description: This template represents a patient's job (occupation and industry), lifestyle, and environmental health risk factors. Demographic data (e.g., marital status, race, ethnicity, religious affiliation) are captured in the header. Though tobacco use and exposure may be represented with a Social History Observation, it is recommended to use the Current Smoking Status template or the Tobacco Use template instead, to represent smoking or tobacco habits.\nThere are supplemental templates and guidance for observations of [Occupational Data for Health](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=522), [nutrition](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=478) and [pregnancy](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=494) that could be captured in the Social History Observation, and implementers may want to consider using those more specific templates in the Social History section.
package_name: hl7.cda.us.ccda
derivation: constraint
name: SocialHistoryObservation
type: http://hl7.org/cda/stds/core/StructureDefinition/Observation
elements:
  entryRelationship:
    index: 15
    slicing:
      rules: open
      discriminator:
      - {path: act, type: profile}
      - {path: observation, type: profile}
      min: null
      slices:
        social-history-entry-sprt-obs:
          match: {}
          schema:
            short: When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
            array: true
            index: 16
            elements:
              typeCode:
                pattern: {type: Code, value: SPRT}
                index: 17
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 18}
            required: [observation]
        social-history-entry-sprt-act:
          match: {}
          schema:
            short: When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
            array: true
            index: 19
            elements:
              typeCode:
                pattern: {type: Code, value: SPRT}
                index: 20
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 21}
            required: [act]
  value: {short: 'NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units', index: 13}
  classCode:
    pattern: {type: Code, value: OBS}
    index: 4
  author: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Author', index: 14}
  id: {index: 6}
  code:
    binding: {strength: preferred, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.60'}
    constraint:
      4515-32956: {human: 'If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956).', source: 'http://hl7.org/cda/us/ccda/StructureDefinition/SocialHistoryObservation', severity: warning, expression: codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()}
    index: 7
  moodCode:
    pattern: {type: Code, value: EVN}
    index: 5
  effectiveTime: {index: 12}
  templateId:
    index: 0
    slicing:
      rules: open
      discriminator:
      - {path: root, type: value}
      - {path: extension, type: value}
      min: 1
      slices:
        social-history-obs:
          match: {root: 2.16.840.1.113883.10.20.22.4.38, extension: '2022-06-01'}
          schema:
            _required: true
            index: 1
            elements:
              root:
                pattern: {type: String, value: 2.16.840.1.113883.10.20.22.4.38}
                index: 2
              extension:
                pattern: {type: String, value: '2022-06-01'}
                index: 3
            required: [root, extension]
            extensions: {}
  statusCode:
    index: 10
    elements:
      code:
        pattern: {type: Code, value: completed}
        index: 11
    required: [code]
  text:
    short: SHOULD reference the portion of section narrative text corresponding to this entry
    index: 8
    elements:
      reference:
        constraint:
          value-starts-octothorpe: {human: 'If reference/@value is present, it SHALL begin with a ''#'' and SHALL point to its corresponding narrative', source: 'http://hl7.org/cda/us/ccda/StructureDefinition/SocialHistoryObservation', severity: error, expression: value.exists() implies value.startsWith('#')}
        index: 9
package_version: 3.0.0-ballot
class: logical
kind: logical
url: http://hl7.org/cda/us/ccda/StructureDefinition/SocialHistoryObservation
base: http://hl7.org/cda/stds/core/StructureDefinition/Observation
version: 3.0.0-ballot
required: [id, effectiveTime, statusCode, templateId]