None of the Observation profiles in US Core are a good match for the intended content of the PACIO Personal Functioning and Engagement Narrative History of Status Profile: (https://build.fhir.org/ig/HL7/fhir-pacio-pfe/StructureDefinition-pfe-narrative-history-of-status.html )Specifically narrative content not related to a specific test.

Other profiles considered:

• US Core Observation Clinical Test Result Profile: intended data is not tied to a specific test
• US Core Observation Social History Profile: supports narrative data, but our intended data doesn't fit within 'social history'
• US Core Observation Survey Profile: intended data not taken from a specific survey or assessment tool (unlike data for other profiles in our IG which do) 
• US Core DocumentReference Profile: intended data is a specific observation, rather than a more general note and the expected codes don't fit in the US Core Doc Ref code value set.

Therefore, we request a variance to profile the base FHIR Observation resource. In defining our profile, we have followed requirements and must support flags on other US Core Observation profiles.