Pharmaceutical Quality - Chemistry, Manufacturing and Controls (PQ-CMC) Submissions to FDA
2.0.0 - STU2

Pharmaceutical Quality - Chemistry, Manufacturing and Controls (PQ-CMC) Submissions to FDA, published by HL7 International / Biomedical Research and Regulation. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/FHIR-us-pq-cmc-fda/ and changes regularly. See the Directory of published versions

## Resource Profile: Base64DocumentReference - XML Profile

Page standards status: Trial-use | Maturity Level: 2

XML representation of the cmc-document-reference resource profile.

Raw xml | Download

    <StructureDefinition xmlns="http://hl7.org/fhir">
      <id value="cmc-document-reference"/>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: StructureDefinition cmc-document-reference</b></p><a name="cmc-document-reference"> </a><a name="hccmc-document-reference"> </a><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Minimum and Maximum # of times the element can appear in the instance">Card.</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px; width: 100px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Additional information about the element">Description &amp; Constraints</a><span style="float: right"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64, " alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: white; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-cmc-document-reference-definitions.html#DocumentReference">DocumentReference</a><a name="DocumentReference"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R5/documentreference.html">DocumentReference</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">This is an abstract profile. Child profiles: <a href="StructureDefinition-pqcmc-graphic-reference.html">GraphicReference</a>, <a href="StructureDefinition-pqcmc-structure-reference.html">StructureReference</a></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-cmc-document-reference-definitions.html#DocumentReference.status">status</a><a name="DocumentReference.status"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5; opacity: 0.5" href="http://hl7.org/fhir/R5/datatypes.html#code">code</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">current | superseded | entered-in-error</span><br/><span style="font-weight:bold">Required Pattern: </span><span style="color: darkgreen">current</span></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-cmc-document-reference-definitions.html#DocumentReference.content">content</a><a name="DocumentReference.content"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5; opacity: 0.5" href="http://hl7.org/fhir/R5/types.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Document referenced</span></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-cmc-document-reference-definitions.html#DocumentReference.content.attachment">attachment</a><a name="DocumentReference.content.attachment"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="StructureDefinition-pqcmc-attachment.html" title="Attachment">PqcmcAttachment</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Where to access the document</span></td></tr>
    <tr><td colspan="5" class="hierarchy"><br/><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64, " alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
        <valueCode value="brr"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
        <valueInteger value="2">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
            <valueCanonical
                            value="http://hl7.org/fhir/us/pq-cmc-fda/ImplementationGuide/hl7.fhir.us.pq-cmc-fda"/>
          </extension>
        </valueInteger>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
        <valueCode value="trial-use">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
            <valueCanonical
                            value="http://hl7.org/fhir/us/pq-cmc-fda/ImplementationGuide/hl7.fhir.us.pq-cmc-fda"/>
          </extension>
        </valueCode>
      </extension>
      <url
           value="http://hl7.org/fhir/us/pq-cmc-fda/StructureDefinition/cmc-document-reference"/>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.4.642.40.36.42.1"/>
      </identifier>
      <version value="2.0.0"/>
      <name value="Base64DocumentReference"/>
      <title value="Document Reference Attachment"/>
      <status value="active"/>
      <date value="2025-07-03T13:07:08+00:00"/>
      <publisher value="HL7 International / Biomedical Research and Regulation"/>
      <contact>
        <name value="HL7 International / Biomedical Research and Regulation"/>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/rcrim"/>
        </telecom>
        <telecom>
          <system value="email"/>
          <value value="brr@lists.HL7.org"/>
        </telecom>
      </contact>
      <description
                   value="A profile that represents the document or diagram in base64."/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="US"/>
          <display value="United States of America"/>
        </coding>
      </jurisdiction>
      <fhirVersion value="5.0.0"/>
      <mapping>
        <identity value="workflow"/>
        <uri value="http://hl7.org/fhir/workflow"/>
        <name value="Workflow Pattern"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <uri value="http://hl7.org/fhir/fivews"/>
        <name value="FiveWs Pattern Mapping"/>
      </mapping>
      <mapping>
        <identity value="fhircomposition"/>
        <uri value="http://hl7.org/fhir/composition"/>
        <name value="FHIR Composition"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <uri value="http://hl7.org/v3"/>
        <name value="RIM Mapping"/>
      </mapping>
      <mapping>
        <identity value="xds"/>
        <uri value="http://ihe.net/xds"/>
        <name value="XDS metadata equivalent"/>
      </mapping>
      <mapping>
        <identity value="cda"/>
        <uri value="http://hl7.org/v3/cda"/>
        <name value="CDA (R2)"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <uri value="http://hl7.org/v2"/>
        <name value="HL7 V2 Mapping"/>
      </mapping>
      <kind value="resource"/>
      <abstract value="true"/>
      <type value="DocumentReference"/>
      <baseDefinition
                      value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/>
      <derivation value="constraint"/>
      <snapshot>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version">
