Canadian Baseline
1.2.0 - CI Build

Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-Canada/ca-baseline/ and changes regularly. See the Directory of published versions

## Resource Profile: Document Reference Profile

Official URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-documentreference | Version: 1.2.0
Draft as of 2024-08-09 | Computable Name: DocumentReferenceProfile

Proposed constraints on the DocumentReference resource for the minimal set of data required to reference to a document of any kind for any purpose.

# CA Core DocumentReference Profile

This DocumentReference profile sets minimum expectations for mandatory core elements, constraints and value sets required to provide metadata about the document of any kind so that the document can be published, discovered and managed.

This profile defines core localisation concepts for use in an Canadian context.

## Mandatory Data Elements

All elements or attributes defined in FHIR have cardinality as part of their definition - a minimum number of required appearances and a maximum number.

Most elements in FHIR specification have a minimum cardinality of 0, which means that they may be missing from a resource when it is exchanged between systems.

Required elements:

- status of the refence
- document referenced

## Must Support Data Elements

Some elements are labeled as MustSupport meaning that implementations that produce or consume resources SHALL provide "support" for the element in some meaningful way (see Must Support definition).

Following elements are marked as Must Support in the Canadian DocumentReference profile to aid record matching in databases.

Must Support elements:

- master version identifier
- kind of document
- categorization of document
- subject of the document
- document author
- document authenticator
- organization which maintains the document
- the document itself or URL
- context of the document content
- practice settings
- patient demographics

## Usage Note

The following are example usage scenarios for the DocumentReference profile.

- Publishing a new document. This can be done using the IHE MHD Provide Document Bundle [ITI-65] transaction that carries both the document and its metadata.
- Querying the document repository for specific document(s) matching various metadata parameters. This is similar to the IHE MHD Find Document References [ITI-67] transaction.

Usages:

- Refer to this Profile: Procedure Profile and ServiceRequest Profile for Results Reporting

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | DocumentReference Profile
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | S Σ | 0..1 | Identifier | Master Version Specific Identifier
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type | S Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category | S Σ | 0..* | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | S Σ | 0..1 | Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable)) | Who/what is the subject of the document
author | S Σ | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(Organization Profile) | Organization which maintains the document
content | Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: ca-baseline-documentreference-1
context | Σ | 0..1 | BackboneElement | Clinical context of document
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..* | Reference(Encounter Profile) | Context of the document content
practiceSetting | S | 0..1 | CodeableConcept | PractitionerSpecialty Binding: PractitionerSpecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo | S | 0..1 | Reference(Patient Profile) | Patient demographics from source
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std.
DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | preferred | PractitionerSpecialty | 📦1.2.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-documentreference-1 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. | `url.exists() or data.exists()`
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DocumentReference | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from DocumentReference

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | DocumentReference Profile
masterIdentifier | S | 0..1 | Identifier | Master Version Specific Identifier
type | S | 0..1 | CodeableConcept | Kind of document (LOINC if possible)
category | S | 0..* | CodeableConcept | Categorization of document
subject | S | 0..1 | Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable)) | Who/what is the subject of the document
author | S | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(Organization Profile) | Organization which maintains the document
content |  |  |  |
attachment | S C | 1..1 | Attachment | Where to access the document Constraints: ca-baseline-documentreference-1
context |  |  |  |
encounter | S | 0..* | Reference(Encounter Profile) | Context of the document content
practiceSetting | S | 0..1 | CodeableConcept | PractitionerSpecialty Binding: PractitionerSpecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo | S | 0..1 | Reference(Patient Profile) | Patient demographics from source
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.context.​practiceSetting | Base | preferred | PractitionerSpecialty | 📦1.2.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-documentreference-1 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. | `url.exists() or data.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | DocumentReference Profile
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | S Σ | 0..1 | Identifier | Master Version Specific Identifier
identifier | Σ | 0..* | Identifier | Other identifiers for the document
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type | S Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category | S Σ | 0..* | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | S Σ | 0..1 | Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable)) | Who/what is the subject of the document
date | Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(Organization Profile) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | Σ | 1..* | BackboneElement | Document referenced
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: ca-baseline-documentreference-1
format | Σ | 0..1 | Coding | Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
context | Σ | 0..1 | BackboneElement | Clinical context of document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..* | Reference(Encounter Profile) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period | Σ | 0..1 | Period | Time of service that is being documented
facilityType |  | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | S | 0..1 | CodeableConcept | PractitionerSpecialty Binding: PractitionerSpecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo | S | 0..1 | Reference(Patient Profile) | Patient demographics from source
related |  | 0..* | Reference(Resource) | Related identifiers or resources
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std.
DocumentReference.docStatus | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std.
DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
DocumentReference.content.​format | Base | preferred | DocumentReference Format Code Set | 📍4.0.1 | FHIR Std.
DocumentReference.context.​event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v6.5
DocumentReference.context.​facilityType | Base | example | Facility Type Code Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | preferred | PractitionerSpecialty | 📦1.2.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-documentreference-1 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. | `url.exists() or data.exists()`
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DocumentReference | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from DocumentReference

