Genomics Reporting Implementation Guide
4.0.0-cibuild - CI Build

Genomics Reporting Implementation Guide, published by HL7 International / Clinical Genomics. This guide is not an authorized publication; it is the continuous build for version 4.0.0-cibuild built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/genomics-reporting/ and changes regularly. See the Directory of published versions

## Resource Profile: Genomic Report

Official URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report | Version: 4.0.0-cibuild
Standards status: Trial-use | Maturity Level: 2 | Computable Name: GenomicReport

Genomic profile of DiagnosticReport.

### Scope and Usage

The genomic report is the focus of all genomic reporting. It conveys metadata about the overall report (what kind of report it was, when it was written, who wrote it, final vs. draft, etc.). It also typically includes a rendered version for review by a clinician. It also groups together all relevant information found as part of the genomic analysis (Rules for relevancy will depend on the type of testing ordered, the reason for testing and the policies of the lab). Most of the structured genomic information is expressed as FHIR Observations. Any recommendations that come with the report are expressed as FHIR Tasks. The report can be organized into sub-reports using core DiagnosticReport extensions like extends or summaryOf, which is especially useful for later analysis steps. Additionally, an observation can be used to group content for viewing purposes or to indicate a higher-level panel (with a specific LOINC panel code in the `Observation.code` for example).

Genomic Report Overview

Usages:

- Refer to this Profile: Genomic Data File
- Examples for this Profile: DiagnosticReport/GenomicReportExample01, DiagnosticReport/PGxGenomicReportEMERGE-withGrouping, DiagnosticReport/PGxGenomicReportEMERGE, DiagnosticReport/diagnosticreport-hla-glstring-r4 and DiagnosticReport/somaticReport

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReport | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recommended-action |  | 0..* | Reference(Medication Recommendation | Followup Recommendation) | Recommended Action URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action
extension:genomic-risk-assessment |  | 0..* | Reference(RiskAssessment) | Genomic Risk Assessment URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-risk-assessment
extension:coded-note |  | 0..* | CodedAnnotation | Comments about the report that also contain a coded type URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report-note
extension:supporting-info |  | 0..* | Reference(Resource) | Other information that may be relevant to this event. URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
extension:genomic-study |  | 0..* | Reference(Genomic Study) | Reference to full details of an genomic study associated with the diagnostic report URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference
extension:hla-genotyping-results-allele-database |  | 0..1 | CodeableConcept | Allele Database URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-allele-database
extension:hla-genotyping-results-glstring |  | 0..1 | (Complex) | glstring URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-glstring
extension:workflow-relatedArtifact |  | 0..* | RelatedArtifact | Documentation relevant to the 'parent' resource URL: http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
Slices for category | Σ | 1..* | CodeableConcept | Service category Slice: Unordered, Open by value:coding Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:Genetics | Σ | 1..1 | CodeableConcept | Service category Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
coding | Σ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: 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: GE
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
code | Σ | 1..1 | CodeableConcept | Name/Code for this diagnostic report Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports. 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://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 51969-4
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
effective[x] | Σ | 0..1 | dateTime | Clinically relevant time/time-period for report
Slices for result |  | 0..* | Reference(Observation) | Observations Slice: Unordered, Open by profile:resolve()
result:diagnostic-implication |  | 0..* | Reference(Diagnostic Implication) | Diagnostic Implication
result:therapeutic-implication |  | 0..* | Reference(Therapeutic Implication) | Therapeutic Implication
result:molecular-consequence |  | 0..* | Reference(Molecular Consequence) | Molecular Consequence
result:variant |  | 0..* | Reference(Variant) | Variant
result:sequence-phase-relation |  | 0..* | Reference(Sequence Phase Relationship) | Sequence Phase Relationship
result:genotype |  | 0..* | Reference(Genotype) | Genotype
result:haplotype |  | 0..* | Reference(Haplotype) | Haplotype
result:biomarker |  | 0..* | Reference(Molecular Biomarker) | MolecularBiomarker
conclusion |  | 0..1 | string | Assessment of overall results
conclusionCode |  | 0..* | CodeableConcept | Coarse overall interpretation of the genomic results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
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 | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.category:Genetics | Base | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.code | Base | preferred | LOINC Diagnostic Report Codes | 📍4.0.1 | FHIR Std.
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()`