          <valueString value="5.0.0"/>
        </extension>
        <element id="DocumentReference">
          <path value="DocumentReference"/>
          <short value="A reference to a document"/>
          <definition
                      value="A reference to a document of any kind for any purpose. While the term “document” implies a more narrow focus, for this resource this &quot;document&quot; encompasses *any* serialized object with a mime-type, it includes formal patient-centric documents (CDA), clinical notes, scanned paper, non-patient specific documents like policy text, as well as a photo, video, or audio recording acquired or used in healthcare.  The DocumentReference resource provides metadata about the document so that the document can be discovered and managed.  The actual content may be inline base64 encoded data or provided by direct reference."/>
          <comment
                   value="Usually, this is used for documents other than those defined by FHIR."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <constraint>
            <key value="docRef-1"/>
            <severity value="warning"/>
            <human
                   value="facilityType SHALL only be present if context is not an encounter"/>
            <expression
                        value="facilityType.empty() or context.where(resolve() is Encounter).empty()"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/>
          </constraint>
          <constraint>
            <key value="docRef-2"/>
            <severity value="warning"/>
            <human
                   value="practiceSetting SHALL only be present if context is not present"/>
            <expression
                        value="practiceSetting.empty() or context.where(resolve() is Encounter).empty()"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/>
          </constraint>
          <constraint>
            <key value="dom-2"/>
            <severity value="error"/>
            <human
                   value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
            <expression value="contained.contained.empty()"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-3"/>
            <severity value="error"/>
            <human
                   value="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"/>
            <expression
                        value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-4"/>
            <severity value="error"/>
            <human
                   value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
            <expression
                        value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-5"/>
            <severity value="error"/>
            <human
                   value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
            <expression value="contained.meta.security.empty()"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
              <valueBoolean value="true"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
              <valueMarkdown
                             value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/>
            </extension>
            <key value="dom-6"/>
            <severity value="warning"/>
            <human
                   value="A resource should have narrative for robust management"/>
            <expression value="text.`div`.exists()"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map
                 value="Entity, Role, or Act,Document[classCode=&quot;DOC&quot; and moodCode=&quot;EVN&quot;]"/>
          </mapping>
          <mapping>
            <identity value="workflow"/>
            <map value="Event"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="infrastructure.documents"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="when describing a Composition"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="when describing a CDA"/>
          </mapping>
        </element>
        <element id="DocumentReference.id">
          <path value="DocumentReference.id"/>
          <short value="Logical id of this artifact"/>
          <definition
                      value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
          <comment
                   value="Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="id"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
        </element>
        <element id="DocumentReference.meta">
          <path value="DocumentReference.meta"/>
          <short value="Metadata about the resource"/>
          <definition
                      value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.meta"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Meta"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
        </element>
        <element id="DocumentReference.implicitRules">
          <path value="DocumentReference.implicitRules"/>
          <short value="A set of rules under which this content was created"/>
          <definition
                      value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc."/>
          <comment
                   value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.implicitRules"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="uri"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="true"/>
          <isModifierReason
                            value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation"/>
          <isSummary value="true"/>
        </element>
        <element id="DocumentReference.language">
          <path value="DocumentReference.language"/>
          <short value="Language of the resource content"/>
          <definition
                      value="The base language in which the resource is written."/>
          <comment
                   value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.language"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="Language"/>
            </extension>
            <strength value="required"/>
            <description value="IETF language tag for a human language"/>
            <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|5.0.0"/>
            <additional>
              <purpose value="starter"/>
              <valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
            </additional>
          </binding>
        </element>
        <element id="DocumentReference.text">
          <path value="DocumentReference.text"/>
