Australian Digital Health Agency FHIR Implementation Guide, published by Australian Digital Health Agency. This guide is not an authorized publication; it is the continuous build for version 1.2.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/AuDigitalHealth/ci-fhir-r4/ and changes regularly. See the Directory of published versions

Resource Profile: ADHADiagnosticReportPath - Detailed Descriptions

Draft as of 2024-12-19

Definitions for the dh-diagnosticreport-path-1 resource profile.

Guidance on how to interpret the contents of this table can be found here

0. DiagnosticReport
Definition

A pathology report sent from the service provider to the requester, i.e. the results including any interpretation provided, for an individual‘s pathology test.

ShortA pathology report in an Australian healthcare context
2. DiagnosticReport.category
ShortClassification of the report as laboratory + more specific discipline where available
Comments

A fixed category denoting a laboratory report and supports handling and searching of reports. A second category to provide a finer grain of discipline, e.g. Haematology should be provided if possible.

BindingUnless not suitable, these codes SHALL be taken from Pathology Diagnostic Service Category .
(extensible to https://healthterminologies.gov.au/fhir/ValueSet/pathology-diagnostic-service-category-1)
SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ $this
  • 4. DiagnosticReport.category:Lab
    Slice NameLab
    ShortReport generated by laboratories
    Control1..1
    Pattern Value{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
        "code" : "LAB"
      }]
    }
    6. DiagnosticReport.code
    BindingUnless not suitable, these codes SHALL be taken from RCPA SPIA Pathology Reporting .
    (extensible to https://healthterminologies.gov.au/fhir/ValueSet/spia-pathology-reporting-1)
    8. DiagnosticReport.effective[x]
    ShortTime of specimen collection
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    10. DiagnosticReport.result
    TypeReference(ADHA Pathology Result Observation)

    Guidance on how to interpret the contents of this table can be found here

    0. DiagnosticReport
    Definition

    A pathology report sent from the service provider to the requester, i.e. the results including any interpretation provided, for an individual‘s pathology test.


    The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.

    ShortA pathology report in an Australian healthcare contextA Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
    Comments

    This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

    Control0..*
    Is Modifierfalse
    Summaryfalse
    Alternate NamesReport, Test, Result, Results, Labs, Laboratory
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    inv-dh-dir-01: The report shall at least have a result or a presentedForm (result.exists() or presentedForm.exists())
    2. DiagnosticReport.implicitRules
    Definition

    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

    ShortA set of rules under which this content was created
    Comments

    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

    Control0..1
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. DiagnosticReport.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    6. DiagnosticReport.identifier
    Definition

    Identifiers assigned to this report by the performer or other systems.

    ShortBusiness identifier for report
    Comments

    Usually assigned by the Information System of the diagnostic service provider (filler id).

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..*
    This element is affected by the following invariants: ele-1
    TypeIdentifier(Identifier, AU Local Order Identifier, AU Local Report Identifier, AU Accession Number)
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Requirements

    Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

    Alternate NamesReportID, Filler ID, Placer ID
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. DiagnosticReport.basedOn
    Definition

    Details concerning a service requested.

    ShortDiagnostic investigation orderWhat was requested
    Comments

    Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

    Control0..*
    TypeReference(ADHA Core ServiceRequest, CarePlan, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Requirements

    This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

    Alternate NamesRequest
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. DiagnosticReport.status
    Definition

    The status of the diagnostic report.

    Shortpartial | preliminary | final +registered | partial | preliminary | final +
    Control1..1
    BindingThe codes SHALL be taken from DiagnosticReportStatus Report Available .http://hl7.org/fhir/ValueSet/diagnostic-report-status|4.0.1
    (required to https://healthterminologies.gov.au/fhir/ValueSet/diagnosticreportstatus-report-available-1)
    Typecode
    Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. DiagnosticReport.category
    Definition

    A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

    ShortClassification of the report as laboratory + more specific discipline where availableService category
    Comments

    A fixed category denoting a laboratory report and supports handling and searching of reports. A second category to provide a finer grain of discipline, e.g. Haematology should be provided if possible.


    Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

    Control10..*
    BindingUnless not suitable, these codes SHALL be taken from For example codes, see Pathology Diagnostic Service Category .http://hl7.org/fhir/ValueSet/diagnostic-service-sections
    (extensible to https://healthterminologies.gov.au/fhir/ValueSet/pathology-diagnostic-service-category-1)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Alternate NamesDepartment, Sub-department, Service, Discipline
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ $this
    • 14. DiagnosticReport.category:Lab
      Slice NameLab
      Definition

      A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

      ShortReport generated by laboratoriesService category
      Comments

      Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

      Control10..1*
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see DiagnosticServiceSectionCodeshttp://hl7.org/fhir/ValueSet/diagnostic-service-sections
      (extensible to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Alternate NamesDepartment, Sub-department, Service, Discipline
      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
          "code" : "LAB"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. DiagnosticReport.code
      Definition

      A code or name that describes this diagnostic report.

