QI-Core Implementation Guide
8.0.0-ballot - STU 8 - ballot

QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 8.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-qi-core/ and changes regularly. See the Directory of published versions

## Resource Profile: QICore DiagnosticReport Profile for Laboratory Results Reporting

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-diagnosticreport-lab | Version: 8.0.0-ballot
Standards status: Trial-use Active as of 2023-08-01 | Maturity Level: 4 | Computable Name: QICoreDiagnosticReportLab

Profile of DiagnosticReport for laboratory results for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

"Must Have", "QI Elements" and "primary code path" are defined in the QI-Core Must Support section.
Must Have:

- subject: (QI) The subject of the report - usually, but not always, the patient
- status: (QI)registered | partial | preliminary | final +
- code: (QI) US Core Laboratory Report Order Code
- category: (QI) Service category
- category(LaboratorySlice): (QI) Service category

QI Elements:

- effective[x]: (QI) Diagnostically relevant time (typically the time of specimen collection)
- result: (QI) Observations
- basedOn: (QI) What was requested
- performer: (QI) Responsible Diagnostic Service

Primary code path: code
(PCPath) This element is the primary code path for this resource CQL Retrieve
Usage

See the patterns page for implementation and usage patterns.

### Examples

Blood Panel Example

Usages:

- This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport | C | 0..* | USCoreDiagnosticReportProfileLaboratoryReporting | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports Constraints: us-core-8, us-core-9
meta | S Σ | 0..1 | Meta | Metadata about the resource
lastUpdated | S Σ | 0..1 | instant | When the resource last changed
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
basedOn |  | 0..* | Reference(QICore CarePlan | QICore ImmunizationRecommendation | QICore MedicationRequest | QICore NutritionOrder | QICore ServiceRequest) | (QI) What was requested
status | ?!S Σ C | 1..1 | code | (QI)registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | S Σ | 1..* | CodeableConcept | (QI) Service category Slice: Unordered, Open by value:$this Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections.
category:LaboratorySlice | S Σ | 1..1 | CodeableConcept | (QI) Service category Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
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: http://terminology.hl7.org/CodeSystem/v2-0074
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: LAB
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code | S Σ | 1..1 | CodeableConcept | (QI) US Core Laboratory Report Order Code Binding: US Core Laboratory Test Codes (extensible): LOINC codes
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) The subject of the report - usually, but not always, the patient
encounter | S Σ | 0..1 | Reference(QICore Encounter) | (QI) Encounter associated with DiagnosticReport
effective[x] | S Σ C | 0..1 |  | (QI) Diagnostically relevant time (typically the time of specimen collection)
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | S Σ C | 0..1 | instant | (QI) DateTime this version was made
performer | S Σ | 0..* | Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization) | (QI) Responsible Diagnostic Service
resultsInterpreter | S Σ | 0..* | Reference(US Core Practitioner Profile S | US Core Organization Profile | PractitionerRole | US Core CareTeam Profile) | Who analyzed and reported the conclusions and interpretations
result | S | 0..* | Reference(QICore Laboratory Result Observation) | (QI) Observations
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:LaboratorySlice | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.code | Base | extensible | US Core Laboratory Test Codes | 📦8.0.0 | US Core v8.0