          <short value="Text summary of the resource, for human interpretation"/>
          <definition
                      value="A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/>
          <comment
                   value="Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded information is added later."/>
          <alias value="narrative"/>
          <alias value="html"/>
          <alias value="xhtml"/>
          <alias value="display"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DomainResource.text"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Narrative"/>
          </type>
          <condition value="dom-6"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="Act.text?"/>
          </mapping>
        </element>
        <element id="DocumentReference.contained">
          <path value="DocumentReference.contained"/>
          <short value="Contained, inline Resources"/>
          <definition
                      value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning."/>
          <comment
                   value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels."/>
          <alias value="inline resources"/>
          <alias value="anonymous resources"/>
          <alias value="contained resources"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.contained"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Resource"/>
          </type>
          <condition value="dom-2"/>
          <condition value="dom-4"/>
          <condition value="dom-3"/>
          <condition value="dom-5"/>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.extension">
          <path value="DocumentReference.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.modifierExtension">
          <path value="DocumentReference.modifierExtension"/>
          <short value="Extensions that cannot be ignored"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <requirements
                        value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.identifier">
          <path value="DocumentReference.identifier"/>
          <short value="Business identifiers for the document"/>
          <definition
                      value="Other business identifiers associated with the document, including version independent identifiers."/>
          <comment
                   value="The structure and format of this identifier would be consistent with the specification corresponding to the format of the document. (e.g. for a DICOM standard document, a 64-character numeric UID; for an HL7 CDA format, the CDA Document Id root and extension)."/>
          <requirements
                        value="Document identifiers usually assigned by the source of the document, or other business identifiers such as XDS DocumentEntry.uniqueId and DocumentEntry.entryUUID. These identifiers are specific to this instance of the document."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.identifier"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Identifier"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.identifier"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.identifier"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.identifier"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-12"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".id / .setId"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.entryUUID, DocumentEntry.uniqueId"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/id"/>
          </mapping>
        </element>
        <element id="DocumentReference.version">
          <path value="DocumentReference.version"/>
          <short
                 value="An explicitly assigned identifer of a variation of the content in the DocumentReference"/>
          <definition
                      value="An explicitly assigned identifer of a variation of the content in the DocumentReference."/>
          <comment
                   value="While each resource, including the DocumentReference itself, has its own version identifier, this is a formal identifier for the logical version of the DocumentReference as a whole. It would remain constant if the resources were moved to a new server, and all got new individual resource versions, for example."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.version"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.version"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.version"/>
          </mapping>
        </element>
        <element id="DocumentReference.basedOn">
          <path value="DocumentReference.basedOn"/>
          <short value="Procedure that caused this media to be created"/>
          <definition
                      value="A procedure that is fulfilled in whole or in part by the creation of this media."/>
          <requirements
                        value="Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon."/>
          <alias value="fulfills"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.basedOn"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Appointment"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/AppointmentResponse"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/CarePlan"/>
            <targetProfile value="http://hl7.org/fhir/StructureDefinition/Claim"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/CommunicationRequest"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Contract"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/DeviceRequest"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/EnrollmentRequest"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/NutritionOrder"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/RequestOrchestration"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/SupplyRequest"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/VisionPrescription"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship[typeCode=FLFS].target"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.referenceIdList"/>
          </mapping>
        </element>
        <element id="DocumentReference.status">
          <path value="DocumentReference.status"/>
          <short value="current | superseded | entered-in-error"/>
          <definition value="The status of this document reference."/>
          <comment
                   value="This is the status of the DocumentReference object, which might be independent from the docStatus element.

