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{
  "resourceType": "ConceptMap",
  "id": "R2-Observation-element-map-to-R4",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fhir"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 0,
      "_valueInteger": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r2.r4"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r2.r4"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/uv/xver/ConceptMap/R2-Observation-element-map-to-R4",
  "version": "0.1.0",
  "name": "R2ObservationElementMapToR4",
  "title": "Cross-version mapping for FHIR DSTU2 Observation to FHIR R4 Observation",
  "status": "active",
  "experimental": false,
  "date": "2026-03-17T16:04:02.7599183-05:00",
  "contact": [
    {
      "name": "FHIR Infrastructure",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/fiwg"
        }
      ]
    }
  ],
  "description": "This ConceptMap represents cross-version mappings for elements from a FHIR DSTU2 Observation to FHIR R4.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code": "001",
          "display": "World"
        }
      ]
    }
  ],
  "sourceCanonical": "http://hl7.org/fhir/1.0",
  "targetUri": "http://hl7.org/fhir/4.0",
  "group": [
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/StructureDefinition/Observation",
      "targetVersion": "4.0.1",
      "element": [
        {
          "code": "Observation.meta",
          "display": "meta",
          "target": [
            {
              "code": "Observation.meta",
              "display": "Observation.meta",
              "equivalence": "wider",
              "comment": "Element `Observation.meta` is mapped to FHIR R4 element `Observation.meta` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.meta` do not cover the following types: Meta.\nThe mappings for `Observation.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId."
            }
          ]
        },
        {
          "code": "Observation.implicitRules",
          "display": "implicitRules",
          "target": [
            {
              "code": "Observation.implicitRules",
              "display": "Observation.implicitRules",
              "equivalence": "equivalent",
              "comment": "Element `Observation.implicitRules` is mapped to FHIR R4 element `Observation.implicitRules` as `Equivalent`.\nAsserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible."
            }
          ]
        },
        {
          "code": "Observation.language",
          "display": "language",
          "target": [
            {
              "code": "Observation.language",
              "display": "Observation.language",
              "equivalence": "equivalent",
              "comment": "Element `Observation.language` is mapped to FHIR R4 element `Observation.language` as `Equivalent`.\nLanguage is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource  Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."
            }
          ]
        },
        {
          "code": "Observation.text",
          "display": "text",
          "target": [
            {
              "code": "Observation.text",
              "display": "Observation.text",
              "equivalence": "wider",
              "comment": "Element `Observation.text` is mapped to FHIR R4 element `Observation.text` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.text` do not cover the following types: Narrative.\nThe mappings for `Observation.text` do not cover the following types based on type expansion: div, status.\nContained resources do not have narrative. Resources that are not contained SHOULD have a narrative."
            }
          ]
        },
        {
          "code": "Observation.contained",
          "display": "contained",
          "target": [
            {
              "code": "Observation.contained",
              "display": "Observation.contained",
              "equivalence": "equivalent",
              "comment": "Element `Observation.contained` is mapped to FHIR R4 element `Observation.contained` as `SourceIsBroaderThanTarget`.\nThis should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again."
            }
          ]
        },
        {
          "code": "Observation.identifier",
          "display": "identifier",
          "target": [
            {
              "code": "Observation.identifier",
              "display": "Observation.identifier",
              "equivalence": "wider",
              "comment": "Element `Observation.identifier` is mapped to FHIR R4 element `Observation.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.identifier` do not cover the following types: Identifier.\nThe mappings for `Observation.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value."
            }
          ]
        },
        {
          "code": "Observation.status",
          "display": "status",
          "target": [
            {
              "code": "Observation.status",
              "display": "Observation.status",
              "equivalence": "wider",
              "comment": "Element `Observation.status` is mapped to FHIR R4 element `Observation.status` as `RelatedTo`.\nThe mappings for `Observation.status` do not allow expression of the necessary codes, per the bindings on the source and target.\nThe target context `Observation.status` is a modifier element, so this extension does not need to be defined as a modifier."
            }
          ]
        },
        {
          "code": "Observation.category",
          "display": "category",
          "target": [
            {
              "code": "Observation.category",
              "display": "Observation.category",
              "equivalence": "equivalent",
              "comment": "Element `Observation.category` is mapped to FHIR R4 element `Observation.category` as `SourceIsNarrowerThanTarget`.\nThe level of granularity is defined by the category concepts in the value set.   More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in Observation.code."
