PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - STU 2 – Ballot

PACIO Advance Healthcare Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/pacio-adi/ and changes regularly. See the Directory of published versions

## Resource Profile: ADI Document Reference

Official URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-DocumentReference | Version: 2.0.0-ballot
Standards status: Trial-use | Maturity Level: 2 | Computable Name: ADIDocumentReference

This profile defines constraints that represent the information needed to register an advance directive information document on a FHIR server.

Conformance:

Advance Directive Information `versionNumber` represents a string value used to version successive replacement documents. Best practice for systems that support distributed document creation and updating is to populate the versionNumber with the timestamp created from the date/time when the version of the document is created in the system. Note: this may or may not be equivalent to the timestamp integer for Composition.date. the versionNumber timestamp always will be equivalent to the Bundle.timestamp for the document.

To better align with CDA, `versionNumber` should be a string label generated by converting the ClinicalDocument.effectiveTime (or Composition.date) to UTC time (-0000) and then using the YYYYMMDDhhmmss as the version.

For documents created within a system will follow the pattern that the timestamp-label versionNumber will be equivalent to the timestamp of the Composition.date and the Bundle.timestamp. However, for unstructured historical documents uploaded into a system, the timestamp-label versionNumber will be equivalent to the timestamp of the timestamp of the system dateTime when the document was uploaded, but the Composition.date will reflect the creation date of the original document, if it is available. If the creation date of the original document is not known, then Composition.date may be the system dateTime when the document is uploaded.

This profile defines constraints that represent the information needed to register an advance directive information document on a FHIR server. Temporal information is essential to the document registration process. DocumentReference.date holds the date when the document was registered and DocumentReference.content.attachment.creation holds the "creation date" associated with the document itself.

Usages:

- Refer to this Profile: ADI Documentation Observation and ADI PMO Initial Treatment ServiceRequest
- Examples for this Profile: DocumentReference/Example-Smith-Johnson-DocRef-Bundle and DocumentReference/Example-Smith-Johnson-DocRef-DocumentReference
- CapabilityStatements using this Profile: ADI CapabilityStatement

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
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreADIDocumentReferenceProfile | A reference to a document
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:authenticationTime | S | 0..1 | dateTime | Authentication Time URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
extension:DocumentReferenceVersionNumber | S | 0..1 | string | Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Advance Healthcare Directive Document Types Grouper (extensible): Advance Directives Content Type
Slices for coding | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:cdaDocument | S Σ | 0..1 | Coding | CDA Document Type Coding 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/v3-HL7DocumentFormatCodes
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
system | Σ | 1..1 | uri | Identity of the terminology system
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system Required Pattern: PACP Structured Body CDA Document
coding:fhirADIBundle | S Σ | 0..1 | Coding | FHIR PACP Bundle Type Coding Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: urn:ietf:rfc:3986
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
system | Σ | 1..1 | uri | Identity of the terminology system
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system Required Pattern: pacp-structuredBody:1.3
Slices for category | S Σ | 1..* | CodeableConcept | Categorization of document Slice: Unordered, Open by value:$this Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
category:adi | S Σ | 0..* | CodeableConcept | Categorization of ADI document" Binding: Advance Healthcare Directive Categories LOINC (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
subject | S Σ | 1..1 | Reference(US Core Patient Profile S) | Who/what is the subject of the document
date | S Σ | 1..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
content | S Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: us-core-6
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
data | S C | 0..1 | base64Binary | Data inline, base64ed
url | S Σ C | 0..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
creation | S Σ | 1..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: HL7FormatCodes (2.1.0) (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..* | Reference(US Core Encounter Profile) | Context of the document content
period | S Σ | 0..1 | Period | Time of service that is being documented
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
DocumentReference.status | required | DocumentReferenceStatus `http://hl7.org/fhir/ValueSet/document-reference-status` From the FHIR Standard
DocumentReference.docStatus | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
DocumentReference.type | extensible | AdvanceHealthcareDirectiveDocumentTypesGrouper `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41` From https://vsac.nlm.nih.gov
DocumentReference.category | extensible | USCoreDocumentReferenceCategory `http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category|8.0.0`
DocumentReference.category:adi | required | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov
DocumentReference.content.attachment.contentType | required | Mime Types(a valid code from `urn:ietf:bcp:13`) `http://hl7.org/fhir/ValueSet/mimetypes|4.0.1` From the FHIR Standard
DocumentReference.content.format | extensible | HL7FormatCodes `http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes|2.1.0`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | DocumentReference | 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 | DocumentReference | 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 | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | DocumentReference | 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-6 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists() |