    This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.status"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <patternCode value="current"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="true"/>
          <isModifierReason
                            value="This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentReferenceStatus"/>
            </extension>
            <strength value="required"/>
            <description value="The status of the document reference."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0"/>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.status"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.status"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-19"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="interim: .completionCode=&quot;IN&quot; &amp; ./statusCode[isNormalDatatype()]=&quot;active&quot;;  final: .completionCode=&quot;AU&quot; &amp;&amp;  ./statusCode[isNormalDatatype()]=&quot;complete&quot; and not(./inboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()]/source[subsumesCode(&quot;ActClass#CACT&quot;) and moodCode=&quot;EVN&quot; and domainMember(&quot;ReviseDocument&quot;, code) and isNormalAct()]);  amended: .completionCode=&quot;AU&quot; &amp;&amp;  ./statusCode[isNormalDatatype()]=&quot;complete&quot; and ./inboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()]/source[subsumesCode(&quot;ActClass#CACT&quot;) and moodCode=&quot;EVN&quot; and domainMember(&quot;ReviseDocument&quot;, code) and isNormalAct() and statusCode=&quot;completed&quot;];  withdrawn : .completionCode=NI &amp;&amp;  ./statusCode[isNormalDatatype()]=&quot;obsolete&quot;"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.availabilityStatus"/>
          </mapping>
        </element>
        <element id="DocumentReference.docStatus">
          <path value="DocumentReference.docStatus"/>
          <short
                 value="registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown"/>
          <definition value="The status of the underlying document."/>
          <comment
                   value="The document that is pointed to might be in various lifecycle states."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.docStatus"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ReferredDocumentStatus"/>
            </extension>
            <strength value="required"/>
            <description value="Status of the underlying document."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/composition-status|5.0.0"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.status"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.status"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-17"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".statusCode"/>
          </mapping>
        </element>
        <element id="DocumentReference.modality">
          <path value="DocumentReference.modality"/>
          <short value="Imaging modality used"/>
          <definition
                      value="Imaging modality used. This may include both acquisition and non-acquisition modalities."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.modality"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ImagingModality"/>
            </extension>
            <strength value="extensible"/>
            <description value="Type of acquired data in the instance."/>
            <valueSet
                      value="http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.class"/>
          </mapping>
        </element>
        <element id="DocumentReference.type">
          <path value="DocumentReference.type"/>
          <short value="Kind of document (LOINC if possible)"/>
          <definition
                      value="Specifies the particular kind of document referenced  (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced."/>
          <comment
                   value="Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.type"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentType"/>
            </extension>
            <strength value="preferred"/>
            <description value="Precise type of clinical document."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/doc-typecodes"/>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.code"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.what[x]"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.type"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-2"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.typeCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="ClinicalDocument/code/@code

    The typeCode should be mapped from the ClinicalDocument/code element to a set of document type codes configured in the affinity domain. One suggested coding system to use for typeCode is LOINC, in which case the mapping step can be omitted."/>
          </mapping>
        </element>
        <element id="DocumentReference.category">
          <path value="DocumentReference.category"/>
          <short value="Categorization of document"/>
          <definition
                      value="A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type."/>
          <comment
                   value="Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching."/>
          <alias value="class"/>
          <alias value="classCode"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.category"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ReferencedItemCategory"/>
            </extension>
            <strength value="example"/>
            <description value="High-level kind of document at a macro level."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/referenced-item-category"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.what[x]"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.category"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.classCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="Derived from a mapping of /ClinicalDocument/code/@code to an Affinity Domain specified coded value to use and coding system. Affinity Domains are encouraged to use the appropriate value for Type of Service, based on the LOINC Type of Service (see Page 53 of the LOINC User's Manual). Must be consistent with /ClinicalDocument/code/@code"/>
          </mapping>
        </element>
        <element id="DocumentReference.subject">
          <path value="DocumentReference.subject"/>
          <short value="Who/what is the subject of the document"/>
          <definition
                      value="Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.subject"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Resource"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.subject"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.subject[x]"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.subject"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map
                 value="PID-3 (No standard way to define a Practitioner or Group subject in HL7 V2 MDM message)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;SBJ&quot;].role[typeCode=&quot;PAT&quot;]"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.patientId"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/recordTarget/"/>
          </mapping>
        </element>
        <element id="DocumentReference.context">
          <path value="DocumentReference.context"/>
          <short value="Context of the document content"/>
          <definition
                      value="Describes the clinical encounter or type of care that the document content is associated with."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.context"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Appointment"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"/>
          </type>
          <condition value="docRef-1"/>
          <condition value="docRef-2"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.encounter"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.context"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.encounter"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="unique(highest(./outboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()], priorityNumber)/target[moodCode=&quot;EVN&quot; and classCode=(&quot;ENC&quot;, &quot;PCPR&quot;) and isNormalAct])"/>
          </mapping>
        </element>
        <element id="DocumentReference.event">
          <path value="DocumentReference.event"/>
          <short value="Main clinical acts documented"/>
          <definition
                      value="This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a &quot;History and Physical Report&quot; in which the procedure being documented is necessarily a &quot;History and Physical&quot; act."/>
          <comment
