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

<id value="glasgow"/>
<text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: glasgow</p><p><b>contained</b>: , , </p><p><b>status</b>: final</p><p><b>code</b>: Glasgow Coma Scale , (GCS) <span>(Details : {LOINC code &#39;9269-2&#39; = &#39;Glasgow coma score total&#39;, given as &#39;Glasgow coma score total&#39;})</span></p><p><b>subject</b>: <a>Peter James Chalmers</a></p><p><b>effective</b>: 11/12/2014 3:44:16 PM</p><p><b>value</b>: 13 {score}<span> (Details: http://unitsofmeasure.org code {score} = &#39;??&#39;)</span></p><blockquote><p><b>referenceRange</b></p><p><b>high</b>: 8 {score}<span> (Details: http://unitsofmeasure.org code {score} = &#39;??&#39;)</span></p><p><b>meaning</b>: Severe TBI <span>(Details )</span></p></blockquote><blockquote><p><b>referenceRange</b></p><p><b>low</b>: 9 {score}<span> (Details: http://unitsofmeasure.org code {score} = &#39;??&#39;)</span></p><p><b>high</b>: 12 {score}<span> (Details: http://unitsofmeasure.org code {score} = &#39;??&#39;)</span></p><p><b>meaning</b>: Moderate TBI <span>(Details )</span></p></blockquote><blockquote><p><b>referenceRange</b></p><p><b>low</b>: 13 {score}<span> (Details: http://unitsofmeasure.org code {score} = &#39;??&#39;)</span></p><p><b>meaning</b>: Mild TBI <span>(Details )</span></p></blockquote><blockquote><p><b>related</b></p><p><b>type</b>: derived-from</p><p><b>target</b>: Motor score. Generated Summary: id: motor; status: final; GCS motor <span>(Details : {LOINC code &#39;9268-4&#39; = &#39;Glasgow coma score motor&#39;, given as &#39;Glasgow coma score motor&#39;})</span>; Patient/example; effective: 11/12/2014 3:44:16 PM; 5 (Localizes painful stimuli) <span>(Details : {http:/acme.ec/gcsmotor code &#39;5&#39; = &#39;??&#39;, given as &#39;Localizes painful stimuli&#39;}; {LOINC code &#39;LA6566-9&#39; = &#39;Localizing pain&#39;, given as &#39;Localizing pain&#39;})</span></p></blockquote><blockquote><p><b>related</b></p><p><b>type</b>: derived-from</p><p><b>target</b>: Verbal score. Generated Summary: id: verbal; status: final; Verbal <span>(Details : {LOINC code &#39;9270-0&#39; = &#39;Glasgow coma score verbal&#39;, given as &#39;Glasgow coma score verbal&#39;})</span>; Patient/example; effective: 11/12/2014 3:44:16 PM; 4 (Confused, disoriented) <span>(Details : {http:/acme.ec/gcsverbal code &#39;4&#39; = &#39;??&#39;, given as &#39;Confused, disoriented&#39;}; {LOINC code &#39;LA6560-2&#39; = &#39;Confused&#39;, given as &#39;Confused&#39;})</span></p></blockquote><blockquote><p><b>related</b></p><p><b>type</b>: derived-from</p><p><b>target</b>: Eyes score. Generated Summary: id: eyes; status: final; Eyes <span>(Details : {LOINC code &#39;9267-6&#39; = &#39;Glasgow coma score eye opening&#39;, given as &#39;Glasgow coma score eye opening&#39;})</span>; Patient/example; effective: 11/12/2014 3:44:16 PM; 4 (Opens eyes spontaneously) <span>(Details : {http:/acme.ec/gcseye code &#39;4&#39; = &#39;??&#39;, given as &#39;Opens eyes spontaneously&#39;}; {LOINC code &#39;LA6556-0&#39; = &#39;Eyes open spontaneously&#39;, given as &#39;Eyes open spontaneously&#39;})</span></p></blockquote></div></text><contained>
<!--    FHIR build is generating the narratives

<text>

              <status value="generated"></status>
               <div xmlns="http://www.w3.org/1999/xhtml">
               <h2>Observation: Glasgow Coma Scale , (GCS)</h2>
      <h3>Date Time: 2014-12-11 20:44PM</h3>
      <h3>Patient Name: Peter James Chalmers</h3>

              <ul>
                      <li>
                              <b>Glasgow Coma Scale , (GCS)=</b>13<ul>
                                      <li>
                                              <b>Motor=</b>5</li>
                                      <li>
                                              <b>Verbal=</b>4</li>
                                      <li>
                                              <b>Eyes=</b>4</li>
                              </ul></li>
              </ul>

