PACIO Advance Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. 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/fhir-pacio-adi/ and changes regularly. See the Directory of published versions
Active as of 2024-09-06 |
Definitions for the ADI-DocumentReference resource profile.
Guidance on how to interpret the contents of this table can be found here
0. DocumentReference | |
2. DocumentReference.extension | |
Slicing | This element introduces a set of slices on DocumentReference.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
4. DocumentReference.extension:DocumentRevokeStatusExtension | |
Slice Name | DocumentRevokeStatusExtension |
Control | 0..1 |
Type | Extension(Revoke Status) (Extension Type: code) |
Must Support | true |
6. DocumentReference.docStatus | |
Binding | The codes SHALL be taken from ADI Document Reference Status (required to http://hl7.org/fhir/us/pacio-adi/ValueSet/ADIDocumentReferenceStatusVS ) |
8. DocumentReference.category | |
Binding | Unless not suitable, these codes SHALL be taken from US Core DocumentReference Category (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category ) |
10. DocumentReference.date | |
Control | 1..? |
12. DocumentReference.author | |
Type | Reference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile) |
14. DocumentReference.custodian | |
Type | Reference(US Core Organization Profile) |
Must Support | true |
16. DocumentReference.content | |
18. DocumentReference.content.attachment | |
20. DocumentReference.content.attachment.contentType | |
Control | 1..? |
22. DocumentReference.content.attachment.creation | |
Control | 1..? |
Must Support | true |
Guidance on how to interpret the contents of this table can be found here
0. DocumentReference | |||||
Definition | - A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text. | ||||
Short | A reference to a document | ||||
Comments | - Usually, this is used for documents other than those defined by FHIR. | ||||
Control | 0..* | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) | ||||
2. DocumentReference.implicitRules | |||||
Definition | 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. | ||||
Short | A set of rules under which this content was created | ||||
Comments | 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 it's narrative along with other profiles, value sets, etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
4. DocumentReference.extension | |||||
Definition | An Extension 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 manageable, 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. | ||||
Short | ExtensionAdditional content defined by implementations | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) | ||||
Slicing | This element introduces a set of slices on DocumentReference.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
6. DocumentReference.extension:DocumentRevokeStatusExtension | |||||
Slice Name | DocumentRevokeStatusExtension | ||||
Definition | The Advance Directive document revoke status. | ||||
Short | Revoke Status | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Revoke Status) (Extension Type: code) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) | ||||
8. DocumentReference.modifierExtension | |||||
Definition | 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 manageable, 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). | ||||
Short | Extensions that cannot be ignored | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them | ||||
Summary | false | ||||
Requirements | 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. | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) | ||||
10. DocumentReference.identifier | |||||
Definition | Other identifiers associated with the document, including version independent identifiers. | ||||
Short | (USCDI) Other identifiers for the documentOther identifiers for the document | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..* | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
12. DocumentReference.status | |||||
Definition | The status of this document reference. | ||||
Short | (USCDI) current | superseded | entered-in-errorcurrent | superseded | entered-in-error | ||||
Comments | 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. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from DocumentReferenceStatushttp://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 (required to http://hl7.org/fhir/ValueSet/document-reference-status ) | ||||
Type | code | ||||
Is Modifier | true because 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 | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
14. DocumentReference.docStatus | |||||
Definition | The status of the underlying document. | ||||
Short | preliminary | final | amended | entered-in-error | ||||
Comments | The document that is pointed to might be in various lifecycle states. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from ADI Document Reference Statushttp://hl7.org/fhir/ValueSet/composition-status|4.0.1 (required to http://hl7.org/fhir/us/pacio-adi/ValueSet/ADIDocumentReferenceStatusVS ) | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
16. DocumentReference.type | |||||
Definition | 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. | ||||
Short | (USCDI) Kind of document (LOINC if possible)Kind of document (LOINC if possible) | ||||
Comments | 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. | ||||
Control | 10..1 | ||||
Binding | The codes SHALL be taken from The codes SHOULD be taken from US Core DocumentReference Typehttp://hl7.org/fhir/ValueSet/c80-doc-typecodes (required to http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type )All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Precise type of clinical document.
| ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
18. DocumentReference.category | |||||
Definition | 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. | ||||
Short | (USCDI) Categorization of documentCategorization of document | ||||
Comments | 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. | ||||
Control | 10..* | ||||
Binding | Unless not suitable, these codes SHALL be taken from For example codes, see US Core DocumentReference Categoryhttp://hl7.org/fhir/ValueSet/document-classcodes (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Alternate Names | claxs | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
Slicing | This element introduces a set of slices on DocumentReference.category . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
20. DocumentReference.category:uscore | |||||
Slice Name | uscore | ||||
Definition | 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. | ||||
Short | (USCDI) Categorization of documentCategorization of document | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Binding | The codes SHALL be taken from For example codes, see US Core DocumentReference Categoryhttp://hl7.org/fhir/ValueSet/document-classcodes (required to http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category )The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets High-level kind of a clinical document at a macro level. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | true | ||||
Alternate Names | claxs | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
22. DocumentReference.subject | |||||
Definition | 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). | ||||
Short | (USCDI) Who/what is the subject of the documentWho/what is the subject of the document | ||||
Control | 10..1 | ||||
Type | Reference(US Core Patient Profile, Patient, Practitioner, Group, Device) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
24. DocumentReference.date | |||||
Definition | When the document reference was created. | ||||
Short | (USCDI) When this document reference was createdWhen this document reference was created | ||||
Comments | Referencing/indexing time is used for tracking, organizing versions and searching. | ||||
Control | 10..1 | ||||
Type | instant | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Alternate Names | indexed | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
26. DocumentReference.author | |||||
Definition | Identifies who is responsible for adding the information to the document. | ||||
Short | (USCDI) Who and/or what authored the documentWho and/or what authored the document | ||||
Comments | Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant). | ||||
Control | 0..* | ||||
Type | Reference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Must Support Types | Reference(US Core Practitioner Profile) | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
28. DocumentReference.custodian | |||||
Definition | Identifies the organization or group who is responsible for ongoing maintenance of and access to the document. | ||||
Short | Organization which maintains the document | ||||
Comments | 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. | ||||
Control | 0..1 | ||||
Type | Reference(US Core Organization Profile, Organization) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
30. DocumentReference.content | |||||
Definition | The document and format referenced. There may be multiple content element repetitions, each with a different format. | ||||
Short | (USCDI) Document referencedDocument referenced | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
32. DocumentReference.content.modifierExtension | |||||
Definition | 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 manageable, 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). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | 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. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) | ||||
34. DocumentReference.content.attachment | |||||
Definition | The document or URL of the document along with critical metadata to prove content has integrity. | ||||
Short | (USCDI) Where to access the documentWhere to access the document | ||||
Control | 1..1 | ||||
Type | Attachment | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. ( url.exists() or data.exists() ) | ||||
36. DocumentReference.content.attachment.contentType | |||||
Definition | Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate. | ||||
Short | (USCDI) Mime type of the content, with charset etc.Mime type of the content, with charset etc. | ||||
Control | 10..1 | ||||
Binding | The codes SHALL be taken from Mime Typeshttp://hl7.org/fhir/ValueSet/mimetypes|4.0.1 (required to http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 )The mime type of an attachment. Any valid mime type is allowed. | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | Processors of the data need to be able to know how to interpret the data. | ||||
Example | <br/><b>General</b>:text/plain; charset=UTF-8, image/png | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
38. DocumentReference.content.attachment.data | |||||
Definition | The actual data of the attachment - a sequence of bytes, base64 encoded. | ||||