            }
          ]
        },
        {
          "code": "Observation.code",
          "display": "code",
          "target": [
            {
              "code": "Observation.code",
              "display": "Observation.code",
              "equivalence": "equivalent",
              "comment": "Element `Observation.code` is mapped to FHIR R4 element `Observation.code` as `Equivalent`."
            }
          ]
        },
        {
          "code": "Observation.subject",
          "display": "subject",
          "target": [
            {
              "code": "Observation.subject",
              "display": "Observation.subject",
              "equivalence": "wider",
              "comment": "Element `Observation.subject` is mapped to FHIR R4 element `Observation.subject` as `SourceIsBroaderThanTarget`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `Observation.subject` with unmapped reference targets: Device, Group, Location, Patient.\nOne would expect this element to be a cardinality  of 1..1.  The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.  If the target of the observation is different than the subject, the general extension [observation-focal-subject](https://hl7.org/fhir/extension-observation-focal-subject.html).  may be used.  However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code."
            }
          ]
        },
        {
          "code": "Observation.encounter",
          "display": "encounter",
          "target": [
            {
              "code": "Observation.encounter",
              "display": "Observation.encounter",
              "equivalence": "wider",
              "comment": "Element `Observation.encounter` is mapped to FHIR R4 element `Observation.encounter` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.encounter` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `Observation.encounter` with unmapped reference targets: Encounter."
            }
          ]
        },
        {
          "code": "Observation.effective[x]",
          "display": "effective[x]",
          "target": [
            {
              "code": "Observation.effective[x]",
              "display": "Observation.effective[x]",
              "equivalence": "equivalent",
              "comment": "Element `Observation.effective[x]` is mapped to FHIR R4 element `Observation.effective[x]` as `SourceIsBroaderThanTarget`.\nThe target context `Observation.effective[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Observation`.\nAt least a date should be present unless this observation is a historical report."
            }
          ]
        },
        {
          "code": "Observation.issued",
          "display": "issued",
          "target": [
            {
              "code": "Observation.issued",
              "display": "Observation.issued",
              "equivalence": "equivalent",
              "comment": "Element `Observation.issued` is mapped to FHIR R4 element `Observation.issued` as `Equivalent`.\nUpdated when the result is updated."
            }
          ]
        },
        {
          "code": "Observation.performer",
          "display": "performer",
          "target": [
            {
              "code": "Observation.performer",
              "display": "Observation.performer",
              "equivalence": "wider",
              "comment": "Element `Observation.performer` is mapped to FHIR R4 element `Observation.performer` as `RelatedTo`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `Observation.performer` with unmapped reference targets: Organization, Patient, Practitioner, RelatedPerson."
            }
          ]
        },
        {
          "code": "Observation.value[x]",
          "display": "value[x]",
          "target": [
            {
              "code": "Observation.value[x]",
              "display": "Observation.value[x]",
              "equivalence": "wider",
              "comment": "Element `Observation.value[x]` is mapped to FHIR R4 element `Observation.value[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.value[x]` do not cover the following types: Attachment, Period, Range, Ratio, SampledData.\nThe target context `Observation.value[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Observation`.\nNormally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is \"'value' + the type name\" with a capital on the first letter of the type).   If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text.  A value set is bound to the ValueCodeableConcept element.  For boolean values use valueCodeableConcept and select codes from [HL7 Version 2 Table 0136](https://hl7.org/fhir/v2/0136/index.html). These \"yes/no\" concepts can be mapped to the display name \"true/false\" or other mutually exclusive terms that may be needed.   For further discussion and examples see the  [notes section](https://hl7.org/fhir/observa.html#4.20.4) below."
            }
          ]
        },
        {
          "code": "Observation.dataAbsentReason",
          "display": "dataAbsentReason",
          "target": [
            {
              "code": "Observation.dataAbsentReason",
              "display": "Observation.dataAbsentReason",
              "equivalence": "equivalent",
              "comment": "Element `Observation.dataAbsentReason` is mapped to FHIR R4 element `Observation.dataAbsentReason` as `Equivalent`.\nNull or exceptional values can be represented two ways in FHIR Observations.  One way is to simply include them in the value set and represent the exceptions in the value.  For example, measurement values for a serology test could be  \"detected\", \"not detected\", \"inconclusive\", or  \"specimen unsatisfactory\".   The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason code \"error\" could be used when the measurement was not completed.  Because of these options, use-case agreements are required to interpret general observations for exceptional values."
