Source | hl7.cda.us.ccdar2dot2#current:Consolidated CDA Release 2.1 StructureDefinition Publication (v5.0.0) |
resourceType | StructureDefinition |
id | 2.16.840.1.113883.10.20.22.4.69 |
canonical | http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.4.69 |
version | 2.2 |
status | active |
publisher | Health Level Seven |
name | AssessmentScaleObservation |
title | Assessment Scale Observation |
date | 2021-11-24T17:43:01+00:00 |
description | An assessment scale is a collection of observations that together yield a summary evaluation of a particular condition. Examples include the Braden Scale (assesses pressure ulcer risk), APACHE Score (estimates mortality in critically ill patients), Mini-Mental Status Exam (assesses cognitive function), APGAR Score (assesses the health of a newborn), and Glasgow Coma Scale (assesses coma and impaired consciousness). |
jurisdictions | us |
fhirVersion | 4.0.1 |
kind | resource |
abstract | false |
sdTtype | Observation |
derivation | constraint |
base | http://hl7.org/fhir/cda/StructureDefinition/Observation |
Usages |
|
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Observation | ||||
classCode | 1..1 | Required Pattern: OBS | ||
moodCode | 1..1 | Required Pattern: EVN | ||
Slices for templateId | Slice: Unordered, Open by value:root | |||
templateId:primary | 1..1 | |||
root | 1..1 | Required Pattern: 2.16.840.1.113883.10.20.22.4.69 | ||
id | 1..* | |||
code | C | 1..1 | 81-14440: **SHOULD** be from LOINC (CodeSystem: 2.16.840.1.113883.6.1) or SNOMED CT (CodeSystem: 2.16.840.1.113883.6.96) identifying the assessment scale (CONF:81-14440). | |
derivationExpr | 0..1 | Such derivation expression can contain a text calculation of how the components total up to the summed score | ||
statusCode | 1..1 | |||
code | 1..1 | Required Pattern: completed | ||
effectiveTime | 1..1 | Represents clinically effective time of the measurement, which may be when the measurement was performed (e.g., a BP measurement), or may be when sample was taken (and measured some time afterwards) | ||
value | 1..1 | |||
interpretationCode | 0..* | |||
translation | 0..* | |||
author | 0..* | |||
Slices for entryRelationship | Slice: Unordered, Open by profile:observation | |||
entryRelationship:supporting | 0..* | |||
typeCode | 1..1 | Required Pattern: COMP | ||
observation | 1..1 | http://hl7.org/fhir/cda/StructureDefinition/Observation | ||
referenceRange | 0..* |
The referenceRange/observationRange/text, if present, MAY contain a description of the scale (e.g., for a Pain Scale 1 to 10: 1 to 3 = little pain, 4 to 7= moderate pain, 8 to 10 = severe pain) |
||
observationRange | 1..1 | |||
text | 0..1 | The text may contain a description of the scale (e.g., for a Pain Scale 1 to 10: 1 to 3 = little pain, 4 to 7= moderate pain, 8 to 10 = severe pain) | ||
reference | 0..1 | |||
value | C | 0..1 | 81-16804: This reference/@value SHALL begin with a '#' and SHALL point to its corresponding narrative (using the approach defined in CDA Release 2, section 4.3.5.1) (CONF:81-16804). | |
Documentation for this format |
Produced 08 Sep 2023