Short | (USCDI) Data inline, base64edData inline, base64ed | ||||
Comments | The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON. | ||||
Control | 0..1 This element is affected by the following invariants: us-core-6 | ||||
Type | base64Binary | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | The data needs to able to be transmitted inline. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
40. DocumentReference.content.attachment.url | |||||
Definition | A location where the data can be accessed. | ||||
Short | (USCDI) Uri where the data can be foundUri where the data can be found | ||||
Comments | If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data. | ||||
Control | 0..1 This element is affected by the following invariants: us-core-6 | ||||
Type | url | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | The data needs to be transmitted by reference. | ||||
Example | <br/><b>General</b>:http://www.acme.com/logo-small.png | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
42. DocumentReference.content.attachment.creation | |||||
Definition | The date that the attachment was first created. | ||||
Short | Date attachment was first created | ||||
Control | 10..1 | ||||
Type | dateTime | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | This is often tracked as an integrity issue for use of the attachment. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
44. DocumentReference.content.format | |||||
Definition | An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType. | ||||
Short | (USCDI) Format/content rules for the documentFormat/content rules for the document | ||||
Comments | Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI. | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from The codes SHOULD be taken from DocumentReferenceFormatCodeSethttp://hl7.org/fhir/ValueSet/formatcodes (extensible to http://hl7.org/fhir/ValueSet/formatcodes ) | ||||
Type | Coding | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
46. DocumentReference.context | |||||
Definition | The clinical context in which the document was prepared. | ||||
Short | (USCDI) Clinical context of documentClinical context of document | ||||
Comments | These values are primarily added to help with searching for interesting/relevant documents. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
48. DocumentReference.context.modifierExtension | |||||
Definition | 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 manageable, 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). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | 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. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) | ||||
50. DocumentReference.context.encounter | |||||
Definition | Describes the clinical encounter or type of care that the document content is associated with. | ||||
Short | (USCDI) Context of the document contentContext of the document content | ||||
Control | 0..1* | ||||
Type | Reference(US Core Encounter Profile, Encounter, EpisodeOfCare) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
52. DocumentReference.context.period | |||||
Definition | The time period over which the service that is described by the document was provided. | ||||
Short | (USCDI) Time of service that is being documentedTime of service that is being documented | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Guidance on how to interpret the contents of this table can be found here
0. DocumentReference | |||||
Definition | - | ||||
Short | A reference to a document | ||||
Comments | - | ||||
Control | 0..* | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty() )dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource ( contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() )dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated ( contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() )dom-5: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty() )dom-6: A resource should have narrative for robust management ( text.`div`.exists() ) | ||||
2. DocumentReference.id | |||||
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. | ||||
Short | Logical id of this artifact | ||||
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||||
Control | 0..1 | ||||
Type | id | ||||
Is Modifier | false | ||||
Summary | true | ||||
4. DocumentReference.meta | |||||
Definition | 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. | ||||
Short | Metadata about the resource | ||||
Control | 0..1 | ||||
Type | Meta | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
6. DocumentReference.implicitRules | |||||
Definition | 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. | ||||
Short | A set of rules under which this content was created | ||||
Comments | 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 it's narrative along with other profiles, value sets, etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
8. DocumentReference.language | |||||
Definition | The base language in which the resource is written. | ||||
Short | Language of the resource content | ||||
Comments | 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). | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CommonLanguages (preferred to http://hl7.org/fhir/ValueSet/languages )A human language.
| ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
10. DocumentReference.text | |||||
Definition | 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 "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. | ||||
Short | Text summary of the resource, for human interpretation | ||||
Comments | Contained resources do not have 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 "text blob" or where text is additionally entered raw or narrated and encoded information is added later. | ||||
Control | 0..1 | ||||
Type | Narrative | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | narrative, html, xhtml, display | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
12. DocumentReference.contained | |||||
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. | ||||
Short | Contained, inline Resources | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Resource | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | inline resources, anonymous resources, contained resources | ||||
14. DocumentReference.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on DocumentReference.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
16. DocumentReference.extension:DocumentRevokeStatusExtension | |||||
Slice Name | DocumentRevokeStatusExtension | ||||
Definition | The Advance Directive document revoke status. | ||||
Short | Revoke Status | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Revoke Status) (Extension Type: code) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
18. DocumentReference.modifierExtension | |||||
Definition | 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 manageable, 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). | ||||
Short | Extensions that cannot be ignored | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them | ||||
Summary | false | ||||
Requirements | 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. | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
20. DocumentReference.masterIdentifier | |||||
Definition | Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document. | ||||
Short | Master Version Specific Identifier | ||||
Comments | CDA Document Id extension and root. | ||||
Control | 0..1 | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.). | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
22. DocumentReference.identifier | |||||
Definition | Other identifiers associated with the document, including version independent identifiers. | ||||
Short | (USCDI) Other identifiers for the document | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..* | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
24. DocumentReference.status | |||||
Definition | The status of this document reference. | ||||
Short | (USCDI) current | superseded | entered-in-error | ||||
Comments | 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. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from DocumentReferenceStatus (required to http://hl7.org/fhir/ValueSet/document-reference-status ) | ||||
Type | code | ||||
Is Modifier | true because 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 | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
26. DocumentReference.docStatus | |||||
Definition | The status of the underlying document. | ||||
Short | preliminary | final | amended | entered-in-error | ||||
Comments | The document that is pointed to might be in various lifecycle states. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from ADI Document Reference Status (required to http://hl7.org/fhir/us/pacio-adi/ValueSet/ADIDocumentReferenceStatusVS ) | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
28. DocumentReference.type | |||||
Definition | 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. | ||||
Short | (USCDI) Kind of document (LOINC if possible) | ||||
Comments | 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. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from US Core DocumentReference Type (required to http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type )All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
| ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
30. DocumentReference.category | |||||
Definition | 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. | ||||
Short | (USCDI) Categorization of document | ||||
Comments | 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. | ||||
Control | 1..* | ||||
Binding | Unless not suitable, these codes SHALL be taken from US Core DocumentReference Category (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Alternate Names | claxs | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on DocumentReference.category . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
32. DocumentReference.category:uscore | |||||
Slice Name | uscore | ||||
Definition | 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. | ||||
Short | (USCDI) Categorization of document | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Binding | The codes SHALL be taken from US Core DocumentReference Category (required to http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category )The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | true | ||||
Alternate Names | claxs | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
34. DocumentReference.subject | |||||
Definition | 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). | ||||
Short | (USCDI) Who/what is the subject of the document | ||||
Control | 1..1 | ||||
Type | Reference(US Core Patient Profile) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
36. DocumentReference.date | |||||
Definition | When the document reference was created. | ||||
Short | (USCDI) When this document reference was created | ||||
Comments | Referencing/indexing time is used for tracking, organizing versions and searching. | ||||
Control | 1..1 | ||||
Type | instant | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Alternate Names | indexed | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
38. DocumentReference.author | |||||
Definition | Identifies who is responsible for adding the information to the document. | ||||
Short | (USCDI) Who and/or what authored the document | ||||
Comments | Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant). | ||||
Control | 0..* | ||||
Type | Reference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Must Support Types | Reference(US Core Practitioner Profile) | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
40. DocumentReference.authenticator | |||||
