US Quality Core Implementation Guide
0.1.0 - cibuild

US Quality Core Implementation Guide, published by ASTP. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/FHIR/us-quality-core/ and changes regularly. See the Directory of published versions

## Resource Profile: US Quality Core DiagnosticReport Profile for Report and Note Exchange

Official URL: http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-diagnosticreport-note | Version: 0.1.0
Active as of 2023-08-01 | Computable Name: USQualityCoreDiagnosticReportNote

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

Usage

See the patterns page for implementation and usage patterns.

### Examples

Radiology Diagnostic Report Example

USCDI+ Quality Elements:

- status: (USCDI+ Quality) (USCDI) registered \| partial \| preliminary \| final +
- category:us-core: (USCDI+ Quality) (USCDI) Service category
- code: (USCDI+ Quality) (USCDI) US Quality Core Report Code
- effective[x]: (USCDI+ Quality) (USCDI) Diagnostically relevant time (typically the time of the procedure)
- result: (USCDI+ Quality) (USCDI) Observations
- imagingStudy: (USCDI+ Quality) Reference to full details of imaging associated with the diagnostic report

Usages:

- Refer to this Profile: US Quality Core ImagingStudy and US Quality Core Procedure
- Examples for this Profile: DiagnosticReport/note-example
- CapabilityStatements using this Profile: US Quality Core Client CapabilityStatement and US Quality Core Server 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
--- | --- | --- | --- | ---
DiagnosticReport | C | 0..* | USCoreDiagnosticReportProfileNoteExchange | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports Constraints: us-core-10
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | S Σ | 1..* | CodeableConcept | (USCDI) Service Category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:us-core | S Σ | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) Service category Binding: US Core Diagnostic Report Category Codes (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) US Quality Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) The subject of the report - usually, but not always, the patient
encounter | S Σ | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Health care event when test ordered
effective[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | S Σ | 0..1 | instant | (USCDI) DateTime this version was made
performer | S Σ | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization) | (USCDI) Responsible Diagnostic Service
result | S | 0..* | Reference(US Quality Core Laboratory Result Observation | US Quality Core Observation Clinical Result) | (USCDI+ Quality) (USCDI) Observations
imagingStudy |  | 0..* | Reference(US Quality Core ImagingStudy) | (USCDI+ Quality) Reference to full details of imaging associated with the diagnostic report
media | S Σ | 0..* | BackboneElement | (USCDI) Key images associated with this report
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
link | S Σ | 1..1 | Reference(Media) | (USCDI) Reference to the image source
presentedForm | S | 0..* | Attachment | (USCDI) Entire report as issued
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | example | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:us-core | Base | required | US Core Diagnostic Report Category Codes | 📦6.1.0 | US Core v6.1
DiagnosticReport.code | Base | extensible | US Core Non Laboratory Codes | 📦6.1.0 | US Core v6.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-10 | error | DiagnosticReport | effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()`

This structure is derived from USCoreDiagnosticReportProfileNoteExchange

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | USCoreDiagnosticReportProfileNoteExchange | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) registered | partial | preliminary | final +
Slices for category |  | 1..* | CodeableConcept | (USCDI) Service Category Slice: Unordered, Open by pattern:$this
category:us-core |  | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) Service category
code | Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) US Quality Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) The subject of the report - usually, but not always, the patient
encounter |  | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Health care event when test ordered
effective[x] | Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
issued |  | 0..1 | instant | (USCDI) DateTime this version was made
performer |  | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization) | (USCDI) Responsible Diagnostic Service
result |  | 0..* | Reference(US Quality Core Laboratory Result Observation | US Quality Core Observation Clinical Result) | (USCDI+ Quality) (USCDI) Observations
imagingStudy |  | 0..* | Reference(US Quality Core ImagingStudy) | (USCDI+ Quality) Reference to full details of imaging associated with the diagnostic report
media |  | 0..* | BackboneElement | (USCDI) Key images associated with this report
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.code | Base | extensible | US Core Non Laboratory Codes | 📦6.1.0 | US Core v6.1

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport | C | 0..* | USCoreDiagnosticReportProfileNoteExchange | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports Constraints: us-core-10
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for report
basedOn |  | 0..* | Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | What was requested
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | S Σ | 1..* | CodeableConcept | (USCDI) Service Category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:us-core | S Σ | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) Service category Binding: US Core Diagnostic Report Category Codes (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) US Quality Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) The subject of the report - usually, but not always, the patient
encounter | S Σ | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Health care event when test ordered
effective[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | S Σ | 0..1 | instant | (USCDI) DateTime this version was made
performer | S Σ | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization) | (USCDI) Responsible Diagnostic Service
resultsInterpreter | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam) | Primary result interpreter
specimen |  | 0..* | Reference(Specimen) | Specimens this report is based on
result | S | 0..* | Reference(US Quality Core Laboratory Result Observation | US Quality Core Observation Clinical Result) | (USCDI+ Quality) (USCDI) Observations
imagingStudy |  | 0..* | Reference(US Quality Core ImagingStudy) | (USCDI+ Quality) Reference to full details of imaging associated with the diagnostic report
media | S Σ | 0..* | BackboneElement | (USCDI) Key images associated with this report
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
comment |  | 0..1 | string | Comment about the image (e.g. explanation)
link | S Σ | 1..1 | Reference(Media) | (USCDI) Reference to the image source
conclusion |  | 0..1 | string | Clinical conclusion (interpretation) of test results
conclusionCode |  | 0..* | CodeableConcept | Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm | S | 0..* | Attachment | (USCDI) Entire report as issued
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | example | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:us-core | Base | required | US Core Diagnostic Report Category Codes | 📦6.1.0 | US Core v6.1
DiagnosticReport.code | Base | extensible | US Core Non Laboratory Codes | 📦6.1.0 | US Core v6.1
DiagnosticReport.conclusionCode | Base | example | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-10 | error | DiagnosticReport | effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()`

