Patient)
• Encounter: Outpatient (http://va.gov/fhir/StructureDefinition/EncounterOutpatient)
• Practitioner (http://va.gov/fhir/StructureDefinition/Practitioner)

Other representations of profile: CSV, Excel, Schematron