This structure is derived from USCoreADIDocumentReferenceProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  |  | USCoreADIDocumentReferenceProfile |
Slices for extension |  |  |  | Content/Rules for all slices
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
extension:DocumentReferenceVersionNumber | S | 0..1 | string | Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
docStatus |  | 0..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type |  |  |  |
Slices for coding |  | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:cdaDocument | S | 0..1 | Coding | CDA Document Type Coding Required Pattern: At least the following
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
system |  | 1..1 | uri | Identity of the terminology system
code |  | 1..1 | code | Symbol in syntax defined by the system
display |  | 0..1 | string | Representation defined by the system Required Pattern: PACP Structured Body CDA Document
coding:fhirADIBundle | S | 0..1 | Coding | FHIR PACP Bundle Type Coding Required Pattern: At least the following
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: urn:ietf:rfc:3986
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
system |  | 1..1 | uri | Identity of the terminology system
code |  | 1..1 | code | Symbol in syntax defined by the system
display |  | 0..1 | string | Representation defined by the system Required Pattern: pacp-structuredBody:1.3
category |  | 1..* | CodeableConcept | Categorization of document Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
subject |  | 1..1 | Reference(US Core Patient Profile) | Who/what is the subject of the document
date |  | 1..1 | instant | When this document reference was created
author |  | 0..* | Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) | Who and/or what authored the document
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
content |  |  |  |
attachment |  |  |  |
contentType |  | 1..1 | code | Mime type of the content, with charset etc.
creation | S | 1..1 | dateTime | Date attachment was first created
context | S | 0..1 | BackboneElement | Clinical context of document
encounter | S | 0..* | Reference(US Core Encounter Profile) | Context of the document content
period | S | 0..1 | Period | Time of service that is being documented
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
DocumentReference.docStatus | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
DocumentReference.category | extensible | USCoreDocumentReferenceCategory `http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category|8.0.0`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreADIDocumentReferenceProfile | A reference to a document
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:authenticationTime | S | 0..1 | dateTime | Authentication Time URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
extension:DocumentReferenceVersionNumber | S | 0..1 | string | Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | Σ | 0..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Advance Healthcare Directive Document Types Grouper (extensible): Advance Directives Content Type
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:cdaDocument | S Σ | 0..1 | Coding | CDA Document Type Coding 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/v3-HL7DocumentFormatCodes
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system Required Pattern: PACP Structured Body CDA Document
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
coding:fhirADIBundle | S Σ | 0..1 | Coding | FHIR PACP Bundle Type Coding Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: urn:ietf:rfc:3986
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system Required Pattern: pacp-structuredBody:1.3
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
Slices for category | S Σ | 1..* | CodeableConcept | Categorization of document Slice: Unordered, Open by value:$this Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
category:adi | S Σ | 0..* | CodeableConcept | Categorization of ADI document" Binding: Advance Healthcare Directive Categories LOINC (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
subject | S Σ | 1..1 | Reference(US Core Patient Profile S) | Who/what is the subject of the document
date | S Σ | 1..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
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
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..* | BackboneElement | Document referenced
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
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: us-core-6
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Example General: en-AU
data | S C | 0..1 | base64Binary | Data inline, base64ed
url | S Σ C | 0..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
creation | S Σ | 1..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: HL7FormatCodes (2.1.0) (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
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
encounter | S | 0..* | Reference(US Core Encounter Profile) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
facilityType |  | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting |  | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo |  | 0..1 | Reference(Patient) | Patient demographics from source
related |  | 0..* | Reference(Resource) | Related identifiers or resources
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
DocumentReference.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
DocumentReference.status | required | DocumentReferenceStatus `http://hl7.org/fhir/ValueSet/document-reference-status` From the FHIR Standard
DocumentReference.docStatus | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
DocumentReference.type | extensible | AdvanceHealthcareDirectiveDocumentTypesGrouper `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41` From https://vsac.nlm.nih.gov
DocumentReference.category | extensible | USCoreDocumentReferenceCategory `http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category|8.0.0`
DocumentReference.category:adi | required | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov
DocumentReference.relatesTo.code | required | DocumentRelationshipType `http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1` From the FHIR Standard
DocumentReference.securityLabel | extensible | All Security Labels `http://hl7.org/fhir/ValueSet/security-labels` From the FHIR Standard
DocumentReference.content.attachment.contentType | required | Mime Types(a valid code from `urn:ietf:bcp:13`) `http://hl7.org/fhir/ValueSet/mimetypes|4.0.1` From the FHIR Standard
DocumentReference.content.attachment.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
DocumentReference.content.format | extensible | HL7FormatCodes `http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes|2.1.0`
DocumentReference.context.event | example | ActCode `http://terminology.hl7.org/ValueSet/v3-ActCode`
DocumentReference.context.facilityType | example | FacilityTypeCodeValueSet `http://hl7.org/fhir/ValueSet/c80-facilitycodes` From the FHIR Standard
DocumentReference.context.practiceSetting | example | PracticeSettingCodeValueSet `http://hl7.org/fhir/ValueSet/c80-practice-codes` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | DocumentReference | 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 | DocumentReference | 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 | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | DocumentReference | 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-6 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists() |

