Clinical Document Architecture with Australian Schema
1.0.1 - active
Clinical Document Architecture with Australian Schema, published by Australian Digital Health Agency. This guide is not an authorized publication; it is the continuous build for version 1.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/AuDigitalHealth/cda-au-schema/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/cda/stds/core/StructureDefinition/Reference | Version: 1.0.1 | |||
| Active as of 2025-10-09 | Maturity Level: 1 | Responsible: HL7 | Computable Name: Reference | |
CDA entries can reference external objects such as external images and prior reports. These external objects are not part of the authenticated document content. They contain sufficient attributes to enable an explicit reference rather than duplicating the entire referenced object. The CDA entry that wraps the external reference can be used to encode the specific portions of the external reference that are addressed in the narrative block.
Each object allows for an identifier and a code, and contains the RIM Act.text attribute, which can be used to store the URL and MIME type of the object. External objects always have a fixed moodCode of "EVN".
The reference class contains the attribute reference.seperatableInd, which indicates whether or not the source is intended to be interpreted independently of the target. The indicator cannot prevent an individual or application from separating the source and target, but indicates the author's desire and willingness to attest to the content of the source if separated from the target. Typically, where seperatableInd is "false", the exchanged package should include the target of the reference so that the recipient can render it.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  Reference |
C | 1..* | InfrastructureRoot | XML Namespace: urn:hl7-org:v3 Base for all types and resources Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) Constraints: reference-external |
  @nullFlavor |
0..1 | cs | Binding: CDANullFlavor (required) | |
 realmCode |
0..* | CS | ||
 typeId |
C | 0..1 | II | Constraints: II-1 |
 @nullFlavor |
0..1 | cs | Binding: CDANullFlavor (required) | |
| @assigningAuthorityName |
0..1 | st | ||
| @displayable |
0..1 | bl | ||
| @root |
1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
 @extension |
1..1 | st | ||
| templateId |
0..* | II | ||
| @typeCode |
1..1 | cs | Binding: x_ActRelationshipExternalReference (required) | |
| seperatableInd |
0..1 | BL | ||
  (Choice of one) |
1..1 | |||
  externalAct |
0..1 | ExternalAct | ||
| externalObservation |
0..1 | ExternalObservation | ||
| externalProcedure |
0..1 | ExternalProcedure | ||
 externalDocument |
0..1 | ExternalDocument | ||
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Reference.nullFlavor | Base | required | CDANullFlavor | 📦1.0.1 | This IG |
| Reference.typeId.nullFlavor | Base | required | CDANullFlavor | 📦1.0.1 | This IG |
| Reference.typeCode | Base | required | x_ActRelationshipExternalReference | 📦2.0.0 | THO v5.2 |
| Id | Grade | Path(s) | Description | Expression |
| II-1 | error | Reference.typeId | An II instance must have either a root or an nullFlavor. |
root.exists() or nullFlavor.exists()
|
| reference-external | error | Reference | Must contain one (and only one) external reference |
(externalAct | externalObservation | externalProcedure | externalDocument).count() = 1
|
This structure is derived from InfrastructureRoot
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Reference |
C | 1..* | InfrastructureRoot | XML Namespace: urn:hl7-org:v3 Base for all types and resources Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) Constraints: reference-external |
| @typeCode |
1..1 | cs | Binding: x_ActRelationshipExternalReference (required) | |
| seperatableInd |
0..1 | BL | ||
| (Choice of one) |
1..1 | |||
| externalAct |
0..1 | ExternalAct | ||
| externalObservation |
0..1 | ExternalObservation | ||
| externalProcedure |
0..1 | ExternalProcedure | ||
| externalDocument |
0..1 | ExternalDocument | ||
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Reference.typeCode | Base | required | x_ActRelationshipExternalReference | 📦2.0.0 | THO v5.2 |
| Id | Grade | Path(s) | Description | Expression |
| reference-external | error | Reference | Must contain one (and only one) external reference |
(externalAct | externalObservation | externalProcedure | externalDocument).count() = 1
|
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Reference |
C | 1..* | InfrastructureRoot | XML Namespace: urn:hl7-org:v3 Base for all types and resources Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) Constraints: reference-external |
| @nullFlavor |
0..1 | cs | Binding: CDANullFlavor (required) | |
| realmCode |
0..* | CS | ||
| typeId |
C | 0..1 | II | Constraints: II-1 |
| @nullFlavor |
0..1 | cs | Binding: CDANullFlavor (required) | |
| @assigningAuthorityName |
0..1 | st | ||
| @displayable |
0..1 | bl | ||
| @root |
1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
| @extension |
1..1 | st | ||
| templateId |
0..* | II | ||
| @typeCode |
1..1 | cs | Binding: x_ActRelationshipExternalReference (required) | |
| seperatableInd |
0..1 | BL | ||
| (Choice of one) |
1..1 | |||
| externalAct |
0..1 | ExternalAct | ||
| externalObservation |
0..1 | ExternalObservation | ||
| externalProcedure |
0..1 | ExternalProcedure | ||
| externalDocument |
0..1 | ExternalDocument | ||
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Reference.nullFlavor | Base | required | CDANullFlavor | 📦1.0.1 | This IG |
