CA Core DocumentReference Profile

This DocumentReference profile sets minimum expectations for mandatory core elements, constraints and value sets required to provide metadata about the document of any kind so that the document can be published, discovered and managed.

This profile defines core localisation concepts for use in an Canadian context.

Mandatory Data Elements

All elements or attributes defined in FHIR have cardinality as part of their definition - a minimum number of required appearances and a maximum number.

Most elements in FHIR specification have a minimum cardinality of 0, which means that they may be missing from a resource when it is exchanged between systems.

Required elements:

• status of the refence
• document referenced

Must Support Data Elements

Some elements are labeled as MustSupport meaning that implementations that produce or consume resources SHALL provide “support” for the element in some meaningful way (see Must Support definition).

Following elements are marked as Must Support in the Canadian DocumentReference profile to aid record matching in databases.

Must Support elements:

• master version identifier
• kind of document
• categorization of document
• subject of the document
• document author
• document authenticator
• organization which maintains the document
• the document itself or URL
• context of the document content
• practice settings
• patient demographics

Usage Note

The following are example usage scenarios for the DocumentReference profile.

• Publishing a new document. This can be done using the IHE MHD Provide Document Bundle [ITI-65] transaction that carries both the document and its metadata.
• Querying the document repository for specific document(s) matching various metadata parameters. This is similar to the IHE MHD Find Document References [ITI-67] transaction.

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

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	DocumentReference Profile
masterIdentifier	S	0..1	Identifier	Master Version Specific Identifier
type	S	0..1	CodeableConcept	Kind of document (LOINC if possible)
category	S	0..*	CodeableConcept	Categorization of document
subject	S	0..1	Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable))	Who/what is the subject of the document
author	S	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization Profile)	Organization which maintains the document
content
attachment	SC	1..1	Attachment	Where to access the document ca-baseline-documentreference-1: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
context
encounter	S	0..*	Reference(Encounter Profile)	Context of the document content
practiceSetting	S	0..1	CodeableConcept	PractitionerSpecialty Binding: https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo	S	0..1	Reference(Patient Profile)	Patient demographics from source
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.context.practiceSetting	preferred	https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-documentreference-1	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	DocumentReference Profile
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	SΣ	0..1	Identifier	Master Version Specific Identifier
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..*	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable))	Who/what is the subject of the document
author	SΣ	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization Profile)	Organization which maintains the document
content	Σ	1..*	BackboneElement	Document referenced
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	Where to access the document ca-baseline-documentreference-1: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
context	Σ	0..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..*	Reference(Encounter Profile)	Context of the document content
practiceSetting	S	0..1	CodeableConcept	PractitionerSpecialty Binding: https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo	S	0..1	Reference(Patient Profile)	Patient demographics from source
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes from the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.context.practiceSetting	preferred	https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-documentreference-1	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	DocumentReference Profile
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
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	SΣ	0..1	Identifier	Master Version Specific Identifier
identifier	Σ	0..*	Identifier	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..*	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable))	Who/what is the subject of the document
date	Σ	0..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization Profile)	Organization which maintains the document
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	Where to access the document ca-baseline-documentreference-1: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
format	Σ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
context	Σ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..*	Reference(Encounter Profile)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	Time of service that is being documented
facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	PractitionerSpecialty Binding: https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo	S	0..1	Reference(Patient Profile)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
DocumentReference.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes from the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.format	preferred	DocumentReferenceFormatCodeSet (a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes from the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.context.practiceSetting	preferred	https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-documentreference-1	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	DocumentReference Profile
masterIdentifier	S	0..1	Identifier	Master Version Specific Identifier
type	S	0..1	CodeableConcept	Kind of document (LOINC if possible)
category	S	0..*	CodeableConcept	Categorization of document
subject	S	0..1	Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable))	Who/what is the subject of the document
author	S	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization Profile)	Organization which maintains the document
content
attachment	SC	1..1	Attachment	Where to access the document ca-baseline-documentreference-1: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
context
encounter	S	0..*	Reference(Encounter Profile)	Context of the document content
practiceSetting	S	0..1	CodeableConcept	PractitionerSpecialty Binding: https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo	S	0..1	Reference(Patient Profile)	Patient demographics from source
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.context.practiceSetting	preferred	https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-documentreference-1	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	DocumentReference Profile
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	SΣ	0..1	Identifier	Master Version Specific Identifier
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..*	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable))	Who/what is the subject of the document
author	SΣ	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization Profile)	Organization which maintains the document
content	Σ	1..*	BackboneElement	Document referenced
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	Where to access the document ca-baseline-documentreference-1: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
context	Σ	0..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..*	Reference(Encounter Profile)	Context of the document content
practiceSetting	S	0..1	CodeableConcept	PractitionerSpecialty Binding: https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo	S	0..1	Reference(Patient Profile)	Patient demographics from source
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes from the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.context.practiceSetting	preferred	https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-documentreference-1	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	DocumentReference Profile
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
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	SΣ	0..1	Identifier	Master Version Specific Identifier
identifier	Σ	0..*	Identifier	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..*	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(Patient Profile | Practitioner Profile (General) | Device Profile (Implantable))	Who/what is the subject of the document
date	Σ	0..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Device Profile (Implantable) | Patient Profile)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization Profile)	Organization which maintains the document
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	Where to access the document ca-baseline-documentreference-1: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
format	Σ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
context	Σ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..*	Reference(Encounter Profile)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	Time of service that is being documented
facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	PractitionerSpecialty Binding: https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty (preferred): Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.
sourcePatientInfo	S	0..1	Reference(Patient Profile)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
DocumentReference.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes from the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.format	preferred	DocumentReferenceFormatCodeSet (a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes from the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.context.practiceSetting	preferred	https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-documentreference-1	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from DocumentReference

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