This structure is derived from USCoreADIDocumentReferenceProfile

Summary

Mandatory: 3 elements(4 nested mandatory elements)
Must-Support: 9 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of DocumentReference.type.coding

Maturity: 2

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreADIDocumentReferenceProfile | A reference to a document
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:authenticationTime | S | 0..1 | dateTime | Authentication Time URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
extension:DocumentReferenceVersionNumber | S | 0..1 | string | Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Advance Healthcare Directive Document Types Grouper (extensible): Advance Directives Content Type
Slices for coding | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:cdaDocument | S Σ | 0..1 | Coding | CDA Document Type Coding 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/v3-HL7DocumentFormatCodes
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
system | Σ | 1..1 | uri | Identity of the terminology system
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system Required Pattern: PACP Structured Body CDA Document
coding:fhirADIBundle | S Σ | 0..1 | Coding | FHIR PACP Bundle Type Coding Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: urn:ietf:rfc:3986
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
system | Σ | 1..1 | uri | Identity of the terminology system
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system Required Pattern: pacp-structuredBody:1.3
Slices for category | S Σ | 1..* | CodeableConcept | Categorization of document Slice: Unordered, Open by value:$this Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
category:adi | S Σ | 0..* | CodeableConcept | Categorization of ADI document" Binding: Advance Healthcare Directive Categories LOINC (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
subject | S Σ | 1..1 | Reference(US Core Patient Profile S) | Who/what is the subject of the document
date | S Σ | 1..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
content | S Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: us-core-6
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
data | S C | 0..1 | base64Binary | Data inline, base64ed
url | S Σ C | 0..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
creation | S Σ | 1..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: HL7FormatCodes (2.1.0) (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..* | Reference(US Core Encounter Profile) | Context of the document content
period | S Σ | 0..1 | Period | Time of service that is being documented
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
DocumentReference.status | required | DocumentReferenceStatus `http://hl7.org/fhir/ValueSet/document-reference-status` From the FHIR Standard
DocumentReference.docStatus | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
DocumentReference.type | extensible | AdvanceHealthcareDirectiveDocumentTypesGrouper `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41` From https://vsac.nlm.nih.gov
DocumentReference.category | extensible | USCoreDocumentReferenceCategory `http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category|8.0.0`
DocumentReference.category:adi | required | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov
DocumentReference.content.attachment.contentType | required | Mime Types(a valid code from `urn:ietf:bcp:13`) `http://hl7.org/fhir/ValueSet/mimetypes|4.0.1` From the FHIR Standard
DocumentReference.content.format | extensible | HL7FormatCodes `http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes|2.1.0`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | DocumentReference | 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 | DocumentReference | 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 | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | DocumentReference | 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-6 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists() |

Differential View

This structure is derived from USCoreADIDocumentReferenceProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  |  | USCoreADIDocumentReferenceProfile |
Slices for extension |  |  |  | Content/Rules for all slices
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
extension:DocumentReferenceVersionNumber | S | 0..1 | string | Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
docStatus |  | 0..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type |  |  |  |
Slices for coding |  | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:cdaDocument | S | 0..1 | Coding | CDA Document Type Coding Required Pattern: At least the following
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
system |  | 1..1 | uri | Identity of the terminology system
code |  | 1..1 | code | Symbol in syntax defined by the system
display |  | 0..1 | string | Representation defined by the system Required Pattern: PACP Structured Body CDA Document
coding:fhirADIBundle | S | 0..1 | Coding | FHIR PACP Bundle Type Coding Required Pattern: At least the following
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: urn:ietf:rfc:3986
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
system |  | 1..1 | uri | Identity of the terminology system
code |  | 1..1 | code | Symbol in syntax defined by the system
display |  | 0..1 | string | Representation defined by the system Required Pattern: pacp-structuredBody:1.3
category |  | 1..* | CodeableConcept | Categorization of document Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
subject |  | 1..1 | Reference(US Core Patient Profile) | Who/what is the subject of the document
date |  | 1..1 | instant | When this document reference was created
author |  | 0..* | Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) | Who and/or what authored the document
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
content |  |  |  |
attachment |  |  |  |
contentType |  | 1..1 | code | Mime type of the content, with charset etc.
creation | S | 1..1 | dateTime | Date attachment was first created
context | S | 0..1 | BackboneElement | Clinical context of document
encounter | S | 0..* | Reference(US Core Encounter Profile) | Context of the document content
period | S | 0..1 | Period | Time of service that is being documented
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
DocumentReference.docStatus | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
DocumentReference.category | extensible | USCoreDocumentReferenceCategory `http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category|8.0.0`