Definition | Which person or organization authenticates that this document is valid. | ||||
Short | Who/what authenticated the document | ||||
Comments | Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator. | ||||
Control | 0..1 | ||||
Type | Reference(Practitioner, PractitionerRole, Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
42. DocumentReference.custodian | |||||
Definition | Identifies the organization or group who is responsible for ongoing maintenance of and access to the document. | ||||
Short | Organization which maintains the document | ||||
Comments | 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. | ||||
Control | 0..1 | ||||
Type | Reference(US Core Organization Profile) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
44. DocumentReference.relatesTo | |||||
Definition | Relationships that this document has with other document references that already exist. | ||||
Short | Relationships to other documents | ||||
Comments | This element is labeled as a modifier because documents that append to other documents are incomplete on their own. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
46. DocumentReference.relatesTo.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
48. DocumentReference.relatesTo.extension | |||||
Definition | 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 manageable, 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. | ||||
Short | Additional content defined by implementations | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
50. DocumentReference.relatesTo.modifierExtension | |||||
Definition | 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 manageable, 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). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | 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. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
52. DocumentReference.relatesTo.code | |||||
Definition | The type of relationship that this document has with anther document. | ||||
Short | replaces | transforms | signs | appends | ||||
Comments | If this document appends another document, then the document cannot be fully understood without also accessing the referenced document. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from DocumentRelationshipType (required to http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 )The type of relationship between documents. | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
54. DocumentReference.relatesTo.target | |||||
Definition | The target document of this relationship. | ||||
Short | Target of the relationship | ||||
Control | 1..1 | ||||
Type | Reference(DocumentReference) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
56. DocumentReference.description | |||||
Definition | Human-readable description of the source document. | ||||
Short | Human-readable description | ||||
Comments | What the document is about, a terse summary of the document. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Helps humans to assess whether the document is of interest. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
58. DocumentReference.securityLabel | |||||
Definition | A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to. | ||||
Short | Document security-tags | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Binding | Unless not suitable, these codes SHALL be taken from All Security Labels (extensible to http://hl7.org/fhir/ValueSet/security-labels )Security Labels from the Healthcare Privacy and Security Classification System. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
60. DocumentReference.content | |||||
Definition | The document and format referenced. There may be multiple content element repetitions, each with a different format. | ||||
Short | (USCDI) Document referenced | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
62. DocumentReference.content.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
64. DocumentReference.content.extension | |||||
Definition | 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 manageable, 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. | ||||
Short | Additional content defined by implementations | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
66. DocumentReference.content.modifierExtension | |||||
Definition | 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 manageable, 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). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | 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. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
68. DocumentReference.content.attachment | |||||
Definition | The document or URL of the document along with critical metadata to prove content has integrity. | ||||
Short | (USCDI) Where to access the document | ||||
Control | 1..1 | ||||
Type | Attachment | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. ( url.exists() or data.exists() ) | ||||
70. DocumentReference.content.attachment.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
72. DocumentReference.content.attachment.extension | |||||
Definition | 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 manageable, 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. | ||||
Short | Additional content defined by implementations | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on DocumentReference.content.attachment.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
74. DocumentReference.content.attachment.contentType | |||||
Definition | Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate. | ||||
Short | (USCDI) Mime type of the content, with charset etc. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from Mime Types (required to http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 )The mime type of an attachment. Any valid mime type is allowed. | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | Processors of the data need to be able to know how to interpret the data. | ||||
Example | <br/><b>General</b>:text/plain; charset=UTF-8, image/png | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
76. DocumentReference.content.attachment.language | |||||
Definition | The human language of the content. The value can be any valid value according to BCP 47. | ||||
Short | Human language of the content (BCP-47) | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CommonLanguages (preferred to http://hl7.org/fhir/ValueSet/languages )A human language.
| ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Users need to be able to choose between the languages in a set of attachments. | ||||
Example | <br/><b>General</b>:en-AU | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
78. DocumentReference.content.attachment.data | |||||
Definition | The actual data of the attachment - a sequence of bytes, base64 encoded. | ||||
Short | (USCDI) Data inline, base64ed | ||||
Comments | The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON. | ||||
Control | 0..1 This element is affected by the following invariants: us-core-6 | ||||
Type | base64Binary | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | The data needs to able to be transmitted inline. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
80. DocumentReference.content.attachment.url | |||||
Definition | A location where the data can be accessed. | ||||
Short | (USCDI) Uri where the data can be found | ||||
Comments | If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data. | ||||
Control | 0..1 This element is affected by the following invariants: us-core-6 | ||||
Type | url | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | The data needs to be transmitted by reference. | ||||
Example | <br/><b>General</b>:http://www.acme.com/logo-small.png | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
82. DocumentReference.content.attachment.size | |||||
Definition | The number of bytes of data that make up this attachment (before base64 encoding, if that is done). | ||||
Short | Number of bytes of content (if url provided) | ||||
Comments | The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference. | ||||
Control | 0..1 | ||||
Type | unsignedInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
84. DocumentReference.content.attachment.hash | |||||
Definition | The calculated hash of the data using SHA-1. Represented using base64. | ||||
Short | Hash of the data (sha-1, base64ed) | ||||
Comments | The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature. | ||||
Control | 0..1 | ||||
Type | base64Binary | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version). | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
86. DocumentReference.content.attachment.title | |||||
Definition | A label or set of text to display in place of the data. | ||||
Short | Label to display in place of the data | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer. | ||||
Example | <br/><b>General</b>:Official Corporate Logo | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
88. DocumentReference.content.attachment.creation | |||||
Definition | The date that the attachment was first created. | ||||
Short | Date attachment was first created | ||||
Control | 1..1 | ||||
Type | dateTime | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | This is often tracked as an integrity issue for use of the attachment. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
90. DocumentReference.content.format | |||||
Definition | An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType. | ||||
Short | (USCDI) Format/content rules for the document | ||||
Comments | Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI. | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from DocumentReferenceFormatCodeSet (extensible to http://hl7.org/fhir/ValueSet/formatcodes ) | ||||
Type | Coding | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
92. DocumentReference.context | |||||
Definition | The clinical context in which the document was prepared. | ||||
Short | (USCDI) Clinical context of document | ||||
Comments | These values are primarily added to help with searching for interesting/relevant documents. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
94. DocumentReference.context.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
96. DocumentReference.context.extension | |||||
Definition | 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 manageable, 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. | ||||
Short | Additional content defined by implementations | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
98. DocumentReference.context.modifierExtension | |||||
Definition | 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 manageable, 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). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | 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. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | 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. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
100. DocumentReference.context.encounter | |||||
Definition | Describes the clinical encounter or type of care that the document content is associated with. | ||||
Short | (USCDI) Context of the document content | ||||
Control | 0..1 | ||||
Type | Reference(US Core Encounter Profile) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
102. DocumentReference.context.event | |||||
Definition | 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 "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act. | ||||
Short | Main clinical acts documented | ||||
Comments | An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". 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. | ||||
Control | 0..* | ||||
Binding | For example codes, see v3 Code System ActCode (example to http://terminology.hl7.org/ValueSet/v3-ActCode )This list of codes represents the main clinical acts being documented. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
104. DocumentReference.context.period | |||||
Definition | The time period over which the service that is described by the document was provided. | ||||
Short | (USCDI) Time of service that is being documented | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
106. DocumentReference.context.facilityType | |||||
Definition | The kind of facility where the patient was seen. | ||||
Short | Kind of facility where patient was seen | ||||
Control | 0..1 | ||||
Binding | For example codes, see FacilityTypeCodeValueSet (example to http://hl7.org/fhir/ValueSet/c80-facilitycodes )XDS Facility Type. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
108. DocumentReference.context.practiceSetting | |||||
Definition | This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty. | ||||
Short | Additional details about where the content was created (e.g. clinical specialty) | ||||
Comments | 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. | ||||
Control | 0..1 | ||||
Binding | For example codes, see PracticeSettingCodeValueSet (example to http://hl7.org/fhir/ValueSet/c80-practice-codes )Additional details about where the content was created (e.g. clinical specialty). | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
110. DocumentReference.context.sourcePatientInfo | |||||
Definition | The Patient Information as known when the document was published. May be a reference to a version specific, or contained. | ||||
Short | Patient demographics from source | ||||
Control | 0..1 | ||||
Type | Reference(Patient) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
112. DocumentReference.context.related | |||||
Definition | Related identifiers or resources associated with the DocumentReference. | ||||
Short | Related identifiers or resources | ||||
Comments | May be identifiers or resources that caused the DocumentReference or referenced Document to be created. | ||||
Control | 0..* | ||||
Type | Reference(Resource) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |