HL7 Czech Imaging Report IG
0.1.0-ballot - ci-build Czechia flag

HL7 Czech Imaging Report IG, published by HL7 Czech Republic. This guide is not an authorized publication; it is the continuous build for version 0.1.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-cz/img/ and changes regularly. See the Directory of published versions

Resource Profile: CZ_KeyImageDocumentReference - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the cz-keyImage-documentReference resource profile.

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

0. DocumentReference
Definition

A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.

ShortA reference to a document
Comments

Usually, this is used for documents other than those defined by FHIR.

Control0..*
Is Modifierfalse
Summaryfalse
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())
2. DocumentReference.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. DocumentReference.extension
Definition

An Extension


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.

ShortExtensionAdditional 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.

Control10..*
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 DocumentReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • value @ value
  • 6. DocumentReference.extension:basedOn
    Slice NamebasedOn
    Definition

    Optional Extension Element - found in all resources.

    ShortOptional Extensions Element
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Extension Definition for DocumentReference.basedOn for Version 5.0) (Extension Type: Reference(Appointment, AppointmentResponse, CarePlan, Claim, CommunicationRequest, Contract, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription))
    Is Modifierfalse
    Summaryfalse
    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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. DocumentReference.extension:basedOn.extension
    Definition

    An Extension


    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.

    ShortExtensionAdditional 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..0*
    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 DocumentReference.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 10. DocumentReference.extension:basedOn.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.basedOn
      12. DocumentReference.extension:basedOn.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control10..1
      TypeReference(Appointment, AppointmentResponse, Care plan: Imaging Report (CZ), Claim, CommunicationRequest, Contract, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription, Service Request: Imaging Report (CZ)), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      14. DocumentReference.extension:basedOn/imorderaccession
      Slice NamebasedOn/imorderaccession
      Definition

      An Extension

      ShortExtension
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension Definition for DocumentReference.basedOn for Version 5.0) (Extension Type: Reference(Appointment, AppointmentResponse, CarePlan, Claim, CommunicationRequest, Contract, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription))
      Is Modifierfalse
      Summaryfalse
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. DocumentReference.extension:basedOn/imorderaccession.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional 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..0*
      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 DocumentReference.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 18. DocumentReference.extension:basedOn/imorderaccession.url
        Definition

        Source of the definition for the extension code - a logical name or a URL.

        Shortidentifies the meaning of the extension
        Comments

        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.basedOn
        20. DocumentReference.extension:basedOn/imorderaccession.value[x]
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortValue of extension
        Control10..1
        TypeReference(Service Request: Imaging Report (CZ)), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. DocumentReference.extension:basedOn/imorderaccession.value[x].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)
        Control10..1
        TypeIdentifier(Imaging Accession Number Identifier)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. DocumentReference.extension:modality
        Slice Namemodality
        Definition

        Extension to backport DocumentReference.modality in R4.

        ShortDocumentReference.modality extension for R4
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(DocumentReference.modality extension for R4) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        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())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        26. DocumentReference.extension:modality.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional 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..0*
        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 DocumentReference.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 28. DocumentReference.extension:modality.url
          Definition

          Source of the definition for the extension code - a logical name or a URL.

          Shortidentifies the meaning of the extension
          Comments

          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

          Control1..1
          Typeuri
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuehttps://hl7.cz/fhir/img/StructureDefinition/modality-cz
          30. DocumentReference.extension:modality.value[x]
          Definition

          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

          ShortValue of extension
          Control10..1
          TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          32. DocumentReference.extension:modality.value[x].coding
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..*
          BindingThe codes SHOULD be taken from For codes, see CZ Modality
          (preferred to https://hl7.cz/fhir/img/ValueSet/cz-modality-vs)
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          34. DocumentReference.extension:note
          Slice Namenote
          Definition

          Additional notes that apply to this resource or element.

          ShortAdditional notes that apply to this resource or element.
          Comments

          This extension SHALL NOT be used if the resource already has standard 'note' element (or equivalent) of type Annotation on the same element

          Control0..1
          TypeExtension(Note) (Extension Type: Annotation)
          Is Modifierfalse
          Summaryfalse
          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())
          ele-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())
          36. DocumentReference.extension:view
          Slice Nameview
          Definition

          This cross version extension includes the FHIR R4 version of the Media.view field which has at this point in time (April 18, 2025), not yet been included in the extension pack.

