The purpose statement for the Sex Observation needs to be clearer. It needs to explain the relationship between recordTarget.administrativeGender and itself.  Do these data element concepts represent the same information?  Does Sex Observation hold "the recorded administrative gender" of the patient as it is entered by the clinician or patient on a data entry screen or form at a point in time? And, is the recordTarget.administrativeGender information in the header information that systematically populated into the document header through the use of prior recorded Sex Observation information or other information for easy indexing and use in patient matching algorithms?

In C-CDA and US Core we now have 3 places for basic "Sex/Gender" information.  Can you just be clear in the Sex Observation purpose statement how they are different or the same?

I think a lot of implementers are going to get confused by the three very similar spots in the model, so over communicating and very specific instructions explaining how all three are intended/expected to function together over time would be useful.

Consult with recent comments provided by Gender Harmony group on the HTI-1 Rule regarding the Patient.extension.sex data element and align with the nuanced clarity they have provided on the difference between data elements that are entered by end-users and data elements that are system generated (not entered by a user).