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Observation - narrative

Guidance for the representation and consumption of Observation resource representing uncoded freetext narrative


There are many instances of uncoded free text narrative notes within patient records.

  • Paragraphs of free text consultation notes perhaps associated with codes via the wider consultation context but not otherwise explicitly coded.
  • Text which may or may not be associated with codes but where the association is inexact and it is considered better to express the notes text as a standalone item rather than bind the text (possibly incorrectly) to an associated coded resource. See Consultation guidance for further information.
  • Representing uncoded or structural elements in patient records for which no suitable resource or is currently available to represent the information and for which falling back to a coded Observation resource as the ‘uncategorised’ representation is inappropriate (for example, no appropriate codes are available to represent the source record entry as an observation).

Because FHIR® does not provide an underlying resource suitable for representing this information, a profile of Observation is utilised to represent narrative text as an Observation Narrative.


The approach for all of these cases is to use an appropriate coded Observation resource to represent the free text.

Instances of Observation narrative are identified by Observation.code of 37331000000100 Comment note (record artifact)

Observation Elements


Data type: Id Optionality: Mandatory Cardinality: 1..1

The logical identifier of the Observation narrative resource.


Data type: uri Optionality: Mandatory Cardinality: 1..1

The Observation narrative profile URL.

Fixed value


Data type: Identifier Optionality: Mandatory Cardinality: 1..*

This MUST be populated with a globally unique and persistent identifier (that is, it doesn’t change between requests and therefore stored with the source data). This MUST be scoped by a provider specific namespace for the identifier.

Where consuming systems are integrating data from this resource to their local system, they MUST also persist this identifier at the same time.


Data type: status Optionality: Mandatory Cardinality: 1..1

Fixed value of finished.


Data type: CodeableConcept Optionality: Mandatory Cardinality: 1..1

Fixed value of 37331000000100 Comment note (record artifact)


Data type: Reference(Patient) Optionality: Mandatory Cardinality: 1..1

Reference to Patient resource representing the patient against whom the narrative text was recorded.


Data type: Reference(Encounter) Optionality: Optional Cardinality: 0..1

Optional reference to the Encounter resource representing the consultation context in which the narrative free text was recorded. Will not be populated where the free text was recorded outside of a consultation context.


Data type: DateTime Optionality: Optional Cardinality: 0..1

The clinically relevant effective data or datetime for the narrative record entry.

Where the effective date is unknown or not recorded will be absent, otherwise it should be populated.


Data type: Instance Optionality: Mandatory Cardinality: 1..1

The audit trail timestamp representing when the narrative was last modified.


Data type: Reference(Practitioner) Optionality: Mandatory Cardinality: 1..1

The Practitioner resource representing the person responsible for recording the narrative.


Data type: String Optionality: Mandatory Cardinality: 1..1

The free text narrative as plain text.

Data type: BackboneElement Optionality: Required Cardinality: 0..*

This attribute is used to specify the sequence of the narrative in relation to other resources (for example, when an ordered set of resource is being used to express the structure of a consultation displayed at source). See Consultation guidance for further information.

The related.type and are used to represent the sequence. Only the related.type value of ‘sequel-to’ is utilised.

All content is available under the Open Government Licence v3.0, except where otherwise stated