                   value="An event can further specialize the act inherent in the type, such as  where it is simply &quot;Procedure Report&quot; and the procedure was a &quot;colonoscopy&quot;. If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.event"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableReference"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentEventType"/>
            </extension>
            <strength value="example"/>
            <description
                         value="This list of codes represents the main clinical acts being documented."/>
            <valueSet value="http://terminology.hl7.org/ValueSet/v3-ActCode"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.event.detail"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.referenceIdList"/>
          </mapping>
        </element>
        <element id="DocumentReference.bodySite">
          <path value="DocumentReference.bodySite"/>
          <short value="Body part included"/>
          <definition value="The anatomic structures included in the document."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.bodySite"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableReference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/BodyStructure"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="BodySite"/>
            </extension>
            <strength value="example"/>
            <description value="SNOMED CT Body site concepts"/>
            <valueSet value="http://hl7.org/fhir/ValueSet/body-site"/>
          </binding>
          <mapping>
            <identity value="rim"/>
            <map value=".targetSiteCode"/>
          </mapping>
        </element>
        <element id="DocumentReference.facilityType">
          <path value="DocumentReference.facilityType"/>
          <short value="Kind of facility where patient was seen"/>
          <definition value="The kind of facility where the patient was seen."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.facilityType"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <condition value="docRef-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentC80FacilityType"/>
            </extension>
            <strength value="example"/>
            <description value="XDS Facility Type."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/c80-facilitycodes"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="usually from a mapping to a local ValueSet"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;LOC&quot;].role[classCode=&quot;DSDLOC&quot;].code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.healthcareFacilityTypeCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="usually a mapping to a local ValueSet. Must be consistent with /clinicalDocument/code"/>
          </mapping>
        </element>
        <element id="DocumentReference.practiceSetting">
          <path value="DocumentReference.practiceSetting"/>
          <short
                 value="Additional details about where the content was created (e.g. clinical specialty)"/>
          <definition
                      value="This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty."/>
          <comment
                   value="This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC."/>
          <requirements
                        value="This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.practiceSetting"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <condition value="docRef-2"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentC80PracticeSetting"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Additional details about where the content was created (e.g. clinical specialty)."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/c80-practice-codes"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="usually from a mapping to a local ValueSet"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;LOC&quot;].role[classCode=&quot;DSDLOC&quot;].code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.practiceSettingCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="usually from a mapping to a local ValueSet"/>
          </mapping>
        </element>
        <element id="DocumentReference.period">
          <path value="DocumentReference.period"/>
          <short value="Time of service that is being documented"/>
          <definition
                      value="The time period over which the service that is described by the document was provided."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.period"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Period"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.event.period"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".effectiveTime"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map
                 value="DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="ClinicalDocument/documentationOf/
    serviceEvent/effectiveTime/low/
    @value --&gt; ClinicalDocument/documentationOf/
    serviceEvent/effectiveTime/high/
    @value"/>
          </mapping>
        </element>
        <element id="DocumentReference.date">
          <path value="DocumentReference.date"/>
          <short value="When this document reference was created"/>
          <definition value="When the document reference was created."/>
          <comment
                   value="Referencing/indexing time is used for tracking, organizing versions and searching."/>
          <alias value="indexed"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.date"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="instant"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.occurrence[x]"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.recorded"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.date"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".availabilityTime[type=&quot;TS&quot;]"/>
          </mapping>
        </element>
        <element id="DocumentReference.author">
          <path value="DocumentReference.author"/>
          <short value="Who and/or what authored the document"/>
          <definition
                      value="Identifies who is responsible for adding the information to the document."/>
          <comment
                   value="Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant)."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.author"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Organization"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Device"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Patient"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/CareTeam"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.performer.actor"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.author"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map
                 value="TXA-9 (No standard way to indicate a Device in HL7 V2 MDM message)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;AUT&quot;].role[classCode=&quot;ASSIGNED&quot;]"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.author"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/author"/>
          </mapping>
        </element>
        <element id="DocumentReference.attester">
          <path value="DocumentReference.attester"/>
          <short value="Attests to accuracy of the document"/>
          <definition
                      value="A participant who has authenticated the accuracy of the document."/>
          <comment value="Only list each attester once."/>
          <requirements
                        value="Identifies responsibility for the accuracy of the document content."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.attester"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.performer.actor"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.attester"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;AUTHEN&quot;].role[classCode=&quot;ASSIGNED&quot;]"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.legalAuthenticator"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value=".authenticator/.legalAuthenticator"/>
          </mapping>
        </element>
        <element id="DocumentReference.attester.id">
          <path value="DocumentReference.attester.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <condition value="ele-1"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.attester.extension">
          <path value="DocumentReference.attester.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.attester.modifierExtension">
          <path value="DocumentReference.attester.modifierExtension"/>
          <short value="Extensions that cannot be ignored even if unrecognized"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <requirements
                        value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.attester.mode">
          <path value="DocumentReference.attester.mode"/>
          <short value="personal | professional | legal | official"/>