            }
          ]
        },
        {
          "code": "Observation.interpretation",
          "display": "interpretation",
          "target": [
            {
              "code": "Observation.interpretation",
              "display": "Observation.interpretation",
              "equivalence": "equivalent",
              "comment": "Element `Observation.interpretation` is mapped to FHIR R4 element `Observation.interpretation` as `SourceIsNarrowerThanTarget`."
            }
          ]
        },
        {
          "code": "Observation.comments",
          "display": "comments",
          "target": [
            {
              "code": "Observation.note",
              "display": "Observation.note",
              "equivalence": "relatedto",
              "comment": "Element `Observation.comments` is mapped to FHIR R4 element `Observation.note` as `RelatedTo`.\nThe mappings for `Observation.comments` do not cover the following types: string.\nThe mappings for `Observation.comments` do not cover the following types based on type expansion: value."
            }
          ]
        },
        {
          "code": "Observation.bodySite",
          "display": "bodySite",
          "target": [
            {
              "code": "Observation.bodySite",
              "display": "Observation.bodySite",
              "equivalence": "equivalent",
              "comment": "Element `Observation.bodySite` is mapped to FHIR R4 element `Observation.bodySite` as `Equivalent`.\nOnly used if not implicit in code found in Observation.code.  If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension[ body-site-instance](https://hl7.org/fhir/extension-body-site-instance.html)."
            }
          ]
        },
        {
          "code": "Observation.method",
          "display": "method",
          "target": [
            {
              "code": "Observation.method",
              "display": "Observation.method",
              "equivalence": "equivalent",
              "comment": "Element `Observation.method` is mapped to FHIR R4 element `Observation.method` as `Equivalent`.\nOnly used if not implicit in code for Observation.code."
            }
          ]
        },
        {
          "code": "Observation.specimen",
          "display": "specimen",
          "target": [
            {
              "code": "Observation.specimen",
              "display": "Observation.specimen",
              "equivalence": "wider",
              "comment": "Element `Observation.specimen` is mapped to FHIR R4 element `Observation.specimen` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.specimen` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `Observation.specimen` with unmapped reference targets: Specimen.\nObservations are not made on specimens themselves; they are made on a subject, but usually by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report)."
            }
          ]
        },
        {
          "code": "Observation.device",
          "display": "device",
          "target": [
            {
              "code": "Observation.device",
              "display": "Observation.device",
              "equivalence": "wider",
              "comment": "Element `Observation.device` is mapped to FHIR R4 element `Observation.device` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.device` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `Observation.device` with unmapped reference targets: Device, DeviceMetric.\nAn extension should be used if further typing of the device is needed.  Devices used to support obtaining an observation can be represented using either extension or through the Observation.related element."
            }
          ]
        },
        {
          "code": "Observation.referenceRange",
          "display": "referenceRange",
          "target": [
            {
              "code": "Observation.referenceRange",
              "display": "Observation.referenceRange",
              "equivalence": "wider",
              "comment": "Element `Observation.referenceRange` is mapped to FHIR R4 element `Observation.referenceRange` as `Equivalent`.\nMost observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g. specific to the patient's age, gender, weight and other factors), but this may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties."
            }
          ]
        },
        {
          "code": "Observation.referenceRange.low",
          "display": "low",
          "target": [
            {
              "code": "Observation.referenceRange.low",
              "display": "Observation.referenceRange.low",
              "equivalence": "equivalent",
              "comment": "Element `Observation.referenceRange.low` is mapped to FHIR R4 element `Observation.referenceRange.low` as `Equivalent`."
            }
          ]
        },
        {
          "code": "Observation.referenceRange.high",
          "display": "high",
          "target": [
            {
              "code": "Observation.referenceRange.high",
              "display": "Observation.referenceRange.high",
              "equivalence": "equivalent",
              "comment": "Element `Observation.referenceRange.high` is mapped to FHIR R4 element `Observation.referenceRange.high` as `Equivalent`."