This structure is derived from DiagnosticReport

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReport | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recommended-action |  | 0..* | Reference(Medication Recommendation | Followup Recommendation) | Recommended Action URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action
extension:genomic-risk-assessment |  | 0..* | Reference(RiskAssessment) | Genomic Risk Assessment URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-risk-assessment
extension:coded-note |  | 0..* | CodedAnnotation | Comments about the report that also contain a coded type URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report-note
extension:supporting-info |  | 0..* | Reference(Resource) | Other information that may be relevant to this event. URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
extension:genomic-study |  | 0..* | Reference(Genomic Study) | Reference to full details of an genomic study associated with the diagnostic report URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference
extension:hla-genotyping-results-allele-database |  | 0..1 | CodeableConcept | Allele Database URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-allele-database
extension:hla-genotyping-results-glstring |  | 0..1 | (Complex) | glstring URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-glstring
extension:workflow-relatedArtifact |  | 0..* | RelatedArtifact | Documentation relevant to the 'parent' resource URL: http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact
Slices for category |  | 1..* | CodeableConcept | Service category Slice: Unordered, Open by value:coding
category:Genetics |  | 1..1 | CodeableConcept | Service category
coding |  | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following
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: GE
code |  | 1..1 | CodeableConcept | Name/Code for this diagnostic report 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://loinc.org
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 51969-4
effective[x] |  | 0..1 | dateTime | Clinically relevant time/time-period for report
Slices for result |  | 0..* | Reference(Observation) | Observations Slice: Unordered, Open by profile:resolve()
result:diagnostic-implication |  | 0..* | Reference(Diagnostic Implication) | Diagnostic Implication
result:therapeutic-implication |  | 0..* | Reference(Therapeutic Implication) | Therapeutic Implication
result:molecular-consequence |  | 0..* | Reference(Molecular Consequence) | Molecular Consequence
result:variant |  | 0..* | Reference(Variant) | Variant
result:sequence-phase-relation |  | 0..* | Reference(Sequence Phase Relationship) | Sequence Phase Relationship
result:genotype |  | 0..* | Reference(Genotype) | Genotype
result:haplotype |  | 0..* | Reference(Haplotype) | Haplotype
result:biomarker |  | 0..* | Reference(Molecular Biomarker) | MolecularBiomarker
conclusion |  | 0..1 | string | Assessment of overall results
conclusionCode |  | 0..* | CodeableConcept | Coarse overall interpretation of the genomic results
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReport | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
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
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recommended-action |  | 0..* | Reference(Medication Recommendation | Followup Recommendation) | Recommended Action URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action
extension:genomic-risk-assessment |  | 0..* | Reference(RiskAssessment) | Genomic Risk Assessment URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-risk-assessment
extension:coded-note |  | 0..* | CodedAnnotation | Comments about the report that also contain a coded type URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report-note
extension:supporting-info |  | 0..* | Reference(Resource) | Other information that may be relevant to this event. URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
extension:genomic-study |  | 0..* | Reference(Genomic Study) | Reference to full details of an genomic study associated with the diagnostic report URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference
extension:hla-genotyping-results-allele-database |  | 0..1 | CodeableConcept | Allele Database URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-allele-database
extension:hla-genotyping-results-glstring |  | 0..1 | (Complex) | glstring URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-glstring
extension:workflow-relatedArtifact |  | 0..* | RelatedArtifact | Documentation relevant to the 'parent' resource URL: http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for report
basedOn |  | 0..* | Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | What was requested
status | ?!Σ | 1..1 | code | registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
Slices for category | Σ | 1..* | CodeableConcept | Service category Slice: Unordered, Open by value:coding Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:Genetics | Σ | 1..1 | CodeableConcept | Service category Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: 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: GE
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
code | Σ | 1..1 | CodeableConcept | Name/Code for this diagnostic report Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports. 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://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 51969-4
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
subject | Σ | 0..1 | Reference(Patient | Group | Device | Location) | The subject of the report - usually, but not always, the patient
encounter | Σ | 0..1 | Reference(Encounter) | Health care event when test ordered
effective[x] | Σ | 0..1 | dateTime | Clinically relevant time/time-period for report
issued | Σ | 0..1 | instant | DateTime this version was made
performer | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam) | Responsible Diagnostic Service
resultsInterpreter | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam) | Primary result interpreter
specimen |  | 0..* | Reference(Specimen) | Specimens this report is based on
Slices for result |  | 0..* | Reference(Observation) | Observations Slice: Unordered, Open by profile:resolve()
result:diagnostic-implication |  | 0..* | Reference(Diagnostic Implication) | Diagnostic Implication
result:therapeutic-implication |  | 0..* | Reference(Therapeutic Implication) | Therapeutic Implication
result:molecular-consequence |  | 0..* | Reference(Molecular Consequence) | Molecular Consequence
result:variant |  | 0..* | Reference(Variant) | Variant
result:sequence-phase-relation |  | 0..* | Reference(Sequence Phase Relationship) | Sequence Phase Relationship
result:genotype |  | 0..* | Reference(Genotype) | Genotype
result:haplotype |  | 0..* | Reference(Haplotype) | Haplotype
result:biomarker |  | 0..* | Reference(Molecular Biomarker) | MolecularBiomarker
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 | Assessment of overall results
conclusionCode |  | 0..* | CodeableConcept | Coarse overall interpretation of the genomic 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.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📍4.0.1 | FHIR Std.
DiagnosticReport.category | Base | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.category:Genetics | Base | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.code | Base | preferred | LOINC Diagnostic Report Codes | 📍4.0.1 | FHIR Std.
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()`

