Dental Data Exchange
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Dental Data Exchange, published by Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of and changes regularly. See the Directory of published versions



This specification defines no new actors beyond those in the C-CDA on FHIR specification which are:

  • Document Source: An application that exposes a clinical document to a consumer. This actor may be the creator of the document but could also be an intermediary. This can be thought of as the server in a client/server interaction.
  • Document Consumer: An application that consumes a clinical document. This can be thought of as the client in a client/server interaction.

FHIR Paradigms Supported by This IG

  • RESTful API
  • Document Bundle

Resources and Profiles

Resource Profiles

This specification defines the following profiles:

  • Dental Referral Note
  • Dental Consult Note
  • Dental Communication
  • Dental Service Request
  • Dental Finding


This implementation guide defines no new extensions.

Claiming Conformance to This Specification

This specification conforms to US Core Profiles. To claim conformance to this specification, servers SHALL:

  • Be able to populate all profile data elements that have a minimum cardinality >= 1 and/or flagged as Must Support as defined by that profile’s StructureDefinition.
  • Conform to this IG’s Server Capability Statement expectations for that profile’s type.

Details on profiles and extensions present in this specification are available on the Artifact Index page.

Must Support and Missing Data

Systems claiming to conform to a profile SHALL support the elements in a profile as defined below. This guide adopts the following definitions of MustSupport for all direct transactions between the Sending and Receiving Systems.

All Sending Systems Sending Systems are defined as Provider Systems and applications.

  • As part of the sending of a Dental Referral Note as exemplified in Use Cases 1 and 3 of this IG, the Sender SHALL be capable of including all elements defined in the profiles that have a MustSupport flag and SHALL populate all elements with a MustSupport flag if the information exists.
  • In situations where information on a particular data element is not present, the Sender SHALL NOT include the data element in the resource instance if the cardinality is 0..n.
  • If the information does not exist and the cardinality of the element is >= 1..*, the Sender SHALL use the dataAbsentReason extension where it is defined. Note: populating the element with the value set absent reason or using the dataAbsent Reason SHOULD be handled by the Sending System and not require provider action.

All Receiving Systems Receiving Systems are defined as Provider Systems and applications receiving transactions from the Sending System.

  • The Receiving System SHALL be capable of processing resource instances containing required and allowed data elements without generating an error or causing the application to fail.
  • Receiving Systems SHOULD be capable of processing (display, store, etc) the data elements based on the utility of the specific element to the receiver.
  • When receiving a dental transaction from the Sender, the Receiving System SHALL interpret missing data elements within resource instances as data not present in the Senders systems.
  • Receiving Systems SHALL be able to process resource instances containing data elements asserting missing information without generating an error or causing the application to fail.

Conformance to US Core Profile

Where this IG does not additionally constrain a US Core profile, the actors shall follow the US Core definition of Must Support and Missing Data.

This specification uses the same Search Syntax rule as US Core. This guide does not define any additional Search Parameters.

Privacy and Security

This Implementation Guide is adopting the Security and Privacy Section of the Da Vinci Project Health Record Exchange (HRex) IG.