Da Vinci Clinical Data Exchange (CDex), published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ecdx/ and changes regularly. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• XML
• JSON

Data Type Profile: CDex Signature Profile

This Signature DataType profile enforces the various elements of signature documented in the CDex guide. It adds the following mandatory (min=1) constraints:

• A Signature.type fixed to ASTM Standard, E1762-95(2013) code = “1.2.840.10065.1.12.1.5” (Verification Signature)
• A Signature.who for the organization or practitioner who signed the Bundle which is either:
  1. a reference to US-Core Practitioner, US-Core PractitionerRole, or US-Core Organization or
  2. an NPI or Tax ID and name of the organization or practitioner
• A Signature.data representing the base64 encoded Signature (JWS, image, etc)

In addition, the following mandatory (min=1) element is inherited from the base standard:

• Signature.when - a system timestamp when the signature was created

Usage:

• Use this DataType Constraint: CDex SDC QuestionnaireResponse Profile and CDex Signature Bundle Profile

Formal Views of Profile Content

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

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

This structure is derived from Signature

Name	Flags	Card.	Type	Description & Constraints
Signature	C	0..*	Signature	JWS Digital Signature cdex-13: The signature element must have either reference to the signer or the signer's identifier and name.
Slices for type	S	1..*	Coding	Indication of the reason the entity signed the object(s) Slice: Unordered, Open by value:$this
type:verify	S	1..1	Coding	Verification Signature Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: urn:iso-astm:E1762-95:2013
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1.2.840.10065.1.12.1.5
display		1..1	string	Representation defined by the system Fixed Value: Verification Signature
when	S	1..1	instant	When the signature was created
who	S	1..1	Reference(US Core Practitioner Profile(3.1.1) S | US Core Practitioner Profile(6.1.0) S | US Core Practitioner Profile(7.0.0) S | HRex Organization Profile(1.1.0-ballot) S | HRex PractitionerRole Profile(1.1.0-ballot))	Organization or practitioner who signed the Bundle
reference	SC	0..1	string	Literal reference, Relative, internal or absolute URL
identifier	SC	0..1	Identifier	NPI or US Tax ID
type	S	1..1	CodeableConcept	Description of identifier Binding: CDex Identifier Types Value Set (required)
value	S	1..1	string	The value that is unique
display	SC	0..1	string	Text alternative for the resource
data	S	1..1	base64Binary	base64 encoded signature (JWS, image, etc)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Signature.who.identifier.type	required	CDexIdentifierTypes http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-identifier-types from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
cdex-13	error	Signature	The signature element must have either reference to the signer or the signer's identifier and name. : who.reference.exists() or (who.identifier.exists() and who.display.exists())

Name	Flags	Card.	Type	Description & Constraints
Signature	C	0..*	Signature	JWS Digital Signature ele-1: All FHIR elements must have a @value or children cdex-13: The signature element must have either reference to the signer or the signer's identifier and name.
Slices for type	SΣ	1..*	Coding	Indication of the reason the entity signed the object(s) Slice: Unordered, Open by value:$this Binding: SignatureTypeCodes (preferred): An indication of the reason that an entity signed the object. ele-1: All FHIR elements must have a @value or children
type:verify	SΣ	1..1	Coding	Verification Signature Binding: SignatureTypeCodes (preferred): An indication of the reason that an entity signed the object. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: urn:iso-astm:E1762-95:2013
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1.2.840.10065.1.12.1.5
display		1..1	string	Representation defined by the system Fixed Value: Verification Signature
when	SΣ	1..1	instant	When the signature was created ele-1: All FHIR elements must have a @value or children
who	SΣ	1..1	Reference(US Core Practitioner Profile(3.1.1) | US Core Practitioner Profile(6.1.0) | US Core Practitioner Profile(7.0.0) | HRex Organization Profile(1.1.0-ballot))	Organization or practitioner who signed the Bundle ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children
identifier	SΣC	0..1	Identifier	NPI or US Tax ID ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: CDex Identifier Types Value Set (required) ele-1: All FHIR elements must have a @value or children
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
display	SΣC	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children
data	S	1..1	base64Binary	base64 encoded signature (JWS, image, etc) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Signature.type	preferred	SignatureTypeCodes http://hl7.org/fhir/ValueSet/signature-type from the FHIR Standard
Signature.type:verify	preferred	Pattern: 1.2.840.10065.1.12.1.5("Verification Signature") http://hl7.org/fhir/ValueSet/signature-type from the FHIR Standard
Signature.who.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Signature.who.identifier.type	required	CDexIdentifierTypes http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-identifier-types from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
cdex-13	error	Signature	The signature element must have either reference to the signer or the signer's identifier and name. : who.reference.exists() or (who.identifier.exists() and who.display.exists())

Name	Flags	Card.	Type	Description & Constraints
Signature	C	0..*	Signature	JWS Digital Signature cdex-13: The signature element must have either reference to the signer or the signer's identifier and name.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for type	SΣ	1..*	Coding	Indication of the reason the entity signed the object(s) Slice: Unordered, Open by value:$this Binding: SignatureTypeCodes (preferred): An indication of the reason that an entity signed the object.
type:verify	SΣ	1..1	Coding	Verification Signature Binding: SignatureTypeCodes (preferred): An indication of the reason that an entity signed the object. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: urn:iso-astm:E1762-95:2013
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1.2.840.10065.1.12.1.5
display		1..1	string	Representation defined by the system Fixed Value: Verification Signature
userSelected		0..1	boolean	If this coding was chosen directly by the user
when	SΣ	1..1	instant	When the signature was created
who	SΣ	1..1	Reference(US Core Practitioner Profile(3.1.1) S | US Core Practitioner Profile(6.1.0) S | US Core Practitioner Profile(7.0.0) S | HRex Organization Profile(1.1.0-ballot) S | HRex PractitionerRole Profile(1.1.0-ballot))	Organization or practitioner who signed the Bundle
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣC	0..1	Identifier	NPI or US Tax ID
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: CDex Identifier Types Value Set (required)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	SΣC	0..1	string	Text alternative for the resource
onBehalfOf	Σ	0..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	The party represented
targetFormat		0..1	code	The technical format of the signed resources Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.
sigFormat		0..1	code	The technical format of the signature Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.
data	S	1..1	base64Binary	base64 encoded signature (JWS, image, etc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Signature.type	preferred	SignatureTypeCodes http://hl7.org/fhir/ValueSet/signature-type from the FHIR Standard
Signature.type:verify	preferred	Pattern: 1.2.840.10065.1.12.1.5("Verification Signature") http://hl7.org/fhir/ValueSet/signature-type from the FHIR Standard
Signature.who.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Signature.who.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Signature.who.identifier.type	required	CDexIdentifierTypes http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-identifier-types from this IG
Signature.targetFormat	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard
Signature.sigFormat	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cdex-13	error	Signature	The signature element must have either reference to the signer or the signer's identifier and name. : who.reference.exists() or (who.identifier.exists() and who.display.exists())

This structure is derived from Signature

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 10 elements

Structures

This structure refers to these other structures:

• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|3.1.1)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|6.1.0)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|7.0.0)
• HRex Organization Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-organization)
• HRex PractitionerRole Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Signature.type

Maturity: 2

Differential View

This structure is derived from Signature

Name	Flags	Card.	Type	Description & Constraints
Signature	C	0..*	Signature	JWS Digital Signature cdex-13: The signature element must have either reference to the signer or the signer's identifier and name.
Slices for type	S	1..*	Coding	Indication of the reason the entity signed the object(s) Slice: Unordered, Open by value:$this
type:verify	S	1..1	Coding	Verification Signature Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: urn:iso-astm:E1762-95:2013
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1.2.840.10065.1.12.1.5
display		1..1	string	Representation defined by the system Fixed Value: Verification Signature
when	S	1..1	instant	When the signature was created
who	S	1..1	Reference(US Core Practitioner Profile(3.1.1) S | US Core Practitioner Profile(6.1.0) S | US Core Practitioner Profile(7.0.0) S | HRex Organization Profile(1.1.0-ballot) S | HRex PractitionerRole Profile(1.1.0-ballot))	Organization or practitioner who signed the Bundle
reference	SC	0..1	string	Literal reference, Relative, internal or absolute URL
identifier	SC	0..1	Identifier	NPI or US Tax ID
type	S	1..1	CodeableConcept	Description of identifier Binding: CDex Identifier Types Value Set (required)
value	S	1..1	string	The value that is unique
display	SC	0..1	string	Text alternative for the resource
data	S	1..1	base64Binary	base64 encoded signature (JWS, image, etc)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Signature.who.identifier.type	required	CDexIdentifierTypes http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-identifier-types from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
cdex-13	error	Signature	The signature element must have either reference to the signer or the signer's identifier and name. : who.reference.exists() or (who.identifier.exists() and who.display.exists())

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Signature	C	0..*	Signature	JWS Digital Signature ele-1: All FHIR elements must have a @value or children cdex-13: The signature element must have either reference to the signer or the signer's identifier and name.
Slices for type	SΣ	1..*	Coding	Indication of the reason the entity signed the object(s) Slice: Unordered, Open by value:$this Binding: SignatureTypeCodes (preferred): An indication of the reason that an entity signed the object. ele-1: All FHIR elements must have a @value or children
type:verify	SΣ	1..1	Coding	Verification Signature Binding: SignatureTypeCodes (preferred): An indication of the reason that an entity signed the object. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: urn:iso-astm:E1762-95:2013
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1.2.840.10065.1.12.1.5
display		1..1	string	Representation defined by the system Fixed Value: Verification Signature
when	SΣ	1..1	instant	When the signature was created ele-1: All FHIR elements must have a @value or children
who	SΣ	1..1	Reference(US Core Practitioner Profile(3.1.1) | US Core Practitioner Profile(6.1.0) | US Core Practitioner Profile(7.0.0) | HRex Organization Profile(1.1.0-ballot))	Organization or practitioner who signed the Bundle ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children
identifier	SΣC	0..1	Identifier	NPI or US Tax ID ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: CDex Identifier Types Value Set (required) ele-1: All FHIR elements must have a @value or children
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
display	SΣC	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children
data	S	1..1	base64Binary	base64 encoded signature (JWS, image, etc) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Signature.type	preferred	SignatureTypeCodes http://hl7.org/fhir/ValueSet/signature-type from the FHIR Standard
Signature.type:verify	preferred	Pattern: 1.2.840.10065.1.12.1.5("Verification Signature") http://hl7.org/fhir/ValueSet/signature-type from the FHIR Standard
Signature.who.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Signature.who.identifier.type	required	CDexIdentifierTypes http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-identifier-types from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
cdex-13	error	Signature	The signature element must have either reference to the signer or the signer's identifier and name. : who.reference.exists() or (who.identifier.exists() and who.display.exists())

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Signature	C	0..*	Signature	JWS Digital Signature cdex-13: The signature element must have either reference to the signer or the signer's identifier and name.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for type	SΣ	1..*	Coding	Indication of the reason the entity signed the object(s) Slice: Unordered, Open by value:$this Binding: SignatureTypeCodes (preferred): An indication of the reason that an entity signed the object.
type:verify	SΣ	1..1	Coding	Verification Signature Binding: SignatureTypeCodes (preferred): An indication of the reason that an entity signed the object. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: urn:iso-astm:E1762-95:2013
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1.2.840.10065.1.12.1.5
display		1..1	string	Representation defined by the system Fixed Value: Verification Signature
userSelected		0..1	boolean	If this coding was chosen directly by the user
when	SΣ	1..1	instant	When the signature was created
who	SΣ	1..1	Reference(US Core Practitioner Profile(3.1.1) S | US Core Practitioner Profile(6.1.0) S | US Core Practitioner Profile(7.0.0) S | HRex Organization Profile(1.1.0-ballot) S | HRex PractitionerRole Profile(1.1.0-ballot))	Organization or practitioner who signed the Bundle
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣC	0..1	Identifier	NPI or US Tax ID
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: CDex Identifier Types Value Set (required)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	SΣC	0..1	string	Text alternative for the resource
onBehalfOf	Σ	0..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	The party represented
targetFormat		0..1	code	The technical format of the signed resources Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.
sigFormat		0..1	code	The technical format of the signature Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.
data	S	1..1	base64Binary	base64 encoded signature (JWS, image, etc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Signature.type	preferred	SignatureTypeCodes http://hl7.org/fhir/ValueSet/signature-type from the FHIR Standard
Signature.type:verify	preferred	Pattern: 1.2.840.10065.1.12.1.5("Verification Signature") http://hl7.org/fhir/ValueSet/signature-type from the FHIR Standard
Signature.who.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Signature.who.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Signature.who.identifier.type	required	CDexIdentifierTypes http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-identifier-types from this IG
Signature.targetFormat	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard
Signature.sigFormat	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cdex-13	error	Signature	The signature element must have either reference to the signer or the signer's identifier and name. : who.reference.exists() or (who.identifier.exists() and who.display.exists())

This structure is derived from Signature

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 10 elements

Structures

This structure refers to these other structures:

• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|3.1.1)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|6.1.0)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|7.0.0)
• HRex Organization Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-organization)
• HRex PractitionerRole Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Signature.type

Maturity: 2

Other representations of profile: CSV, Excel, Schematron