This structure is derived from DiagnosticReport

Summary

Mandatory: 3 elements

Structures

This structure refers to these other structures:

- Diagnostic Implication (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/diagnostic-implication)
- Therapeutic Implication (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/therapeutic-implication)
- Molecular Consequence (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/molecular-consequence)
- Variant (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/variant)
- Sequence Phase Relationship (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/sequence-phase-relationship)
- Genotype (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genotype)
- Haplotype (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/haplotype)
- Molecular Biomarker (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/molecular-biomarker)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action
- http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-risk-assessment
- http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report-note
- http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo|5.2.0
- http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference
- http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-allele-database|5.2.0
- http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-glstring|5.2.0
- http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact|5.2.0

Slices

This structure defines the following Slices:

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

Maturity: 2

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReport | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recommended-action |  | 0..* | Reference(Medication Recommendation | Followup Recommendation) | Recommended Action URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action
extension:genomic-risk-assessment |  | 0..* | Reference(RiskAssessment) | Genomic Risk Assessment URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-risk-assessment
extension:coded-note |  | 0..* | CodedAnnotation | Comments about the report that also contain a coded type URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report-note
extension:supporting-info |  | 0..* | Reference(Resource) | Other information that may be relevant to this event. URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
extension:genomic-study |  | 0..* | Reference(Genomic Study) | Reference to full details of an genomic study associated with the diagnostic report URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference
extension:hla-genotyping-results-allele-database |  | 0..1 | CodeableConcept | Allele Database URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-allele-database
extension:hla-genotyping-results-glstring |  | 0..1 | (Complex) | glstring URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-glstring
extension:workflow-relatedArtifact |  | 0..* | RelatedArtifact | Documentation relevant to the 'parent' resource URL: http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
Slices for category | Σ | 1..* | CodeableConcept | Service category Slice: Unordered, Open by value:coding Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:Genetics | Σ | 1..1 | CodeableConcept | Service category Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
coding | Σ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: 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: GE
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
code | Σ | 1..1 | CodeableConcept | Name/Code for this diagnostic report Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports. 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://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 51969-4
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
effective[x] | Σ | 0..1 | dateTime | Clinically relevant time/time-period for report
Slices for result |  | 0..* | Reference(Observation) | Observations Slice: Unordered, Open by profile:resolve()
result:diagnostic-implication |  | 0..* | Reference(Diagnostic Implication) | Diagnostic Implication
result:therapeutic-implication |  | 0..* | Reference(Therapeutic Implication) | Therapeutic Implication
result:molecular-consequence |  | 0..* | Reference(Molecular Consequence) | Molecular Consequence
result:variant |  | 0..* | Reference(Variant) | Variant
result:sequence-phase-relation |  | 0..* | Reference(Sequence Phase Relationship) | Sequence Phase Relationship
result:genotype |  | 0..* | Reference(Genotype) | Genotype
result:haplotype |  | 0..* | Reference(Haplotype) | Haplotype
result:biomarker |  | 0..* | Reference(Molecular Biomarker) | MolecularBiomarker
conclusion |  | 0..1 | string | Assessment of overall results
conclusionCode |  | 0..* | CodeableConcept | Coarse overall interpretation of the genomic results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
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 | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.category:Genetics | Base | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.code | Base | preferred | LOINC Diagnostic Report Codes | 📍4.0.1 | FHIR Std.
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()`