            }
          ]
        },
        {
          "code": "Observation.referenceRange.meaning",
          "display": "meaning",
          "target": [
            {
              "code": "Observation.referenceRange.appliesTo",
              "display": "Observation.referenceRange.appliesTo",
              "equivalence": "narrower",
              "comment": "Element `Observation.referenceRange.meaning` is mapped to FHIR R4 element `Observation.referenceRange.appliesTo` as `SourceIsNarrowerThanTarget`.\nThis SHOULD be populated if there is more than one range."
            }
          ]
        },
        {
          "code": "Observation.referenceRange.age",
          "display": "age",
          "target": [
            {
              "code": "Observation.referenceRange.age",
              "display": "Observation.referenceRange.age",
              "equivalence": "wider",
              "comment": "Element `Observation.referenceRange.age` is mapped to FHIR R4 element `Observation.referenceRange.age` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.referenceRange.age` do not cover the following types: Range.\nThe mappings for `Observation.referenceRange.age` do not cover the following types based on type expansion: high, low."
            }
          ]
        },
        {
          "code": "Observation.referenceRange.text",
          "display": "text",
          "target": [
            {
              "code": "Observation.referenceRange.text",
              "display": "Observation.referenceRange.text",
              "equivalence": "equivalent",
              "comment": "Element `Observation.referenceRange.text` is mapped to FHIR R4 element `Observation.referenceRange.text` as `Equivalent`."
            }
          ]
        },
        {
          "code": "Observation.related",
          "display": "related",
          "target": [
            {
              "code": "Observation",
              "display": "Observation",
              "equivalence": "relatedto",
              "comment": "Element `Observation.related` is mapped to FHIR R4 element `Observation` as `SourceIsNarrowerThanTarget`.\nElement `Observation.related` is mapped to FHIR R4 element `Observation.hasMember` as `Equivalent`.\nElement `Observation.related` is mapped to FHIR R4 element `Observation.derivedFrom` as `Equivalent`.\nFor a discussion on the ways Observations can assembled in groups together see [Notes below](https://hl7.org/fhir/observa.html#4.20.4)."
            },
            {
              "code": "Observation.derivedFrom",
              "display": "Observation.derivedFrom",
              "equivalence": "relatedto",
              "comment": "Element `Observation.related` is mapped to FHIR R4 element `Observation` as `SourceIsNarrowerThanTarget`.\nElement `Observation.related` is mapped to FHIR R4 element `Observation.hasMember` as `Equivalent`.\nElement `Observation.related` is mapped to FHIR R4 element `Observation.derivedFrom` as `Equivalent`.\nFor a discussion on the ways Observations can assembled in groups together see [Notes below](https://hl7.org/fhir/observa.html#4.20.4)."
            },
            {
              "code": "Observation.hasMember",
              "display": "Observation.hasMember",
              "equivalence": "relatedto",
              "comment": "Element `Observation.related` is mapped to FHIR R4 element `Observation` as `SourceIsNarrowerThanTarget`.\nElement `Observation.related` is mapped to FHIR R4 element `Observation.hasMember` as `Equivalent`.\nElement `Observation.related` is mapped to FHIR R4 element `Observation.derivedFrom` as `Equivalent`.\nFor a discussion on the ways Observations can assembled in groups together see [Notes below](https://hl7.org/fhir/observa.html#4.20.4)."
            }
          ]
        },
        {
          "code": "Observation.related.target",
          "display": "target",
          "target": [
            {
              "code": "Observation.derivedFrom",
              "display": "Observation.derivedFrom",
              "equivalence": "relatedto",
              "comment": "Element `Observation.related.target` is mapped to FHIR R4 element `Observation.hasMember` as `RelatedTo`.\nElement `Observation.related.target` is mapped to FHIR R4 element `Observation.derivedFrom` as `RelatedTo`.\nThe mappings for `Observation.related.target` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `Observation.related.target` with unmapped reference targets: Observation, QuestionnaireResponse."
            },
            {
              "code": "Observation.hasMember",
              "display": "Observation.hasMember",
              "equivalence": "relatedto",
              "comment": "Element `Observation.related.target` is mapped to FHIR R4 element `Observation.hasMember` as `RelatedTo`.\nElement `Observation.related.target` is mapped to FHIR R4 element `Observation.derivedFrom` as `RelatedTo`.\nThe mappings for `Observation.related.target` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `Observation.related.target` with unmapped reference targets: Observation, QuestionnaireResponse."