| Reference.typeId.nullFlavor | Base | required | CDANullFlavor | 📦1.0.1 | This IG |
| Reference.typeCode | Base | required | x_ActRelationshipExternalReference | 📦2.0.0 | THO v5.2 |
| Id | Grade | Path(s) | Description | Expression |
| II-1 | error | Reference.typeId | An II instance must have either a root or an nullFlavor. |
root.exists() or nullFlavor.exists()
|
| reference-external | error | Reference | Must contain one (and only one) external reference |
(externalAct | externalObservation | externalProcedure | externalDocument).count() = 1
|
This structure is derived from InfrastructureRoot
Summary
Mandatory: 0 element(1 nested mandatory element)
Structures
This structure refers to these other structures:
Maturity: 1
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Reference |
C | 1..* | InfrastructureRoot | XML Namespace: urn:hl7-org:v3 Base for all types and resources Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) Constraints: reference-external |
| @nullFlavor |
0..1 | cs | Binding: CDANullFlavor (required) | |
| realmCode |
0..* | CS | ||
| typeId |
C | 0..1 | II | Constraints: II-1 |
| @nullFlavor |
0..1 | cs | Binding: CDANullFlavor (required) | |
| @assigningAuthorityName |
0..1 | st | ||
| @displayable |
0..1 | bl | ||
| @root |
1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
| @extension |
1..1 | st | ||
| templateId |
0..* | II | ||
| @typeCode |
1..1 | cs | Binding: x_ActRelationshipExternalReference (required) | |
| seperatableInd |
0..1 | BL | ||
| (Choice of one) |
1..1 | |||
| externalAct |
0..1 | ExternalAct | ||
| externalObservation |
0..1 | ExternalObservation | ||
| externalProcedure |
0..1 | ExternalProcedure | ||
| externalDocument |
0..1 | ExternalDocument | ||
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Reference.nullFlavor | Base | required | CDANullFlavor | 📦1.0.1 | This IG |
| Reference.typeId.nullFlavor | Base | required | CDANullFlavor | 📦1.0.1 | This IG |
| Reference.typeCode | Base | required | x_ActRelationshipExternalReference | 📦2.0.0 | THO v5.2 |
| Id | Grade | Path(s) | Description | Expression |
| II-1 | error | Reference.typeId | An II instance must have either a root or an nullFlavor. |
root.exists() or nullFlavor.exists()
|
| reference-external | error | Reference | Must contain one (and only one) external reference |
(externalAct | externalObservation | externalProcedure | externalDocument).count() = 1
|
Differential View
This structure is derived from InfrastructureRoot
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Reference |
C | 1..* | InfrastructureRoot | XML Namespace: urn:hl7-org:v3 Base for all types and resources Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) Constraints: reference-external |
| @typeCode |
1..1 | cs | Binding: x_ActRelationshipExternalReference (required) | |
| seperatableInd |
0..1 | BL | ||
| (Choice of one) |
1..1 | |||
| externalAct |
0..1 | ExternalAct | ||
| externalObservation |
0..1 | ExternalObservation | ||
| externalProcedure |
0..1 | ExternalProcedure | ||
| externalDocument |
0..1 | ExternalDocument | ||
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Reference.typeCode | Base | required | x_ActRelationshipExternalReference | 📦2.0.0 | THO v5.2 |
| Id | Grade | Path(s) | Description | Expression |
| reference-external | error | Reference | Must contain one (and only one) external reference |
(externalAct | externalObservation | externalProcedure | externalDocument).count() = 1
|
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Reference |
C | 1..* | InfrastructureRoot | XML Namespace: urn:hl7-org:v3 Base for all types and resources Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) Constraints: reference-external |
| @nullFlavor |
0..1 | cs | Binding: CDANullFlavor (required) | |
| realmCode |
0..* | CS | ||
| typeId |
C | 0..1 | II | Constraints: II-1 |
| @nullFlavor |
0..1 | cs | Binding: CDANullFlavor (required) | |
| @assigningAuthorityName |
0..1 | st | ||
| @displayable |
0..1 | bl | ||
| @root |
1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
| @extension |
1..1 | st | ||
| templateId |
0..* | II | ||
| @typeCode |
1..1 | cs | Binding: x_ActRelationshipExternalReference (required) | |
| seperatableInd |
0..1 | BL | ||
| (Choice of one) |
1..1 | |||
| externalAct |
0..1 | ExternalAct | ||
| externalObservation |
0..1 | ExternalObservation | ||
| externalProcedure |
0..1 | ExternalProcedure | ||
| externalDocument |
0..1 | ExternalDocument | ||
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Reference.nullFlavor | Base | required | CDANullFlavor | 📦1.0.1 | This IG |
| Reference.typeId.nullFlavor | Base | required | CDANullFlavor | 📦1.0.1 | This IG |
| Reference.typeCode | Base | required | x_ActRelationshipExternalReference | 📦2.0.0 | THO v5.2 |
| Id | Grade | Path(s) | Description | Expression |
| II-1 | error | Reference.typeId | An II instance must have either a root or an nullFlavor. |
root.exists() or nullFlavor.exists()
|
| reference-external | error | Reference | Must contain one (and only one) external reference |
(externalAct | externalObservation | externalProcedure | externalDocument).count() = 1
|
This structure is derived from InfrastructureRoot
Summary
Mandatory: 0 element(1 nested mandatory element)
Structures
This structure refers to these other structures:
Maturity: 1
IG © 2024+ Australian Digital Health Agency. Package au.digitalhealth.cda.schema#1.0.1 based on FHIR 5.0.0. Generated 2025-10-09
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