      ShortDiagnostic examination name / study name / group nameName/Code for this diagnostic report
      Control1..1
      BindingUnless not suitable, these codes SHALL be taken from The codes SHOULD be taken from RCPA SPIA Pathology Reporting .http://hl7.org/fhir/ValueSet/report-codes
      (extensible to https://healthterminologies.gov.au/fhir/ValueSet/spia-pathology-reporting-1)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Alternate NamesType
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. DiagnosticReport.subject
      Definition

      The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.

      ShortThe subject of the report - usually, but not always, the patient
      Control10..1
      This element is affected by the following invariants: inv-dh-dir-02
      TypeReference(ADHA Core Patient, Patient, Group, Device, Location)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      SHALL know the subject context.

      Alternate NamesPatient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      inv-dh-dir-02: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
      20. DiagnosticReport.effective[x]
      Definition

      The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

      ShortTime of specimen collectionClinically relevant time/time-period for report
      Comments

      If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

      Control10..1
      This element is affected by the following invariants: inv-dh-dir-04
      TypeChoice of: dateTime, Period
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Requirements

      Need to know where in the patient history to file/present this report.

      Alternate NamesObservation time, Effective Time, Occurrence
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      inv-dh-dir-04: Date shall be at least to day ($this is DateTime implies $this.toString().length() >= 10)
      22. DiagnosticReport.issued
      Definition

      The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.

      ShortDiagnostic report date timeDateTime this version was made
      Comments

      May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.

      Control10..1
      Typeinstant
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Clinicians need to be able to check the date that the report was released.

      Alternate NamesDate published, Date Issued, Date Verified
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. DiagnosticReport.performer
      Definition

      The diagnostic service that is responsible for issuing the report.

      ShortResponsible Diagnostic Service
      Comments

      This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

      Control10..*
      This element is affected by the following invariants: inv-dh-dir-03
      TypeReference(ADHA Authoring PractitionerRole, ADHA Core Organization, Practitioner, PractitionerRole, Organization, CareTeam)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Requirements

      Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

      Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      inv-dh-dir-03: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
      26. DiagnosticReport.result
      Definition

      Observations that are part of this diagnostic report.

      ShortObservations
      Comments

      Observations can contain observations.

      Control0..*
      This element is affected by the following invariants: inv-dh-dir-01
      TypeReference(ADHA Pathology Result Observation, Observation)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

      Alternate NamesData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. DiagnosticReport.result.reference
      Definition

      A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

      ShortLiteral reference, Relative, internal or absolute URL
      Comments

      Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

      Control10..1
      This element is affected by the following invariants: ref-1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. DiagnosticReport.media
      Definition

      A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).

      ShortKey images associated with this report
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Many diagnostic services include images in the report as part of their service.

      Alternate NamesDICOM, Slides, Scans
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. DiagnosticReport.media.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      34. DiagnosticReport.media.link
      Definition

      Reference to the image source.

      ShortReference to the image source
      Control1..1
      TypeReference(ADHA Core Media, Media)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. DiagnosticReport.conclusion
      Definition

      Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.

      ShortClinical conclusion (interpretation) of test results
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Need to be able to provide a conclusion that is not lost among the basic result data.

      Alternate NamesReport
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. DiagnosticReport.conclusionCode
      Definition

      One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.

      ShortCodes for the clinical conclusion of test results
      Control0..*
      BindingThe codes SHOULD be taken from For example codes, see Clinical Finding .http://hl7.org/fhir/ValueSet/clinical-findings
      (preferred to https://healthterminologies.gov.au/fhir/ValueSet/clinical-finding-1)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. DiagnosticReport.presentedForm
      Definition

      Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.

      ShortEntire report as issued
      Comments

      "application/pdf" is recommended as the most reliable and interoperable in this context.

      Control0..*
      This element is affected by the following invariants: inv-dh-dir-01
      TypeAttachment
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be found here

      0. DiagnosticReport
      Definition

      A pathology report sent from the service provider to the requester, i.e. the results including any interpretation provided, for an individual‘s pathology test.