            }
          ]
        },
        {
          "code": "Observation.component",
          "display": "component",
          "target": [
            {
              "code": "Observation.component",
              "display": "Observation.component",
              "equivalence": "wider",
              "comment": "Element `Observation.component` is mapped to FHIR R4 element `Observation.component` as `Equivalent`.\nFor a discussion on the ways Observations can assembled in groups together see [Notes below](https://hl7.org/fhir/observa.html#4.20.4)."
            }
          ]
        },
        {
          "code": "Observation.component.code",
          "display": "code",
          "target": [
            {
              "code": "Observation.component.code",
              "display": "Observation.component.code",
              "equivalence": "equivalent",
              "comment": "Element `Observation.component.code` is mapped to FHIR R4 element `Observation.component.code` as `Equivalent`."
            }
          ]
        },
        {
          "code": "Observation.component.value[x]",
          "display": "value[x]",
          "target": [
            {
              "code": "Observation.component.value[x]",
              "display": "Observation.component.value[x]",
              "equivalence": "wider",
              "comment": "Element `Observation.component.value[x]` is mapped to FHIR R4 element `Observation.component.value[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.component.value[x]` do not cover the following types: Attachment, Period, Range, Ratio, SampledData.\nThe target context `Observation.component.value[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Observation.component`.\nNormally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value.   For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (These \"yes/no\" concepts can be mapped to the display name \"true/false\" or other mutually exclusive terms that may be needed\").  The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (The name format is \"'value' + the type name\" with a capital on the first letter of the type)."
            }
          ]
        },
        {
          "code": "Observation.component.dataAbsentReason",
          "display": "dataAbsentReason",
          "target": [
            {
              "code": "Observation.component.dataAbsentReason",
              "display": "Observation.component.dataAbsentReason",
              "equivalence": "equivalent",
              "comment": "Element `Observation.component.dataAbsentReason` is mapped to FHIR R4 element `Observation.component.dataAbsentReason` as `Equivalent`.\n\"Null\" or exceptional values can be represented two ways in FHIR Observations.  One way is to simply include them in the value set and represent the exceptions in the value.  For example, measurement values for a serology test could be  \"detected\", \"not detected\", \"inconclusive\", or  \"test not done\".   The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason code \"error\" could be used when the measurement was not completed.  Because of these options, use-case agreements are required to interpret general observations for exceptional values."
            }
          ]
        },
        {
          "code": "Observation.component.referenceRange",
          "display": "referenceRange",
          "target": [
            {
              "code": "Observation.component.referenceRange",
              "display": "Observation.component.referenceRange",
              "equivalence": "equivalent",
              "comment": "Element `Observation.component.referenceRange` is mapped to FHIR R4 element `Observation.component.referenceRange` as `Equivalent`.\nMost observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g. specific to the patient's age, gender, weight and other factors), but this may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties."
            }
          ]
        }
      ]
    },
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/1.0/StructureDefinition/extension-Observation.meta",
      "targetVersion": "0.1.0",
      "element": [
        {
          "code": "Observation.meta",
          "display": "meta",
          "target": [
            {
              "code": "Extension",
              "equivalence": "equivalent",
              "comment": "Element `Observation.meta` is mapped to FHIR R4 element `Observation.meta` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.meta` do not cover the following types: Meta.\nThe mappings for `Observation.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId."
            }
          ]
        }
      ]
    },
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/1.0/StructureDefinition/extension-Observation.text",
      "targetVersion": "0.1.0",
      "element": [
        {
          "code": "Observation.text",
          "display": "text",
          "target": [
            {
              "code": "Extension",
              "equivalence": "equivalent",
              "comment": "Element `Observation.text` is mapped to FHIR R4 element `Observation.text` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.text` do not cover the following types: Narrative.\nThe mappings for `Observation.text` do not cover the following types based on type expansion: div, status.\nContained resources do not have narrative. Resources that are not contained SHOULD have a narrative."
            }
          ]
        }
      ]
    },
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/1.0/StructureDefinition/extension-Observation.identifier",
      "targetVersion": "0.1.0",
      "element": [
        {
          "code": "Observation.identifier",
          "display": "identifier",
          "target": [
            {
              "code": "Extension",
              "equivalence": "equivalent",
              "comment": "Element `Observation.identifier` is mapped to FHIR R4 element `Observation.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.identifier` do not cover the following types: Identifier.\nThe mappings for `Observation.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value."
            }
          ]
        }
      ]
    },
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/1.0/StructureDefinition/extension-Observation.status",
      "targetVersion": "0.1.0",
      "element": [
        {
          "code": "Observation.status",
          "display": "status",
          "target": [
            {
              "code": "Extension",
              "equivalence": "equivalent",
              "comment": "Element `Observation.status` is mapped to FHIR R4 element `Observation.status` as `RelatedTo`.\nThe mappings for `Observation.status` do not allow expression of the necessary codes, per the bindings on the source and target.\nThe target context `Observation.status` is a modifier element, so this extension does not need to be defined as a modifier."
            }
          ]
        }
      ]
    },
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/1.0/StructureDefinition/extension-Observation.value",
      "targetVersion": "0.1.0",
      "element": [
        {
          "code": "Observation.value[x]",
          "display": "value[x]",
          "target": [
            {
              "code": "Extension",
              "equivalence": "equivalent",
              "comment": "Element `Observation.value[x]` is mapped to FHIR R4 element `Observation.value[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.value[x]` do not cover the following types: Attachment, Period, Range, Ratio, SampledData.\nThe target context `Observation.value[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Observation`.\nNormally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is \"'value' + the type name\" with a capital on the first letter of the type).   If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text.  A value set is bound to the ValueCodeableConcept element.  For boolean values use valueCodeableConcept and select codes from [HL7 Version 2 Table 0136](https://hl7.org/fhir/v2/0136/index.html). These \"yes/no\" concepts can be mapped to the display name \"true/false\" or other mutually exclusive terms that may be needed.   For further discussion and examples see the  [notes section](https://hl7.org/fhir/observa.html#4.20.4) below."
            }
          ]
        }
      ]
    },
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/1.0/StructureDefinition/extension-Observation.comments",
      "targetVersion": "0.1.0",
      "element": [
        {
          "code": "Observation.comments",
          "display": "comments",
          "target": [
            {
              "code": "Extension",
              "equivalence": "wider",
              "comment": "Element `Observation.comments` is mapped to FHIR R4 element `Observation.note` as `RelatedTo`.\nThe mappings for `Observation.comments` do not cover the following types: string.\nThe mappings for `Observation.comments` do not cover the following types based on type expansion: value."
            }
          ]
        }
      ]
    },
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/1.0/StructureDefinition/extension-Observation.referenceRange.age",
      "targetVersion": "0.1.0",
      "element": [
        {
          "code": "Observation.referenceRange.age",
          "display": "age",
          "target": [
            {
              "code": "Extension",
              "equivalence": "equivalent",
              "comment": "Element `Observation.referenceRange.age` is mapped to FHIR R4 element `Observation.referenceRange.age` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.referenceRange.age` do not cover the following types: Range.\nThe mappings for `Observation.referenceRange.age` do not cover the following types based on type expansion: high, low."
            }
          ]
        }
      ]
    },
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/1.0/StructureDefinition/extension-Observation.related.type",
      "targetVersion": "0.1.0",
      "element": [
        {
          "code": "Observation.related.type",
          "display": "type",
          "target": [
            {
              "code": "Extension",
              "equivalence": "equivalent",
              "comment": "Element `Observation.related.type` has a context of Observation based on following the parent source element upwards and mapping to `Observation`.\nElement `Observation.related.type` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).\n\"derived-from\" is only logical choice when referencing QuestionnaireAnswer resource."
            }
          ]
        }
      ]
    },
    {
      "source": "http://hl7.org/fhir/StructureDefinition/Observation",
      "sourceVersion": "1.0.2",
      "target": "http://hl7.org/fhir/1.0/StructureDefinition/extension-Observation.component.value",
      "targetVersion": "0.1.0",
      "element": [
        {
          "code": "Observation.component.value[x]",
          "display": "value[x]",
          "target": [
            {
              "code": "Extension",
              "equivalence": "equivalent",
              "comment": "Element `Observation.component.value[x]` is mapped to FHIR R4 element `Observation.component.value[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `Observation.component.value[x]` do not cover the following types: Attachment, Period, Range, Ratio, SampledData.\nThe target context `Observation.component.value[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Observation.component`.\nNormally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value.   For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (These \"yes/no\" concepts can be mapped to the display name \"true/false\" or other mutually exclusive terms that may be needed\").  The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (The name format is \"'value' + the type name\" with a capital on the first letter of the type)."
            }
          ]
        }
      ]
    }
  ]
}