          ShortMedia.view extension
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Media.view extension) (Extension Type: CodeableConcept)
          Is Modifierfalse
          Summaryfalse
          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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          38. DocumentReference.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())
          40. DocumentReference.identifier
          Definition

          Other identifiers associated with the document, including version independent identifiers.

          ShortOther identifiers for the document
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          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 DocumentReference.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ $this
          • 42. DocumentReference.identifier:seriesInstanceUid
            Slice NameseriesInstanceUid
            Definition

            Other identifiers associated with the document, including version independent identifiers.

            ShortOther identifiers for the document
            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()))
            44. DocumentReference.identifier:seriesInstanceUid.use
            Definition

            The purpose of this identifier.

            Shortusual | official | temp | secondary | old (If known)
            Comments

            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

            Control0..1
            BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

            Identifies the purpose for this identifier, if known .

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. DocumentReference.identifier:seriesInstanceUid.type
            Definition

            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

            ShortDescription of identifier
            Comments

            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

            Control10..1
            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows users to make use of identifiers when the identifier system is not known.

            Pattern Value{
              "coding" : [{
                "system" : "https://hl7.cz/fhir/img/CodeSystem/codesystem-missing-dicom-terminology",
                "code" : "00080018"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. DocumentReference.identifier:seriesInstanceUid.system
            Definition

            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

            ShortThe namespace for the identifier value
            Comments

            Identifier.system is always case sensitive.

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

            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

            Pattern Valueurn:ietf:rfc:3986
            ExampleGeneral: http://www.acme.com/identifiers/patient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. DocumentReference.identifier:seriesInstanceUid.value
            Definition

            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

            ShortThe value that is unique
            Comments

            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

            Control10..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            ExampleGeneral: 123456
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. DocumentReference.identifier:seriesInstanceUid.assigner
            Definition

            Organization that issued/manages the identifier.

            ShortOrganization that issued id (may be just text)
            Comments

            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

            Control0..1
            TypeReference(Organization (CZ core), Organization)
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. DocumentReference.identifier:sopClassInstanceUid
            Slice NamesopClassInstanceUid
            Definition

            Other identifiers associated with the document, including version independent identifiers.

            ShortOther identifiers for the document
            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. DocumentReference.identifier:sopClassInstanceUid.use
            Definition

            The purpose of this identifier.

            Shortusual | official | temp | secondary | old (If known)
            Comments

            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

            Control0..1
            BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

            Identifies the purpose for this identifier, if known .

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. DocumentReference.identifier:sopClassInstanceUid.type
            Definition

            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

            ShortDescription of identifier
            Comments

            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

            Control10..1
            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows users to make use of identifiers when the identifier system is not known.

            Pattern Value{
              "coding" : [{
                "system" : "http://dicom.nema.org/resources/ontology/DCM",
                "code" : "112002"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. DocumentReference.identifier:sopClassInstanceUid.system
            Definition

            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

            ShortThe namespace for the identifier value
            Comments

            Identifier.system is always case sensitive.

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

            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

            Pattern Valueurn:ietf:rfc:3986
            ExampleGeneral: http://www.acme.com/identifiers/patient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. DocumentReference.identifier:sopClassInstanceUid.value
            Definition

            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

            ShortThe value that is unique
            Comments

            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

            Control10..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            ExampleGeneral: 123456
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            64. DocumentReference.identifier:sopClassInstanceUid.assigner
            Definition

            Organization that issued/manages the identifier.

            ShortOrganization that issued id (may be just text)
            Comments

            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

            Control0..1
            TypeReference(Organization (CZ core), Organization)
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. DocumentReference.status
            Definition

            The status of this document reference.

            Shortcurrent | superseded | entered-in-error
            Comments

            This is the status of the DocumentReference object, which might be independent from the docStatus element.

            This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

            Control1..1
            BindingThe codes SHALL be taken from DocumentReferenceStatushttp://hl7.org/fhir/ValueSet/document-reference-status|4.0.1
            (required to http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1)

            The status of the document reference.

