<?xml version=“1.0” encoding=“UTF-8”?><Observation xmlns=“hl7.org/fhir”>

<id value="20minute-apgar-score"/>
<!--    Using a contained patient for the purposes of this example Observation.  Typically the reference would be to an external resource    -->
<text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: 20minute-apgar-score</p><p><b>contained</b>: </p><p><b>status</b>: final</p><p><b>category</b>: Survey <span>(Details : {http://hl7.org/fhir/observation-category code &#39;survey&#39; = &#39;Survey&#39;, given as &#39;Survey&#39;})</span></p><p><b>code</b>: 20 minute Apgar Score <span>(Details : {SNOMED CT code &#39;443849008&#39; = &#39;Apgar score at 20 minutes&#39;, given as &#39;Apgar score at 20 minutes&#39;})</span></p><p><b>subject</b>: id: newborn; 12345; active; Peter James Chalmers ; gender: male; birthDate: May 18, 2016</p><p><b>effective</b>: May 18, 2016 10:33:22 PM</p><p><b>performer</b>: <a>Practitioner/example</a></p><p><b>value</b>: 10 {score}<span> (Details: UCUM code {score} = &#39;{score}&#39;)</span></p><blockquote><p><b>component</b></p><p><b>code</b>: Apgar color score <span>(Details : {SNOMED CT code &#39;249227004&#39; = &#39;Apgar color score&#39;, given as &#39;Apgar color score&#39;})</span></p><p><b>value</b>: 2. Good color all over <span>(Details : {http://loinc.org/la code &#39;LA6724-4&#39; = &#39;LA6724-4&#39;, given as &#39;Good color all over&#39;}; {http:/acme.ped/apgarcolor code &#39;2&#39; = &#39;2)</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: Apgar respiratory effort score <span>(Details : {SNOMED CT code &#39;249223000&#39; = &#39;Apgar heart rate score&#39;, given as &#39;Apgar heart rate score&#39;})</span></p><p><b>value</b>: 2. At least 100 beats per minute <span>(Details : {http://loinc.org/la code &#39;LA6718-6&#39; = &#39;LA6718-6&#39;, given as &#39;At least 100 beats per minute&#39;}; {http:/acme.ped/apgarheartrate code &#39;2&#39; = &#39;2)</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: Apgar response to stimulus score <span>(Details : {SNOMED CT code &#39;249226008&#39; = &#39;Apgar response to stimulus score&#39;, given as &#39;Apgar response to stimulus score&#39;})</span></p><p><b>value</b>: 2. Grimace and pulling away, cough, or sneeze during suctioning <span>(Details : {http://loinc.org/la code &#39;LA6721-0&#39; = &#39;LA6721-0&#39;, given as &#39;Grimace and pulling away, cough, or sneeze during suctioning&#39;}; {http:/acme.ped/apgarreflexirritability code &#39;2&#39; = &#39;2)</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: Apgar muscle tone score <span>(Details : {SNOMED CT code &#39;249225007&#39; = &#39;Apgar muscle tone score&#39;, given as &#39;Apgar muscle tone score&#39;})</span></p><p><b>value</b>: 2. Active motion <span>(Details : {http://loinc.org/la code &#39;LA6715-2&#39; = &#39;LA6715-2&#39;, given as &#39;Active motion &#39;}; {http:/acme.ped/apgarmuscletone code &#39;2&#39; = &#39;2)</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: Apgar respiratory effort score <span>(Details : {SNOMED CT code &#39;249224006&#39; = &#39;Apgar respiratory effort score&#39;, given as &#39;Apgar respiratory effort score&#39;})</span></p><p><b>value</b>: 2. Good, strong cry; normal rate and effort of breathing <span>(Details : {http://loinc.org/la code &#39;LA6727-7&#39; = &#39;LA6727-7&#39;, given as &#39;Good, strong cry; normal rate and effort of breathing    &#39;}; {http:/acme.ped/apgarrespiratoryeffort code &#39;2&#39; = &#39;2)</span></p></blockquote></div></text><contained>
        <Patient>
                <id value="newborn"/>
                <!--     MRN assigned by ACME healthcare on     -->
                <identifier>
                        <system value="http://acmehealthcare/org/mrns"/>
                        <value value="12345"/>
                </identifier>
                <active value="true"/>
                <!--     Peter James Chalmers     -->
                <name>
                        <family value="Chalmers"/>
                        <given value="Peter"/>
                        <given value="James"/>
                </name>
                <!--     use FHIR code system for male / female     -->
                <gender value="male"/>
                <birthDate value="2016-05-18">
                        <extension url="http://hl7.org/fhir/StructureDefinition/patient-birthTime">
                                <valueDateTime value="2016-05-18T10:28:45Z"/>
                        </extension>
                </birthDate>
        </Patient>
</contained>
<status value="final"/>
<category>
        <coding>
                <system value="http://hl7.org/fhir/observation-category"/>
                <code value="survey"/>
                <display value="Survey"/>
        </coding>
        <text value="Survey"/>
</category>
<code>
        <coding>
                <system value="http://snomed.info/sct"/>
                <code value="443849008"/>
                <display value="Apgar score at 20 minutes"/>
        </coding>
        <text value="20 minute Apgar Score"/>
</code>
<subject>
        <reference value="#newborn"/>
</subject>
<effectiveDateTime value="2016-05-18T22:33:22Z"/>
<performer>
        <reference value="Practitioner/example"/>
</performer>
<valueQuantity>
        <value value="10"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="{score}"/>
</valueQuantity>
<component>
        <code>
                <coding>
                        <system value="http://snomed.info/sct"/>
                        <code value="249227004"/>
                        <display value="Apgar color score"/>
                </coding>
                <text value="Apgar color score"/>