          <definition value="The type of attestation the authenticator offers."/>
          <requirements
                        value="Indicates the level of authority of the attestation."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.attester.mode"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentAttestationMode"/>
            </extension>
            <strength value="preferred"/>
            <description
                         value="The way in which a person authenticated a document."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/composition-attestation-mode"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.attester.mode"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="unique(./modeCode)"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="implied by .authenticator/.legalAuthenticator"/>
          </mapping>
        </element>
        <element id="DocumentReference.attester.time">
          <path value="DocumentReference.attester.time"/>
          <short value="When the document was attested"/>
          <definition value="When the document was attested by the party."/>
          <requirements
                        value="Identifies when the information in the document was deemed accurate.  (Things may have changed since then.)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.attester.time"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="dateTime"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.attester.time"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./time[type=&quot;TS&quot; and isNormalDatatype()]"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value=".authenticator.time"/>
          </mapping>
        </element>
        <element id="DocumentReference.attester.party">
          <path value="DocumentReference.attester.party"/>
          <short value="Who attested the document"/>
          <definition value="Who attested the document in the specified way."/>
          <requirements
                        value="Identifies who has taken on the responsibility for accuracy of the document content."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.attester.party"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Patient"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Organization"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.witness"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.attester.party"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-10"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="./role[classCode=&quot;ASSIGNED&quot; and isNormalRole]/player[determinerCode=&quot;INST&quot; and classCode=(&quot;DEV&quot;, &quot;PSN&quot;) and isNormalEntity()] or ./role[classCode=&quot;ASSIGNED&quot; and isNormalRole and not(player)]/scoper[determinerCode=&quot;INST&quot; and classCode=&quot;ORG&quot; and isNormalEntity()]"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value=".authenticator.assignedEnttty"/>
          </mapping>
        </element>
        <element id="DocumentReference.custodian">
          <path value="DocumentReference.custodian"/>
          <short value="Organization which maintains the document"/>
          <definition
                      value="Identifies the organization or group who is responsible for ongoing maintenance of and access to the document."/>
          <comment
                   value="Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.custodian"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Organization"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.performer.actor"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.custodian"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;RCV&quot;].role[classCode=&quot;CUST&quot;].scoper[classCode=&quot;ORG&quot; and determinerCode=&quot;INST&quot;]"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo">
          <path value="DocumentReference.relatesTo"/>
          <short value="Relationships to other documents"/>
          <definition
                      value="Relationships that this document has with other document references that already exist."/>
          <comment
                   value="This element is labeled as a modifier because documents that append to other documents are incomplete on their own."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.relatesTo"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.relatesTo"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry Associations"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.id">
          <path value="DocumentReference.relatesTo.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <condition value="ele-1"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.extension">
          <path value="DocumentReference.relatesTo.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.modifierExtension">
          <path value="DocumentReference.relatesTo.modifierExtension"/>
          <short value="Extensions that cannot be ignored even if unrecognized"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <requirements
                        value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.code">
          <path value="DocumentReference.relatesTo.code"/>
          <short value="The relationship type with another document"/>
          <definition
                      value="The type of relationship that this document has with anther document."/>
          <comment
                   value="If this document appends another document, then the document cannot be fully understood without also accessing the referenced document."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.relatesTo.code"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentRelationshipType"/>
            </extension>
            <strength value="extensible"/>
            <description value="The type of relationship between the documents."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/document-relationship-type"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.relatesTo.type"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship.typeCode"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry Associations type"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/relatedDocument/typeCode"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.target">
          <path value="DocumentReference.relatesTo.target"/>
          <short value="Target of the relationship"/>
          <definition value="The target document of this relationship."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.relatesTo.target"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.relatesTo.resourceReference"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".target[classCode=&quot;DOC&quot;, moodCode=&quot;EVN&quot;].id"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry Associations reference"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/relatedDocument/parentDocument"/>
          </mapping>
        </element>
        <element id="DocumentReference.description">
          <path value="DocumentReference.description"/>
          <short value="Human-readable description"/>
          <definition value="Human-readable description of the source document."/>
          <comment
                   value="What the document is about,  a terse summary of the document."/>
          <requirements
                        value="Helps humans to assess whether the document is of interest."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.description"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="markdown"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-25"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".outboundRelationship[typeCode=&quot;SUBJ&quot;].target.text"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.comments"/>
          </mapping>
        </element>
        <element id="DocumentReference.securityLabel">
          <path value="DocumentReference.securityLabel"/>
          <short value="Document security-tags"/>
          <definition
                      value="A set of Security-Tag codes specifying the level of privacy/security of the Document found at DocumentReference.content.attachment.url. Note that DocumentReference.meta.security contains the security labels of the data elements in DocumentReference, while DocumentReference.securityLabel contains the security labels for the document the reference refers to. The distinction recognizes that the document may contain sensitive information, while the DocumentReference is metadata about the document and thus might not be as sensitive as the document. For example: a psychotherapy episode may contain highly sensitive information, while the metadata may simply indicate that some episode happened."/>
          <comment
                   value="The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce.