            Typecode
            Is Modifiertrue because This element is labelled 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
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. DocumentReference.category
            Definition

            A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

            ShortCategorization of document
            Comments

            Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

            Control10..*
            BindingFor example codes, see DocumentClassValueSethttp://hl7.org/fhir/ValueSet/document-classcodes
            (example to http://hl7.org/fhir/ValueSet/document-classcodes)

            High-level kind of a clinical document at a macro level.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Alternate Namesclaxs
            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 DocumentReference.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • profile @ $this
            • 70. DocumentReference.category:imkeyimages
              Slice Nameimkeyimages
              Definition

              A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

              ShortCategorization of document
              Comments

              Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

              Control10..1*
              BindingFor example codes, see DocumentClassValueSethttp://hl7.org/fhir/ValueSet/document-classcodes
              (example to http://hl7.org/fhir/ValueSet/document-classcodes)

              High-level kind of a clinical document at a macro level.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Alternate Namesclaxs
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. DocumentReference.category:imkeyimages.coding
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

              Control10..*
              TypeCoding
              Is Modifierfalse
              Summarytrue
              Requirements

              Allows for alternative encodings within a code system, and translations to other code systems.

              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 DocumentReference.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ $this
              • 74. DocumentReference.category:imkeyimages.coding:keyimagecode
                Slice Namekeyimagecode
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                Control10..1*
                TypeCoding
                Is Modifierfalse
                Summarytrue
                Requirements

                Allows for alternative encodings within a code system, and translations to other code systems.

                Pattern Value{
                  "system" : "http://loinc.org",
                  "code" : "55113-5",
                  "display" : "Key images Document Radiology"
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                76. DocumentReference.subject
                Definition

                Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

                ShortWho/what is the subject of the document
                Control10..1
                TypeReference(Patient (CZ core), Patient: Animal (CZ), Patient, Practitioner, Group, Device)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                78. DocumentReference.author
                Definition

                Identifies who is responsible for adding the information to the document.

                ShortWho and/or what authored the document
                Comments

                Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

                Control0..*
                TypeReference(Practitioner (CZ core), Practitioner Role (CZ core), Organization (CZ core), Device: Performer/Observer (CZ), Medical Device (CZ), Patient (CZ core), Related Person (CZ core), Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson)
                Is Modifierfalse
                Summarytrue
                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 DocumentReference.author. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • profile @ $this
                • 80. DocumentReference.author:performer
                  Slice Nameperformer
                  Definition

                  Identifies who is responsible for adding the information to the document.

                  ShortWho and/or what authored the document
                  Comments

                  Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

                  Control0..*
                  TypeReference(Practitioner Role (CZ core), Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson)
                  Is Modifierfalse
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  82. DocumentReference.authenticator
                  Definition

                  Which person or organization authenticates that this document is valid.

                  ShortWho/what authenticated the document
                  Comments

                  Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

                  Control0..1
                  TypeReference(Practitioner (CZ core), Practitioner Role (CZ core), Organization (CZ core), Practitioner, PractitionerRole, Organization)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  84. DocumentReference.custodian
                  Definition

                  Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

                  ShortOrganization which maintains the document
                  Comments

                  Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

                  Control0..1
                  TypeReference(Organization (CZ core), Organization)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  86. DocumentReference.content
                  Definition

                  The document and format referenced. There may be multiple content element repetitions, each with a different format.

                  ShortDocument referenced
                  Control1..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Summarytrue
                  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 DocumentReference.content. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ extension.value
                  • 88. DocumentReference.content.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())
                    90. DocumentReference.content.attachment
                    Definition

                    The document or URL of the document along with critical metadata to prove content has integrity.

                    ShortWhere to access the document
                    Control1..1
                    TypeAttachment
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    92. DocumentReference.content:thumbnail
                    Slice Namethumbnail
                    Definition

                    The document and format referenced. There may be multiple content element repetitions, each with a different format.

                    ShortDocument referenced
                    Control01..1*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    94. DocumentReference.content:thumbnail.extension
                    Definition

                    An Extension


                    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.