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | 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 | error | DiagnosticReport | 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 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-8 | error | DiagnosticReport | effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()`
us-core-9 | error | DiagnosticReport | issued SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies issued.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | USCoreDiagnosticReportProfileLaboratoryReporting | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
basedOn |  | 0..* | Reference(QICore CarePlan | QICore ImmunizationRecommendation | QICore MedicationRequest | QICore NutritionOrder | QICore ServiceRequest) | (QI) What was requested
status | ?!S Σ C | 1..1 | code | (QI)registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | Σ | 1..* | CodeableConcept | (QI) Service category Slice: Unordered, Open by value:$this Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections.
category:LaboratorySlice | Σ | 1..1 | CodeableConcept | (QI) Service category Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections. Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0074
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: LAB
code | S Σ | 1..1 | CodeableConcept | (QI) US Core Laboratory Report Order Code Binding: US Core Laboratory Test Codes (extensible): LOINC codes
subject |  | 1..1 | Reference(QICore Patient) | (QI) The subject of the report - usually, but not always, the patient
encounter |  | 0..1 | Reference(QICore Encounter) | (QI) Encounter associated with DiagnosticReport
effective[x] | Σ | 0..1 |  | (QI) Diagnostically relevant time (typically the time of specimen collection)
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
issued | S Σ C | 0..1 | instant | (QI) DateTime this version was made
performer |  | 0..* | Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization) | (QI) Responsible Diagnostic Service
result |  | 0..* | Reference(QICore Laboratory Result Observation) | (QI) Observations
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:LaboratorySlice | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.code | Base | extensible | US Core Laboratory Test Codes | 📦8.0.0 | US Core v8.0

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport | C | 0..* | USCoreDiagnosticReportProfileLaboratoryReporting | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports Constraints: us-core-8, us-core-9
id | Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | S Σ | 0..1 | instant | When the resource last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for report
basedOn |  | 0..* | Reference(QICore CarePlan | QICore ImmunizationRecommendation | QICore MedicationRequest | QICore NutritionOrder | QICore ServiceRequest) | (QI) What was requested
status | ?!S Σ C | 1..1 | code | (QI)registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | S Σ | 1..* | CodeableConcept | (QI) Service category Slice: Unordered, Open by value:$this Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections.
category:LaboratorySlice | S Σ | 1..1 | CodeableConcept | (QI) Service category Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
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: http://terminology.hl7.org/CodeSystem/v2-0074
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: LAB
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code | S Σ | 1..1 | CodeableConcept | (QI) US Core Laboratory Report Order Code Binding: US Core Laboratory Test Codes (extensible): LOINC codes
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) The subject of the report - usually, but not always, the patient
encounter | S Σ | 0..1 | Reference(QICore Encounter) | (QI) Encounter associated with DiagnosticReport
effective[x] | S Σ C | 0..1 |  | (QI) Diagnostically relevant time (typically the time of specimen collection)
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | S Σ C | 0..1 | instant | (QI) DateTime this version was made
performer | S Σ | 0..* | Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization) | (QI) Responsible Diagnostic Service
resultsInterpreter | S Σ | 0..* | Reference(US Core Practitioner Profile S | US Core Organization Profile | PractitionerRole | US Core CareTeam Profile) | Who analyzed and reported the conclusions and interpretations
specimen |  | 0..* | Reference(Specimen) | Specimens this report is based on
result | S | 0..* | Reference(QICore Laboratory Result Observation) | (QI) Observations
imagingStudy |  | 0..* | Reference(ImagingStudy) | Reference to full details of imaging associated with the diagnostic report
media | Σ | 0..* | BackboneElement | Key images associated with this report
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
comment |  | 0..1 | string | Comment about the image (e.g. explanation)
link | Σ | 1..1 | Reference(Media) | Reference to the image source
conclusion |  | 0..1 | string | Clinical conclusion (interpretation) of test results
conclusionCode |  | 0..* | CodeableConcept | Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm |  | 0..* | Attachment | Entire report as issued
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.meta.​security | Base | extensible | SecurityLabels | 📦4.0.1 | FHIR Std.
DiagnosticReport.meta.​tag | Base | example | Common Tags | 📦4.0.1 | FHIR Std.
DiagnosticReport.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:LaboratorySlice | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.code | Base | extensible | US Core Laboratory Test Codes | 📦8.0.0 | US Core v8.0
DiagnosticReport.conclusionCode | Base | example | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | 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 | error | DiagnosticReport | 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 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-8 | error | DiagnosticReport | effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()`
us-core-9 | error | DiagnosticReport | issued SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies issued.exists()`

