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.

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

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))	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())

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) S | HRex PractitionerRole Profile(1.1.0))	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 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) S | HRex PractitionerRole Profile(1.1.0))	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

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))	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())

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) S | HRex PractitionerRole Profile(1.1.0))	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())

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) S | HRex PractitionerRole Profile(1.1.0))	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