Differential View

This structure is derived from DiagnosticReport

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReport | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recommended-action |  | 0..* | Reference(Medication Recommendation | Followup Recommendation) | Recommended Action URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action
extension:genomic-risk-assessment |  | 0..* | Reference(RiskAssessment) | Genomic Risk Assessment URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-risk-assessment
extension:coded-note |  | 0..* | CodedAnnotation | Comments about the report that also contain a coded type URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report-note
extension:supporting-info |  | 0..* | Reference(Resource) | Other information that may be relevant to this event. URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
extension:genomic-study |  | 0..* | Reference(Genomic Study) | Reference to full details of an genomic study associated with the diagnostic report URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference
extension:hla-genotyping-results-allele-database |  | 0..1 | CodeableConcept | Allele Database URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-allele-database
extension:hla-genotyping-results-glstring |  | 0..1 | (Complex) | glstring URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-glstring
extension:workflow-relatedArtifact |  | 0..* | RelatedArtifact | Documentation relevant to the 'parent' resource URL: http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact
Slices for category |  | 1..* | CodeableConcept | Service category Slice: Unordered, Open by value:coding
category:Genetics |  | 1..1 | CodeableConcept | Service category
coding |  | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following
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: GE
code |  | 1..1 | CodeableConcept | Name/Code for this diagnostic report 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://loinc.org
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 51969-4
effective[x] |  | 0..1 | dateTime | Clinically relevant time/time-period for report
Slices for result |  | 0..* | Reference(Observation) | Observations Slice: Unordered, Open by profile:resolve()
result:diagnostic-implication |  | 0..* | Reference(Diagnostic Implication) | Diagnostic Implication
result:therapeutic-implication |  | 0..* | Reference(Therapeutic Implication) | Therapeutic Implication
result:molecular-consequence |  | 0..* | Reference(Molecular Consequence) | Molecular Consequence
result:variant |  | 0..* | Reference(Variant) | Variant
result:sequence-phase-relation |  | 0..* | Reference(Sequence Phase Relationship) | Sequence Phase Relationship
result:genotype |  | 0..* | Reference(Genotype) | Genotype
result:haplotype |  | 0..* | Reference(Haplotype) | Haplotype
result:biomarker |  | 0..* | Reference(Molecular Biomarker) | MolecularBiomarker
conclusion |  | 0..1 | string | Assessment of overall results
conclusionCode |  | 0..* | CodeableConcept | Coarse overall interpretation of the genomic results
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReport | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
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
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recommended-action |  | 0..* | Reference(Medication Recommendation | Followup Recommendation) | Recommended Action URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action
extension:genomic-risk-assessment |  | 0..* | Reference(RiskAssessment) | Genomic Risk Assessment URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-risk-assessment
extension:coded-note |  | 0..* | CodedAnnotation | Comments about the report that also contain a coded type URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report-note
extension:supporting-info |  | 0..* | Reference(Resource) | Other information that may be relevant to this event. URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
extension:genomic-study |  | 0..* | Reference(Genomic Study) | Reference to full details of an genomic study associated with the diagnostic report URL: http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference
extension:hla-genotyping-results-allele-database |  | 0..1 | CodeableConcept | Allele Database URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-allele-database
extension:hla-genotyping-results-glstring |  | 0..1 | (Complex) | glstring URL: http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-glstring
extension:workflow-relatedArtifact |  | 0..* | RelatedArtifact | Documentation relevant to the 'parent' resource URL: http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for report
basedOn |  | 0..* | Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | What was requested
status | ?!Σ | 1..1 | code | registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
Slices for category | Σ | 1..* | CodeableConcept | Service category Slice: Unordered, Open by value:coding Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:Genetics | Σ | 1..1 | CodeableConcept | Service category Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: 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: GE
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
code | Σ | 1..1 | CodeableConcept | Name/Code for this diagnostic report Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports. 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://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 51969-4
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
subject | Σ | 0..1 | Reference(Patient | Group | Device | Location) | The subject of the report - usually, but not always, the patient
encounter | Σ | 0..1 | Reference(Encounter) | Health care event when test ordered
effective[x] | Σ | 0..1 | dateTime | Clinically relevant time/time-period for report
issued | Σ | 0..1 | instant | DateTime this version was made
performer | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam) | Responsible Diagnostic Service
resultsInterpreter | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam) | Primary result interpreter
specimen |  | 0..* | Reference(Specimen) | Specimens this report is based on
Slices for result |  | 0..* | Reference(Observation) | Observations Slice: Unordered, Open by profile:resolve()
result:diagnostic-implication |  | 0..* | Reference(Diagnostic Implication) | Diagnostic Implication
result:therapeutic-implication |  | 0..* | Reference(Therapeutic Implication) | Therapeutic Implication
result:molecular-consequence |  | 0..* | Reference(Molecular Consequence) | Molecular Consequence
result:variant |  | 0..* | Reference(Variant) | Variant
result:sequence-phase-relation |  | 0..* | Reference(Sequence Phase Relationship) | Sequence Phase Relationship
result:genotype |  | 0..* | Reference(Genotype) | Genotype
result:haplotype |  | 0..* | Reference(Haplotype) | Haplotype
result:biomarker |  | 0..* | Reference(Molecular Biomarker) | MolecularBiomarker
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 | Assessment of overall results
conclusionCode |  | 0..* | CodeableConcept | Coarse overall interpretation of the genomic 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.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📍4.0.1 | FHIR Std.
DiagnosticReport.category | Base | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.category:Genetics | Base | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.code | Base | preferred | LOINC Diagnostic Report Codes | 📍4.0.1 | FHIR Std.
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()`

This structure is derived from DiagnosticReport

Summary

Mandatory: 3 elements

Structures

This structure refers to these other structures:

- Diagnostic Implication (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/diagnostic-implication)
- Therapeutic Implication (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/therapeutic-implication)
- Molecular Consequence (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/molecular-consequence)
- Variant (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/variant)
- Sequence Phase Relationship (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/sequence-phase-relationship)
- Genotype (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genotype)
- Haplotype (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/haplotype)
- Molecular Biomarker (http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/molecular-biomarker)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action
- http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-risk-assessment
- http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report-note
- http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo|5.2.0
- http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference
- http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-allele-database|5.2.0
- http://hl7.org/fhir/StructureDefinition/hla-genotyping-results-glstring|5.2.0
- http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact|5.2.0

Slices

This structure defines the following Slices:

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

Maturity: 2

Other representations of profile: CSV, Excel, Schematron

### Notes:

#### Overall Interpretation and Conclusion

On the report, it is important to answer the question "Did you find anything when you did the test I asked you to do?" The data sender can use attributes of `conclusionCode` and `conclusion` to represent the summary result of the test (e.g., Positive, Negative, Unknown) and a textual summary. These are typically used when the genomic test was looking for a particular genomically-based disease. It allows indication of whether genomic results known to be associated with the disease were found or not.

#### Linking To Genomic Observations

Results observation profiles, like genomic observations, are typically referenced directly by a Genomic Report. The genetic findings and implication profiles all contain links to computably define their composite relationships (e.g., the variant observation is referenced within the implication profile using `derivedFrom`). However, observations could be organized into groups by other observations. See this grouping guidance for an overview with examples and considerations for processing reports. Be aware that consumers of Genomic Diagnostic Report MUST navigate through all `hasMember` relations and navigate through `derivedFrom` relationships to ensure processing of all clinically relevant information.

#### Risk Assessments

In some cases, the lab or other reporting organization may generate risk assessments as part of their reports. These are referenced from a report or an observation from the Genomic Risk extension.

#### Presented Form

When sending a copy of the report (e.g., PDF or other document containing the written report), use `presentedForm`. Note this is different from the Related Artifact extension, which is used to reference citations, evidence and other supporting documentation for the observation or report. Another approach which should be avoided (at least for this current release) is the `DiagnosticReport.media` attribute. Its definition focuses on "Key images associated with this report" which does not align well with this use case.

#### Complex Reports

If needed, large or complex genomic reports may be broken down into sub-reports using core DiagnosticReport extensions like extends or summaryOf. This approach is particularly useful when different labs or services are performing later steps in the analysis, for example. Or a panel `Observation.code` can be used.