                    ShortExtensionAdditional 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.

                    Control10..*
                    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 DocumentReference.content.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 96. DocumentReference.content:thumbnail.extension:thumbnail
                      Slice Namethumbnail
                      Definition

                      True or False indicating whether the content is a thumbnail.

                      ShortThumbnail state
                      Control1..1
                      TypeExtension(DocumentReference Thumbnail) (Extension Type: boolean)
                      Is Modifierfalse
                      Summaryfalse
                      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())
                      ele-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())
                      98. DocumentReference.content:thumbnail.extension:thumbnail.extension
                      Definition

                      An Extension


                      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.

                      ShortExtensionAdditional 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..0*
                      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())
                      ele-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 DocumentReference.content.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 100. DocumentReference.content:thumbnail.extension:thumbnail.url
                        Definition

                        Source of the definition for the extension code - a logical name or a URL.

                        Shortidentifies the meaning of the extension
                        Comments

                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                        Control1..1
                        Typeuri
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        Fixed Valuehttp://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
                        102. DocumentReference.content:thumbnail.extension:thumbnail.value[x]
                        Definition

                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                        ShortValue of extension
                        Control10..1
                        This element is affected by the following invariants: ext-1
                        Typeboolean, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, Expression, Signature, unsignedInt, time
                        [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
                        Summaryfalse
                        Pattern Valuetrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        104. DocumentReference.content:thumbnail.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())
                        106. DocumentReference.content:thumbnail.attachment
                        Definition

                        The document or URL of the document along with critical metadata to prove content has integrity.

                        ShortWhere to access the document
                        Control1..1
                        TypeAttachment
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        108. DocumentReference.content:content
                        Slice Namecontent
                        Definition

                        The document and format referenced. There may be multiple content element repetitions, each with a different format.

                        ShortDocument referenced
                        Control1..1*
                        TypeBackboneElement
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        110. DocumentReference.content:content.extension
                        Definition

                        An Extension


                        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.

                        ShortExtensionAdditional 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.

                        Control10..*
                        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 DocumentReference.content.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 112. DocumentReference.content:content.extension:thumbnail
                          Slice Namethumbnail
                          Definition

                          True or False indicating whether the content is a thumbnail.

                          ShortThumbnail state
                          Control1..1
                          TypeExtension(DocumentReference Thumbnail) (Extension Type: boolean)
                          Is Modifierfalse
                          Summaryfalse
                          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())
                          ele-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())
                          114. DocumentReference.content:content.extension:thumbnail.extension
                          Definition

                          An Extension


                          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.

                          ShortExtensionAdditional 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..0*
                          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())
                          ele-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 DocumentReference.content.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 116. DocumentReference.content:content.extension:thumbnail.url
                            Definition

                            Source of the definition for the extension code - a logical name or a URL.

                            Shortidentifies the meaning of the extension
                            Comments

                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
                            118. DocumentReference.content:content.extension:thumbnail.value[x]
                            Definition

                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                            ShortValue of extension
                            Control10..1
                            This element is affected by the following invariants: ext-1
                            Typeboolean, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, Expression, Signature, unsignedInt, time
                            [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
                            Summaryfalse
                            Pattern Valuefalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            120. DocumentReference.content:content.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())
                            122. DocumentReference.content:content.attachment
                            Definition

                            The document or URL of the document along with critical metadata to prove content has integrity.

                            ShortWhere to access the document
                            Control1..1
                            TypeAttachment
                            Is Modifierfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            124. DocumentReference.content:content.attachment.url
                            Definition

                            A location where the data can be accessed.

                            ShortUri where the data can be found
                            Comments

                            If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

                            The data needs to be transmitted by reference.