Summary

Mandatory: 2 elements
Must-Support: 3 elements

Structures

This structure refers to these other structures:

- QICore CarePlan (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-careplan)
- QICore ImmunizationRecommendation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-immunizationrecommendation)
- QICore MedicationRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest)
- QICore NutritionOrder (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-nutritionorder)
- QICore ServiceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest)
- QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICore Encounter (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter)
- QICore Practitioner (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner)
- QICore PractitionerRole (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole)
- QICore Organization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICore Laboratory Result Observation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of DiagnosticReport.category

Maturity: 4

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport | C | 0..* | USCoreDiagnosticReportProfileLaboratoryReporting | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports Constraints: us-core-8, us-core-9
meta | S Σ | 0..1 | Meta | Metadata about the resource
lastUpdated | S Σ | 0..1 | instant | When the resource last changed
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
basedOn |  | 0..* | Reference(QICore CarePlan | QICore ImmunizationRecommendation | QICore MedicationRequest | QICore NutritionOrder | QICore ServiceRequest) | (QI) What was requested
status | ?!S Σ C | 1..1 | code | (QI)registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | S Σ | 1..* | CodeableConcept | (QI) Service category Slice: Unordered, Open by value:$this Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections.
category:LaboratorySlice | S Σ | 1..1 | CodeableConcept | (QI) Service category Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
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: http://terminology.hl7.org/CodeSystem/v2-0074
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: LAB
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code | S Σ | 1..1 | CodeableConcept | (QI) US Core Laboratory Report Order Code Binding: US Core Laboratory Test Codes (extensible): LOINC codes
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) The subject of the report - usually, but not always, the patient
encounter | S Σ | 0..1 | Reference(QICore Encounter) | (QI) Encounter associated with DiagnosticReport
effective[x] | S Σ C | 0..1 |  | (QI) Diagnostically relevant time (typically the time of specimen collection)
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | S Σ C | 0..1 | instant | (QI) DateTime this version was made
performer | S Σ | 0..* | Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization) | (QI) Responsible Diagnostic Service
resultsInterpreter | S Σ | 0..* | Reference(US Core Practitioner Profile S | US Core Organization Profile | PractitionerRole | US Core CareTeam Profile) | Who analyzed and reported the conclusions and interpretations
result | S | 0..* | Reference(QICore Laboratory Result Observation) | (QI) Observations
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:LaboratorySlice | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.code | Base | extensible | US Core Laboratory Test Codes | 📦8.0.0 | US Core v8.0

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | 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 | error | DiagnosticReport | 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 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-8 | error | DiagnosticReport | effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()`
us-core-9 | error | DiagnosticReport | issued SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies issued.exists()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | USCoreDiagnosticReportProfileLaboratoryReporting | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
basedOn |  | 0..* | Reference(QICore CarePlan | QICore ImmunizationRecommendation | QICore MedicationRequest | QICore NutritionOrder | QICore ServiceRequest) | (QI) What was requested
status | ?!S Σ C | 1..1 | code | (QI)registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | Σ | 1..* | CodeableConcept | (QI) Service category Slice: Unordered, Open by value:$this Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections.
category:LaboratorySlice | Σ | 1..1 | CodeableConcept | (QI) Service category Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections. Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0074
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: LAB
code | S Σ | 1..1 | CodeableConcept | (QI) US Core Laboratory Report Order Code Binding: US Core Laboratory Test Codes (extensible): LOINC codes
subject |  | 1..1 | Reference(QICore Patient) | (QI) The subject of the report - usually, but not always, the patient
encounter |  | 0..1 | Reference(QICore Encounter) | (QI) Encounter associated with DiagnosticReport
effective[x] | Σ | 0..1 |  | (QI) Diagnostically relevant time (typically the time of specimen collection)
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
issued | S Σ C | 0..1 | instant | (QI) DateTime this version was made
performer |  | 0..* | Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization) | (QI) Responsible Diagnostic Service
result |  | 0..* | Reference(QICore Laboratory Result Observation) | (QI) Observations
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:LaboratorySlice | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.code | Base | extensible | US Core Laboratory Test Codes | 📦8.0.0 | US Core v8.0