        </code>
        <valueCodeableConcept>
                <coding>
                        <!--  this  extension  maps a numeric score to the code this may already be known and unecessary  -->
                        <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
                                <valueDecimal value="2"/>
                        </extension>
                        <system value="http://loinc.org/la"/>
                        <code value="LA6724-4"/>
                        <display value="Good color all over"/>
                </coding>
                <coding>
                        <system value="http:/acme.ped/apgarcolor"/>
                        <code value="2"/>
                </coding>
                <text value="2. Good color all over"/>
        </valueCodeableConcept>
</component>
<component>
        <code>
                <coding>
                        <system value="http://snomed.info/sct"/>
                        <code value="249223000"/>
                        <display value="Apgar heart rate score"/>
                </coding>
                <text value="Apgar respiratory effort score"/>
        </code>
        <valueCodeableConcept>
                <coding>
                        <!--  this  extension  maps a numeric score to the code this may already be known and unecessary  -->
                        <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
                                <valueDecimal value="2"/>
                        </extension>
                        <system value="http://loinc.org/la"/>
                        <code value="LA6718-6"/>
                        <display value="At least 100 beats per minute"/>
                </coding>
                <coding>
                        <system value="http:/acme.ped/apgarheartrate"/>
                        <code value="2"/>
                </coding>
                <text value="2. At least 100 beats per minute"/>
        </valueCodeableConcept>
</component>
<component>
        <code>
                <coding>
                        <system value="http://snomed.info/sct"/>
                        <code value="249226008"/>
                        <display value="Apgar response to stimulus score"/>
                </coding>
                <text value="Apgar response to stimulus score"/>
        </code>
        <valueCodeableConcept>
                <coding>
                        <!--  this  extension  maps a numeric score to the code this may already be known and unecessary  -->
                        <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
                                <valueDecimal value="2"/>
                        </extension>
                        <system value="http://loinc.org/la"/>
                        <code value="LA6721-0"/>
                        <display value="Grimace and pulling away, cough, or sneeze during suctioning"/>
                </coding>
                <coding>
                        <system value="http:/acme.ped/apgarreflexirritability"/>
                        <code value="2"/>
                </coding>
                <text value="2. Grimace and pulling away, cough, or sneeze during suctioning"/>
        </valueCodeableConcept>
</component>
<component>
        <code>
                <coding>
                        <system value="http://snomed.info/sct"/>
                        <code value="249225007"/>
                        <display value="Apgar muscle tone score"/>
                </coding>
                <text value="Apgar muscle tone score"/>
        </code>
        <valueCodeableConcept>
                <coding>
                        <!--  this  extension  maps a numeric score to the code this may already be known and unecessary  -->
                        <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
                                <valueDecimal value="2"/>
                        </extension>
                        <system value="http://loinc.org/la"/>
                        <code value="LA6715-2"/>
                        <display value="Active motion "/>
                </coding>
                <coding>
                        <system value="http:/acme.ped/apgarmuscletone"/>
                        <code value="2"/>
                </coding>
                <text value="2. Active motion"/>
        </valueCodeableConcept>
</component>
<component>
        <code>
                <coding>
                        <system value="http://snomed.info/sct"/>
                        <code value="249224006"/>
                        <display value="Apgar respiratory effort score"/>
                </coding>
                <text value="Apgar respiratory effort score"/>
        </code>
        <valueCodeableConcept>
                <coding>
                        <!--  this  extension  maps a numeric score to the code this may already be known and unecessary  -->
                        <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
                                <valueDecimal value="2"/>
                        </extension>
                        <system value="http://loinc.org/la"/>
                        <code value="LA6727-7"/>
                        <display value="Good, strong cry; normal rate and effort of breathing    "/>
                </coding>
                <coding>
                        <system value="http:/acme.ped/apgarrespiratoryeffort"/>
                        <code value="2"/>
                </coding>
                <text value="2. Good, strong cry; normal rate and effort of breathing"/>
        </valueCodeableConcept>
</component>

</Observation>