               </div>
      </text>
 -->
<!--    Note: will use contained elements for this example but could just as easily use external or bundled elements..   -->
<!--    First contained element = Motor component.    -->
  <Observation>
    <id value="motor"/>
    <status value="final"/>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="9268-4"/>
        <display value="Glasgow coma score motor"/>
      </coding>
      <text value="GCS motor"/>
    </code>
    <subject>
      <reference value="Patient/example"/>
    </subject>
    <effectiveDateTime value="2014-12-11T04:44:16Z"/>
    <valueCodeableConcept>
      <coding>
        <system value="http:/acme.ec/gcsmotor"/>
        <code value="5"/>
        <display value="Localizes painful stimuli"/>
      </coding>
      <coding>
      <!--     This example has the extension which maps a numeric score to the code this may already be known and unecessary in the Observation resource    -->
        <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
        <!--    from Element: extension    -->
          <valueDecimal value="5"/>
        <!--    0..1 Value of extension    -->
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA6566-9"/>
        <display value="Localizing pain"/>
      </coding>
      <text value="5 (Localizes painful stimuli)"/>
    </valueCodeableConcept>
  </Observation>
</contained>
<contained>
<!--    Second contained element = Verbal component.    -->
  <Observation>
    <id value="verbal"/>
    <status value="final"/>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="9270-0"/>
        <display value="Glasgow coma score verbal"/>
      </coding>
      <text value="Verbal"/>
    </code>
    <subject>
      <reference value="Patient/example"/>
    </subject>
    <effectiveDateTime value="2014-12-11T04:44:16Z"/>
    <valueCodeableConcept>
      <coding>
        <system value="http:/acme.ec/gcsverbal"/>
        <code value="4"/>
        <display value="Confused, disoriented"/>
      </coding>
      <coding>
      <!--     This example has the extension which maps a numeric score to the code this may already be known and unecessary in the Observation resource    -->
        <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
        <!--    from Element: extension    -->
          <valueDecimal value="4"/>
        <!--    0..1 Value of extension    -->
        </extension>
        <system value="http://loinc.org"/>
      <!--   technicallly the code is '5' and the LA is the identifier to do hav e both  would require an extention   -->
        <code value="LA6560-2"/>
        <display value="Confused"/>
      </coding>
      <text value="4 (Confused, disoriented)"/>
    </valueCodeableConcept>
  </Observation>
</contained>
<contained>
<!--    Third contained element = Eyes component.    -->
  <Observation>
    <id value="eyes"/>
    <status value="final"/>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="9267-6"/>
        <display value="Glasgow coma score eye opening"/>
      </coding>
      <text value="Eyes"/>
    </code>
    <subject>
      <reference value="Patient/example"/>
    </subject>
    <effectiveDateTime value="2014-12-11T04:44:16Z"/>
    <valueCodeableConcept>
      <coding>
        <system value="http:/acme.ec/gcseye"/>
        <code value="4"/>
        <display value="Opens eyes spontaneously"/>
      </coding>
      <coding>
      <!--     This example has the extension which maps a numeric score to the code this may already be known and unecessary in the Observation resource    -->
        <extension url="http://hl7.org/fhir/StructureDefinition/iso21090-CO-value">
        <!--    from Element: extension    -->
          <valueDecimal value="4"/>
        <!--    0..1 Value of extension    -->
        </extension>
        <system value="http://loinc.org"/>
      <!--   technicallly the code is '4' and the LA is the identifier to do hav e both  would require an extention   -->
        <code value="LA6556-0"/>
        <display value="Eyes open spontaneously"/>
      </coding>
      <text value="4 (Opens eyes spontaneously)"/>
    </valueCodeableConcept>
  </Observation>
</contained>

<!– the mandatory quality flags: –>

<status value="final"/>

<!–

  Observations are often coded in multiple code systems.
    - LOINC
              - or SNOMED
    -and/or the source system may provides its own "local" code, which may be less or more granular than LOINC.
      In this example there is only LOINC
   -->
<code>
<!--    LOINC - always recommended to have a LOINC code    -->
  <coding>
    <system value="http://loinc.org"/>
    <code value="9269-2"/>
    <display value="Glasgow coma score total"/>
  </coding>
  <text value="Glasgow Coma Scale , (GCS)"/>
</code>
<subject>
  <reference value="Patient/example"/>
  <display value="Peter James Chalmers"/>
</subject>
<effectiveDateTime value="2014-12-11T04:44:16Z"/>

<!– In FHIR, units may be represented twice. Once in the

  agreed human representation, and once in a coded form.
  In this example the UCUM unit is provided but no human representation since this is often not displayed
    -->
<valueQuantity>
  <value value="13"/>
  <system value="http://unitsofmeasure.org"/>
  <code value="{score}"/>
</valueQuantity>
<referenceRange>
  <high>
    <value value="8"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="{score}"/>
  </high>
<!--    meaning as text    -->
  <meaning>
    <text value="Severe TBI"/>
  </meaning>
</referenceRange>
<referenceRange>
  <low>
    <value value="9"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="{score}"/>
  </low>
  <high>
    <value value="12"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="{score}"/>
  </high>
<!--    meaning as text    -->
  <meaning>
    <text value="Moderate TBI"/>
  </meaning>
</referenceRange>
<referenceRange>
  <low>
    <value value="13"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="{score}"/>
  </low>
<!--    meaning as text    -->
  <meaning>
    <text value="Mild TBI"/>
  </meaning>
</referenceRange>

<!– put the references to the contained components here using the derived-From type –>

<related>
  <type value="derived-from"/>
  <target>
    <reference value="#motor"/>
    <display value="Motor score"/>
  </target>
</related>
<related>
  <type value="derived-from"/>
  <target>
    <reference value="#verbal"/>
    <display value="Verbal score"/>
  </target>
</related>
<related>
  <type value="derived-from"/>
  <target>
    <reference value="#eyes"/>
    <display value="Eyes score"/>
  </target>
</related>

</Observation>