Summary

Must-Support: 11 elements

Structures

This structure refers to these other structures:

- Patient Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient)
- Practitioner Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner)
- Device Profile (Implantable) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-device)
- PractitionerRole Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole)
- Organization Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization)
- Encounter Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-encounter)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | DocumentReference Profile
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | S Σ | 0..1 | Identifier | Master Version Specific Identifier
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type | S Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category | S Σ | 0..* | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | S Σ | 0..1 | Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable)) | Who/what is the subject of the document
author | S Σ | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(Organization Profile) | Organization which maintains the document
content | Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: ca-baseline-documentreference-1
context | Σ | 0..1 | BackboneElement | Clinical context of document
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..* | Reference(Encounter Profile) | Context of the document content
practiceSetting | S | 0..1 | CodeableConcept | PractitionerSpecialty Binding: PractitionerSpecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo | S | 0..1 | Reference(Patient Profile) | Patient demographics from source
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std.
DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | preferred | PractitionerSpecialty | 📦1.2.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-documentreference-1 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. | `url.exists() or data.exists()`
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DocumentReference | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

This structure is derived from DocumentReference

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | DocumentReference Profile
masterIdentifier | S | 0..1 | Identifier | Master Version Specific Identifier
type | S | 0..1 | CodeableConcept | Kind of document (LOINC if possible)
category | S | 0..* | CodeableConcept | Categorization of document
subject | S | 0..1 | Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable)) | Who/what is the subject of the document
author | S | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(Organization Profile) | Organization which maintains the document
content |  |  |  |
attachment | S C | 1..1 | Attachment | Where to access the document Constraints: ca-baseline-documentreference-1
context |  |  |  |
encounter | S | 0..* | Reference(Encounter Profile) | Context of the document content
practiceSetting | S | 0..1 | CodeableConcept | PractitionerSpecialty Binding: PractitionerSpecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo | S | 0..1 | Reference(Patient Profile) | Patient demographics from source
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.context.​practiceSetting | Base | preferred | PractitionerSpecialty | 📦1.2.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-documentreference-1 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. | `url.exists() or data.exists()`

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | DocumentReference Profile
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | S Σ | 0..1 | Identifier | Master Version Specific Identifier
identifier | Σ | 0..* | Identifier | Other identifiers for the document
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type | S Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category | S Σ | 0..* | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | S Σ | 0..1 | Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable)) | Who/what is the subject of the document
date | Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(Organization Profile) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | Σ | 1..* | BackboneElement | Document referenced
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: ca-baseline-documentreference-1
format | Σ | 0..1 | Coding | Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
context | Σ | 0..1 | BackboneElement | Clinical context of document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..* | Reference(Encounter Profile) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period | Σ | 0..1 | Period | Time of service that is being documented
facilityType |  | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | S | 0..1 | CodeableConcept | PractitionerSpecialty Binding: PractitionerSpecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo | S | 0..1 | Reference(Patient Profile) | Patient demographics from source
related |  | 0..* | Reference(Resource) | Related identifiers or resources
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std.
DocumentReference.docStatus | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std.
DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
DocumentReference.content.​format | Base | preferred | DocumentReference Format Code Set | 📍4.0.1 | FHIR Std.
DocumentReference.context.​event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v6.5
DocumentReference.context.​facilityType | Base | example | Facility Type Code Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | preferred | PractitionerSpecialty | 📦1.2.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ca-baseline-documentreference-1 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. | `url.exists() or data.exists()`
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DocumentReference | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from DocumentReference

Summary

Must-Support: 11 elements

Structures

This structure refers to these other structures:

- Patient Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient)
- Practitioner Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner)
- Device Profile (Implantable) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-device)
- PractitionerRole Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole)
- Organization Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization)
- Encounter Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-encounter)

Other representations of profile: CSV, Excel, Schematron