    In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects."/>
          <requirements
                        value="Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.securityLabel"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="SecurityLabels"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Example Security Labels from the Healthcare Privacy and Security Classification System."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/security-label-examples"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Bundle.meta.security"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-18"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".confidentialityCode"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.confidentialityCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/confidentialityCode/@code"/>
          </mapping>
        </element>
        <element id="DocumentReference.content">
          <path value="DocumentReference.content"/>
          <short value="Document referenced"/>
          <definition
                      value="The document and format referenced.  If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata."/>
          <comment
                   value="content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo."/>
          <requirements
                        value="Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats."/>
          <min value="1"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.content"/>
            <min value="1"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Bundle(Composition+*)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="document.text"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.id">
          <path value="DocumentReference.content.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <condition value="ele-1"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.extension">
          <path value="DocumentReference.content.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.modifierExtension">
          <path value="DocumentReference.content.modifierExtension"/>
          <short value="Extensions that cannot be ignored even if unrecognized"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <requirements
                        value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment">
          <path value="DocumentReference.content.attachment"/>
          <short value="Where to access the document"/>
          <definition
                      value="The document or URL of the document along with critical metadata to prove content has integrity."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.content.attachment"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Attachment"/>
            <profile
                     value="http://hl7.org/fhir/us/pq-cmc-fda/StructureDefinition/pqcmc-attachment"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map
                 value="Composition.language,
    Composition.title,
    Composition.date"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-3 for mime type"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="document.text"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map
                 value="DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.profile">
          <path value="DocumentReference.content.profile"/>
          <short value="Content profile rules for the document"/>
          <definition
                      value="An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType."/>
          <comment
                   value="Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

    For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with."/>
          <alias value="format"/>
          <alias value="formatCode"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.content.profile"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.meta.profile"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="document.text"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.formatCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="derived from the IHE Profile or Implementation Guide templateID"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.profile.id">
          <path value="DocumentReference.content.profile.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <condition value="ele-1"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.profile.extension">
          <path value="DocumentReference.content.profile.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.profile.modifierExtension">
          <path value="DocumentReference.content.profile.modifierExtension"/>
          <short value="Extensions that cannot be ignored even if unrecognized"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <requirements
                        value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.profile.value[x]">
          <path value="DocumentReference.content.profile.value[x]"/>
          <short value="Code|uri|canonical"/>
          <definition value="Code|uri|canonical."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.content.profile.value[x]"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Coding"/>
          </type>
          <type>
            <code value="uri"/>
          </type>
          <type>
            <code value="canonical"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentFormat"/>
            </extension>
            <strength value="preferred"/>
            <description value="Document Format Codes."/>
            <valueSet
                      value="http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.meta.profile"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="document.text"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.formatCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="derived from the IHE Profile or Implementation Guide templateID"/>
          </mapping>
        </element>
      </snapshot>
      <differential>
        <element id="DocumentReference.status">
          <path value="DocumentReference.status"/>
          <patternCode value="current"/>
        </element>
        <element id="DocumentReference.content">
          <path value="DocumentReference.content"/>
          <mustSupport value="true"/>
        </element>
        <element id="DocumentReference.content.attachment">
          <path value="DocumentReference.content.attachment"/>
          <type>
            <code value="Attachment"/>
            <profile
                     value="http://hl7.org/fhir/us/pq-cmc-fda/StructureDefinition/pqcmc-attachment"/>
          </type>
          <mustSupport value="true"/>
        </element>
      </differential>
    </StructureDefinition>