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport | C | 0..* | USCoreDiagnosticReportProfileLaboratoryReporting | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports Constraints: us-core-8, us-core-9
id | Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | S Σ | 0..1 | instant | When the resource last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for report
basedOn |  | 0..* | Reference(QICore CarePlan | QICore ImmunizationRecommendation | QICore MedicationRequest | QICore NutritionOrder | QICore ServiceRequest) | (QI) What was requested
status | ?!S Σ C | 1..1 | code | (QI)registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | S Σ | 1..* | CodeableConcept | (QI) Service category Slice: Unordered, Open by value:$this Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections.
category:LaboratorySlice | S Σ | 1..1 | CodeableConcept | (QI) Service category Binding: DiagnosticServiceSectionCodes (preferred): Codes for diagnostic service sections. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
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: http://terminology.hl7.org/CodeSystem/v2-0074
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: LAB
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code | S Σ | 1..1 | CodeableConcept | (QI) US Core Laboratory Report Order Code Binding: US Core Laboratory Test Codes (extensible): LOINC codes
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) The subject of the report - usually, but not always, the patient
encounter | S Σ | 0..1 | Reference(QICore Encounter) | (QI) Encounter associated with DiagnosticReport
effective[x] | S Σ C | 0..1 |  | (QI) Diagnostically relevant time (typically the time of specimen collection)
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | S Σ C | 0..1 | instant | (QI) DateTime this version was made
performer | S Σ | 0..* | Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization) | (QI) Responsible Diagnostic Service
resultsInterpreter | S Σ | 0..* | Reference(US Core Practitioner Profile S | US Core Organization Profile | PractitionerRole | US Core CareTeam Profile) | Who analyzed and reported the conclusions and interpretations
specimen |  | 0..* | Reference(Specimen) | Specimens this report is based on
result | S | 0..* | Reference(QICore Laboratory Result Observation) | (QI) Observations
imagingStudy |  | 0..* | Reference(ImagingStudy) | Reference to full details of imaging associated with the diagnostic report
media | Σ | 0..* | BackboneElement | Key images associated with this report
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
comment |  | 0..1 | string | Comment about the image (e.g. explanation)
link | Σ | 1..1 | Reference(Media) | Reference to the image source
conclusion |  | 0..1 | string | Clinical conclusion (interpretation) of test results
conclusionCode |  | 0..* | CodeableConcept | Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm |  | 0..* | Attachment | Entire report as issued
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.meta.​security | Base | extensible | SecurityLabels | 📦4.0.1 | FHIR Std.
DiagnosticReport.meta.​tag | Base | example | Common Tags | 📦4.0.1 | FHIR Std.
DiagnosticReport.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:LaboratorySlice | Base | preferred | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.code | Base | extensible | US Core Laboratory Test Codes | 📦8.0.0 | US Core v8.0
DiagnosticReport.conclusionCode | Base | example | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | 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 | error | DiagnosticReport | 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 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-8 | error | DiagnosticReport | effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()`
us-core-9 | error | DiagnosticReport | issued SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies issued.exists()`

Summary

Mandatory: 2 elements
Must-Support: 3 elements

Structures

This structure refers to these other structures:

- QICore CarePlan (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-careplan)
- QICore ImmunizationRecommendation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-immunizationrecommendation)
- QICore MedicationRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest)
- QICore NutritionOrder (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-nutritionorder)
- QICore ServiceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest)
- QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICore Encounter (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter)
- QICore Practitioner (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner)
- QICore PractitionerRole (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole)
- QICore Organization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICore Laboratory Result Observation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of DiagnosticReport.category

Maturity: 4

Other representations of profile: CSV, Excel, Schematron