This structure is derived from USCoreDiagnosticReportProfileNoteExchange

Summary

Mandatory: 2 elements

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Encounter (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter)
- US Quality Core Practitioner (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core Organization (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Laboratory Result Observation (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-lab)
- US Quality Core Observation Clinical Result (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-clinical-result)
- US Quality Core ImagingStudy (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-imagingstudy)

Slices

This structure defines the following Slices:

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

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport | C | 0..* | USCoreDiagnosticReportProfileNoteExchange | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports Constraints: us-core-10
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | S Σ | 1..* | CodeableConcept | (USCDI) Service Category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:us-core | S Σ | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) Service category Binding: US Core Diagnostic Report Category Codes (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) US Quality Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) The subject of the report - usually, but not always, the patient
encounter | S Σ | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Health care event when test ordered
effective[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | S Σ | 0..1 | instant | (USCDI) DateTime this version was made
performer | S Σ | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization) | (USCDI) Responsible Diagnostic Service
result | S | 0..* | Reference(US Quality Core Laboratory Result Observation | US Quality Core Observation Clinical Result) | (USCDI+ Quality) (USCDI) Observations
imagingStudy |  | 0..* | Reference(US Quality Core ImagingStudy) | (USCDI+ Quality) Reference to full details of imaging associated with the diagnostic report
media | S Σ | 0..* | BackboneElement | (USCDI) Key images associated with this report
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
link | S Σ | 1..1 | Reference(Media) | (USCDI) Reference to the image source
presentedForm | S | 0..* | Attachment | (USCDI) Entire report as issued
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | example | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:us-core | Base | required | US Core Diagnostic Report Category Codes | 📦6.1.0 | US Core v6.1
DiagnosticReport.code | Base | extensible | US Core Non Laboratory Codes | 📦6.1.0 | US Core v6.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-10 | error | DiagnosticReport | effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()`

Differential View

This structure is derived from USCoreDiagnosticReportProfileNoteExchange

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | USCoreDiagnosticReportProfileNoteExchange | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) registered | partial | preliminary | final +
Slices for category |  | 1..* | CodeableConcept | (USCDI) Service Category Slice: Unordered, Open by pattern:$this
category:us-core |  | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) Service category
code | Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) US Quality Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) The subject of the report - usually, but not always, the patient
encounter |  | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Health care event when test ordered
effective[x] | Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
issued |  | 0..1 | instant | (USCDI) DateTime this version was made
performer |  | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization) | (USCDI) Responsible Diagnostic Service
result |  | 0..* | Reference(US Quality Core Laboratory Result Observation | US Quality Core Observation Clinical Result) | (USCDI+ Quality) (USCDI) Observations
imagingStudy |  | 0..* | Reference(US Quality Core ImagingStudy) | (USCDI+ Quality) Reference to full details of imaging associated with the diagnostic report
media |  | 0..* | BackboneElement | (USCDI) Key images associated with this report
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.code | Base | extensible | US Core Non Laboratory Codes | 📦6.1.0 | US Core v6.1

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport | C | 0..* | USCoreDiagnosticReportProfileNoteExchange | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports Constraints: us-core-10
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for report
basedOn |  | 0..* | Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | What was requested
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category | S Σ | 1..* | CodeableConcept | (USCDI) Service Category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:us-core | S Σ | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) Service category Binding: US Core Diagnostic Report Category Codes (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) US Quality Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) The subject of the report - usually, but not always, the patient
encounter | S Σ | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Health care event when test ordered
effective[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | S Σ | 0..1 | instant | (USCDI) DateTime this version was made
performer | S Σ | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization) | (USCDI) Responsible Diagnostic Service
resultsInterpreter | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam) | Primary result interpreter
specimen |  | 0..* | Reference(Specimen) | Specimens this report is based on
result | S | 0..* | Reference(US Quality Core Laboratory Result Observation | US Quality Core Observation Clinical Result) | (USCDI+ Quality) (USCDI) Observations
imagingStudy |  | 0..* | Reference(US Quality Core ImagingStudy) | (USCDI+ Quality) Reference to full details of imaging associated with the diagnostic report
media | S Σ | 0..* | BackboneElement | (USCDI) Key images associated with this report
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
comment |  | 0..1 | string | Comment about the image (e.g. explanation)
link | S Σ | 1..1 | Reference(Media) | (USCDI) Reference to the image source
conclusion |  | 0..1 | string | Clinical conclusion (interpretation) of test results
conclusionCode |  | 0..* | CodeableConcept | Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm | S | 0..* | Attachment | (USCDI) Entire report as issued
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📦4.0.1 | FHIR Std.
DiagnosticReport.category | Base | example | Diagnostic Service Section Codes | 📦4.0.1 | FHIR Std.
DiagnosticReport.category:us-core | Base | required | US Core Diagnostic Report Category Codes | 📦6.1.0 | US Core v6.1
DiagnosticReport.code | Base | extensible | US Core Non Laboratory Codes | 📦6.1.0 | US Core v6.1
DiagnosticReport.conclusionCode | Base | example | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-10 | error | DiagnosticReport | effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' | `(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()`

This structure is derived from USCoreDiagnosticReportProfileNoteExchange

Summary

Mandatory: 2 elements

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Encounter (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter)
- US Quality Core Practitioner (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core Organization (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Laboratory Result Observation (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-lab)
- US Quality Core Observation Clinical Result (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-clinical-result)
- US Quality Core ImagingStudy (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-imagingstudy)

Slices

This structure defines the following Slices:

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

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