      ShortA pathology report in an Australian healthcare context
      Comments

      This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

      Control0..*
      Is Modifierfalse
      Summaryfalse
      Alternate NamesReport, Test, Result, Results, Labs, Laboratory
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      inv-dh-dir-01: The report shall at least have a result or a presentedForm (result.exists() or presentedForm.exists())
      2. DiagnosticReport.id
      Definition

      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      ShortLogical id of this artifact
      Comments

      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

      Control0..1
      Typeid
      Is Modifierfalse
      Summarytrue
      4. DiagnosticReport.meta
      Definition

      The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. DiagnosticReport.implicitRules
      Definition

      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

      ShortA set of rules under which this content was created
      Comments

      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. DiagnosticReport.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

      Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. DiagnosticReport.text
      Definition

      A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

      ShortText summary of the resource, for human interpretation
      Comments

      Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. DiagnosticReport.contained
      Definition

      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

      ShortContained, inline Resources
      Comments

      This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

      Control0..*
      TypeResource
      Is Modifierfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. DiagnosticReport.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. DiagnosticReport.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Summaryfalse
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      18. DiagnosticReport.identifier
      Definition

      Identifiers assigned to this report by the performer or other systems.

      ShortBusiness identifier for report
      Comments

      Usually assigned by the Information System of the diagnostic service provider (filler id).

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control1..*
      This element is affected by the following invariants: ele-1
      TypeIdentifier(Identifier, AU Local Order Identifier, AU Local Report Identifier, AU Accession Number)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Requirements

      Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

      Alternate NamesReportID, Filler ID, Placer ID
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. DiagnosticReport.basedOn
      Definition

      Details concerning a service requested.

      ShortDiagnostic investigation order
      Comments

      Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

      Control0..*
      TypeReference(ADHA Core ServiceRequest)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

      Alternate NamesRequest
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. DiagnosticReport.status
      Definition

      The status of the diagnostic report.

      Shortpartial | preliminary | final +
      Control1..1
      BindingThe codes SHALL be taken from DiagnosticReportStatus Report Available .
      (required to https://healthterminologies.gov.au/fhir/ValueSet/diagnosticreportstatus-report-available-1)
      Typecode
      Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. DiagnosticReport.category
      Definition

      A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

      ShortClassification of the report as laboratory + more specific discipline where available
      Comments

      A fixed category denoting a laboratory report and supports handling and searching of reports. A second category to provide a finer grain of discipline, e.g. Haematology should be provided if possible.

      Control1..*
      BindingUnless not suitable, these codes SHALL be taken from Pathology Diagnostic Service Category .
      (extensible to https://healthterminologies.gov.au/fhir/ValueSet/pathology-diagnostic-service-category-1)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Alternate NamesDepartment, Sub-department, Service, Discipline
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • pattern @ $this
      • 26. DiagnosticReport.category:Lab
        Slice NameLab
        Definition

        A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

        ShortReport generated by laboratories
        Comments

        Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from DiagnosticServiceSectionCodes
        (extensible to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Alternate NamesDepartment, Sub-department, Service, Discipline
        Pattern Value{
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
            "code" : "LAB"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. DiagnosticReport.code
        Definition

        A code or name that describes this diagnostic report.

        ShortDiagnostic examination name / study name / group name
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from RCPA SPIA Pathology Reporting .
        (extensible to https://healthterminologies.gov.au/fhir/ValueSet/spia-pathology-reporting-1)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Alternate NamesType
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. DiagnosticReport.subject
        Definition

        The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.

        ShortThe subject of the report - usually, but not always, the patient
        Control1..1
        This element is affected by the following invariants: inv-dh-dir-02
        TypeReference(ADHA Core Patient)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        SHALL know the subject context.

        Alternate NamesPatient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        inv-dh-dir-02: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
        32. DiagnosticReport.encounter
        Definition

        The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.

        ShortHealth care event when test ordered
        Comments

        This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

        Control0..1
        TypeReference(Encounter)
        Is Modifierfalse
        Summarytrue
        Requirements

        Links the request to the Encounter context.

        Alternate NamesContext
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. DiagnosticReport.effective[x]
        Definition

        The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

        ShortTime of specimen collection
        Comments

        If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

        Control1..1
        This element is affected by the following invariants: inv-dh-dir-04
        TypeChoice of: dateTime, Period
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summarytrue
        Requirements

        Need to know where in the patient history to file/present this report.

        Alternate NamesObservation time, Effective Time, Occurrence
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        inv-dh-dir-04: Date shall be at least to day ($this is DateTime implies $this.toString().length() >= 10)
        36. DiagnosticReport.issued
        Definition

        The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.