                            ExampleGeneral: http://www.acme.com/logo-small.png
                            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 foundhere

                            0. DocumentReference
                            2. DocumentReference.extension
                            Control1..?
                            SlicingThis element introduces a set of slices on DocumentReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • value @ value
                            • 4. DocumentReference.extension:basedOn
                              Slice NamebasedOn
                              Control0..1
                              TypeExtension(Extension Definition for DocumentReference.basedOn for Version 5.0) (Extension Type: Reference(Appointment, AppointmentResponse, CarePlan, Claim, CommunicationRequest, Contract, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription))
                              6. DocumentReference.extension:basedOn.value[x]
                              TypeReference(Appointment, AppointmentResponse, Care plan: Imaging Report (CZ), Claim, CommunicationRequest, Contract, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription, Service Request: Imaging Report (CZ))
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              8. DocumentReference.extension:basedOn/imorderaccession
                              Slice NamebasedOn/imorderaccession
                              Control0..1
                              10. DocumentReference.extension:basedOn/imorderaccession.value[x]
                              TypeReference(Service Request: Imaging Report (CZ))
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              12. DocumentReference.extension:basedOn/imorderaccession.value[x].identifier
                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control1..?
                              TypeIdentifier(Imaging Accession Number Identifier)
                              14. DocumentReference.extension:modality
                              Slice Namemodality
                              Control1..1
                              TypeExtension(DocumentReference.modality extension for R4) (Extension Type: CodeableConcept)
                              16. DocumentReference.extension:modality.value[x]
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              18. DocumentReference.extension:modality.value[x].coding
                              BindingThe codes SHOULD be taken from CZ Modality
                              (preferred to https://hl7.cz/fhir/img/ValueSet/cz-modality-vs)
                              20. DocumentReference.extension:note
                              Slice Namenote
                              Control0..1
                              TypeExtension(Note) (Extension Type: Annotation)
                              22. DocumentReference.extension:view
                              Slice Nameview
                              Control0..1
                              TypeExtension(Media.view extension) (Extension Type: CodeableConcept)
                              24. DocumentReference.identifier
                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              SlicingThis element introduces a set of slices on DocumentReference.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ $this
                              • 26. DocumentReference.identifier:seriesInstanceUid
                                Slice NameseriesInstanceUid
                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control0..1
                                28. DocumentReference.identifier:seriesInstanceUid.type
                                Control1..?
                                Pattern Value{
                                  "coding" : [{
                                    "system" : "https://hl7.cz/fhir/img/CodeSystem/codesystem-missing-dicom-terminology",
                                    "code" : "00080018"
                                  }]
                                }
                                30. DocumentReference.identifier:seriesInstanceUid.system
                                Control1..?
                                Pattern Valueurn:ietf:rfc:3986
                                32. DocumentReference.identifier:seriesInstanceUid.value
                                Control1..?
                                34. DocumentReference.identifier:seriesInstanceUid.assigner
                                TypeReference(Organization (CZ core))
                                36. DocumentReference.identifier:sopClassInstanceUid
                                Slice NamesopClassInstanceUid
                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control0..1
                                38. DocumentReference.identifier:sopClassInstanceUid.type
                                Control1..?
                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://dicom.nema.org/resources/ontology/DCM",
                                    "code" : "112002"
                                  }]
                                }
                                40. DocumentReference.identifier:sopClassInstanceUid.system
                                Control1..?
                                Pattern Valueurn:ietf:rfc:3986
                                42. DocumentReference.identifier:sopClassInstanceUid.value
                                Control1..?
                                44. DocumentReference.identifier:sopClassInstanceUid.assigner
                                TypeReference(Organization (CZ core))
                                46. DocumentReference.category
                                Control1..?
                                SlicingThis element introduces a set of slices on DocumentReference.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • profile @ $this
                                • 48. DocumentReference.category:imkeyimages
                                  Slice Nameimkeyimages
                                  Control1..1
                                  50. DocumentReference.category:imkeyimages.coding
                                  Control1..?
                                  SlicingThis element introduces a set of slices on DocumentReference.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ $this
                                  • 52. DocumentReference.category:imkeyimages.coding:keyimagecode
                                    Slice Namekeyimagecode
                                    Control1..1
                                    Pattern Value{
                                      "system" : "http://loinc.org",
                                      "code" : "55113-5",
                                      "display" : "Key images Document Radiology"
                                    }
                                    54. DocumentReference.subject
                                    Control1..?
                                    TypeReference(Patient (CZ core), Patient: Animal (CZ))
                                    56. DocumentReference.author
                                    TypeReference(Practitioner (CZ core), Practitioner Role (CZ core), Organization (CZ core), Device: Performer/Observer (CZ), Medical Device (CZ), Patient (CZ core), Related Person (CZ core))
                                    SlicingThis element introduces a set of slices on DocumentReference.author. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • profile @ $this
                                    • 58. DocumentReference.author:performer
                                      Slice Nameperformer
                                      Control0..*
                                      TypeReference(Practitioner Role (CZ core))
                                      60. DocumentReference.authenticator
                                      TypeReference(Practitioner (CZ core), Practitioner Role (CZ core), Organization (CZ core))
                                      62. DocumentReference.custodian
                                      TypeReference(Organization (CZ core))
                                      64. DocumentReference.content
                                      SlicingThis element introduces a set of slices on DocumentReference.content. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ extension.value
                                      • 66. DocumentReference.content:thumbnail
                                        Slice Namethumbnail
                                        Control0..1
                                        68. DocumentReference.content:thumbnail.extension
                                        Control1..?
                                        SlicingThis element introduces a set of slices on DocumentReference.content.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 70. DocumentReference.content:thumbnail.extension:thumbnail
                                          Slice Namethumbnail
                                          Control1..1
                                          TypeExtension(DocumentReference Thumbnail) (Extension Type: boolean)
                                          72. DocumentReference.content:thumbnail.extension:thumbnail.value[x]
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Pattern Valuetrue
                                          74. DocumentReference.content:content
                                          Slice Namecontent
                                          Control1..1
                                          76. DocumentReference.content:content.extension
                                          Control1..?
                                          SlicingThis element introduces a set of slices on DocumentReference.content.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 78. DocumentReference.content:content.extension:thumbnail
                                            Slice Namethumbnail
                                            Control1..1
                                            TypeExtension(DocumentReference Thumbnail) (Extension Type: boolean)
                                            80. DocumentReference.content:content.extension:thumbnail.value[x]
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Pattern Valuefalse
                                            82. DocumentReference.content:content.attachment
                                            84. DocumentReference.content:content.attachment.url
                                            Control1..?
                                            86. DocumentReference.context
                                            88. DocumentReference.context.sourcePatientInfo
                                            TypeReference(Patient (CZ core), Patient: Animal (CZ))