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreADIDocumentReferenceProfile | A reference to a document
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:authenticationTime | S | 0..1 | dateTime | Authentication Time URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
extension:DocumentReferenceVersionNumber | S | 0..1 | string | Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | Σ | 0..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Advance Healthcare Directive Document Types Grouper (extensible): Advance Directives Content Type
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:cdaDocument | S Σ | 0..1 | Coding | CDA Document Type Coding 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/v3-HL7DocumentFormatCodes
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system Required Pattern: PACP Structured Body CDA Document
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
coding:fhirADIBundle | S Σ | 0..1 | Coding | FHIR PACP Bundle Type Coding Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: urn:ietf:rfc:3986
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 1..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system
display | Σ | 0..1 | string | Representation defined by the system Required Pattern: pacp-structuredBody:1.3
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
Slices for category | S Σ | 1..* | CodeableConcept | Categorization of document Slice: Unordered, Open by value:$this Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
category:adi | S Σ | 0..* | CodeableConcept | Categorization of ADI document" Binding: Advance Healthcare Directive Categories LOINC (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
subject | S Σ | 1..1 | Reference(US Core Patient Profile S) | Who/what is the subject of the document
date | S Σ | 1..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) | Who and/or what authored the document
authenticator | S | 0..1 | Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) | Who/what authenticated the document
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
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
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..* | BackboneElement | Document referenced
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
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: us-core-6
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Example General: en-AU
data | S C | 0..1 | base64Binary | Data inline, base64ed
url | S Σ C | 0..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
creation | S Σ | 1..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: HL7FormatCodes (2.1.0) (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
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
encounter | S | 0..* | Reference(US Core Encounter Profile) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
facilityType |  | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting |  | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo |  | 0..1 | Reference(Patient) | Patient demographics from source
related |  | 0..* | Reference(Resource) | Related identifiers or resources
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
DocumentReference.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
DocumentReference.status | required | DocumentReferenceStatus `http://hl7.org/fhir/ValueSet/document-reference-status` From the FHIR Standard
DocumentReference.docStatus | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
DocumentReference.type | extensible | AdvanceHealthcareDirectiveDocumentTypesGrouper `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41` From https://vsac.nlm.nih.gov
DocumentReference.category | extensible | USCoreDocumentReferenceCategory `http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category|8.0.0`
DocumentReference.category:adi | required | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov
DocumentReference.relatesTo.code | required | DocumentRelationshipType `http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1` From the FHIR Standard
DocumentReference.securityLabel | extensible | All Security Labels `http://hl7.org/fhir/ValueSet/security-labels` From the FHIR Standard
DocumentReference.content.attachment.contentType | required | Mime Types(a valid code from `urn:ietf:bcp:13`) `http://hl7.org/fhir/ValueSet/mimetypes|4.0.1` From the FHIR Standard
DocumentReference.content.attachment.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
DocumentReference.content.format | extensible | HL7FormatCodes `http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes|2.1.0`
DocumentReference.context.event | example | ActCode `http://terminology.hl7.org/ValueSet/v3-ActCode`
DocumentReference.context.facilityType | example | FacilityTypeCodeValueSet `http://hl7.org/fhir/ValueSet/c80-facilitycodes` From the FHIR Standard
DocumentReference.context.practiceSetting | example | PracticeSettingCodeValueSet `http://hl7.org/fhir/ValueSet/c80-practice-codes` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | DocumentReference | 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 | DocumentReference | 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 | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | DocumentReference | 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-6 | error | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists() |

This structure is derived from USCoreADIDocumentReferenceProfile

Summary

Mandatory: 3 elements(4 nested mandatory elements)
Must-Support: 9 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of DocumentReference.type.coding

Maturity: 2

Other representations of profile: CSV, Excel, Schematron