        ShortDiagnostic report date time
        Comments

        May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.

        Control1..1
        Typeinstant
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        Clinicians need to be able to check the date that the report was released.

        Alternate NamesDate published, Date Issued, Date Verified
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. DiagnosticReport.performer
        Definition

        The diagnostic service that is responsible for issuing the report.

        ShortResponsible Diagnostic Service
        Comments

        This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

        Control1..*
        This element is affected by the following invariants: inv-dh-dir-03
        TypeReference(ADHA Authoring PractitionerRole, ADHA Core Organization)
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summarytrue
        Requirements

        Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

        Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        inv-dh-dir-03: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
        40. DiagnosticReport.resultsInterpreter
        Definition

        The practitioner or organization that is responsible for the report's conclusions and interpretations.

        ShortPrimary result interpreter
        Comments

        Might not be the same entity that takes responsibility for the clinical report.

        Control0..*
        TypeReference(Practitioner, PractitionerRole, Organization, CareTeam)
        Is Modifierfalse
        Summarytrue
        Requirements

        Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

        Alternate NamesAnalyzed by, Reported by
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. DiagnosticReport.specimen
        Definition

        Details about the specimens on which this diagnostic report is based.

        ShortSpecimens this report is based on
        Comments

        If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.

        Control0..*
        TypeReference(AU Base Specimen)
        Is Modifierfalse
        Summaryfalse
        Requirements

        Need to be able to report information about the collected specimens on which the report is based.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. DiagnosticReport.result
        Definition

        Observations that are part of this diagnostic report.

        ShortObservations
        Comments

        Observations can contain observations.

        Control0..*
        This element is affected by the following invariants: inv-dh-dir-01
        TypeReference(ADHA Pathology Result Observation)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

        Alternate NamesData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. DiagnosticReport.result.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        48. DiagnosticReport.result.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on DiagnosticReport.result.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 50. DiagnosticReport.result.reference
          Definition

          A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

          ShortLiteral reference, Relative, internal or absolute URL
          Comments

          Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

          Control1..1
          This element is affected by the following invariants: ref-1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. DiagnosticReport.result.type
          Definition

          The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

          The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

          ShortType the reference refers to (e.g. "Patient")
          Comments

          This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

          Control0..1
          BindingUnless not suitable, these codes SHALL be taken from ResourceType
          (extensible to http://hl7.org/fhir/ValueSet/resource-types)

          Aa resource (or, for logical models, the URI of the logical model).

          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. DiagnosticReport.result.identifier
          Definition

          An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

          ShortLogical reference, when literal reference is not known
          Comments

          When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

          When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

          Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

          Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..1
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. DiagnosticReport.result.display
          Definition

          Plain text narrative that identifies the resource in addition to the resource reference.

          ShortText alternative for the resource
          Comments

          This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. DiagnosticReport.imagingStudy
          Definition

          One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.

          ShortReference to full details of imaging associated with the diagnostic report
          Comments

          ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.

          Control0..*
          TypeReference(ImagingStudy)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          60. DiagnosticReport.media
          Definition

          A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).

          ShortKey images associated with this report
          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Many diagnostic services include images in the report as part of their service.

          Alternate NamesDICOM, Slides, Scans
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          62. DiagnosticReport.media.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          64. DiagnosticReport.media.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          66. DiagnosticReport.media.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          68. DiagnosticReport.media.comment
          Definition

          A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.

          ShortComment about the image (e.g. explanation)
          Comments

          The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Requirements

          The provider of the report should make a comment about each image included in the report.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          70. DiagnosticReport.media.link
          Definition

          Reference to the image source.

          ShortReference to the image source
          Control1..1
          TypeReference(ADHA Core Media)
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          72. DiagnosticReport.conclusion
          Definition

          Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.

          ShortClinical conclusion (interpretation) of test results
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Requirements

          Need to be able to provide a conclusion that is not lost among the basic result data.

          Alternate NamesReport
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          74. DiagnosticReport.conclusionCode
          Definition

          One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.

          ShortCodes for the clinical conclusion of test results
          Control0..*
          BindingThe codes SHOULD be taken from Clinical Finding .
          (preferred to https://healthterminologies.gov.au/fhir/ValueSet/clinical-finding-1)
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          76. DiagnosticReport.presentedForm
          Definition

          Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.

          ShortEntire report as issued
          Comments

          "application/pdf" is recommended as the most reliable and interoperable in this context.

          Control0..*
          This element is affected by the following invariants: inv-dh-dir-01
          TypeAttachment
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Requirements

          Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))