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

                                            0. DocumentReference
                                            Definition

                                            A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.

                                            ShortA reference to a document
                                            Comments

                                            Usually, this is used for documents other than those defined by FHIR.

                                            Control0..*
                                            Is Modifierfalse
                                            Summaryfalse
                                            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())
                                            2. DocumentReference.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. DocumentReference.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. DocumentReference.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. DocumentReference.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. DocumentReference.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. DocumentReference.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. DocumentReference.extension
                                            Definition

                                            An Extension

                                            ShortExtension
                                            Control1..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            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 DocumentReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • value @ value
                                            • 16. DocumentReference.extension:basedOn
                                              Slice NamebasedOn
                                              Definition

                                              Optional Extension Element - found in all resources.

                                              ShortOptional Extensions Element
                                              Control0..1
                                              This element is affected by the following invariants: ele-1
                                              TypeExtension(Extension Definition for DocumentReference.basedOn for Version 5.0) (Extension Type: Reference(Appointment, AppointmentResponse, CarePlan, Claim, CommunicationRequest, Contract, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription))
                                              Is Modifierfalse
                                              Summaryfalse
                                              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. DocumentReference.extension:basedOn.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
                                              20. DocumentReference.extension:basedOn.extension
                                              Definition

                                              An Extension

                                              ShortExtension
                                              Control0..0
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              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 DocumentReference.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 22. DocumentReference.extension:basedOn.url
                                                Definition

                                                Source of the definition for the extension code - a logical name or a URL.

                                                Shortidentifies the meaning of the extension
                                                Comments

                                                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                Control1..1
                                                Typeuri
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.basedOn
                                                24. DocumentReference.extension:basedOn.value[x]
                                                Definition

                                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                ShortValue of extension
                                                Control1..1
                                                TypeReference(Appointment, AppointmentResponse, Care plan: Imaging Report (CZ), Claim, CommunicationRequest, Contract, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription, Service Request: Imaging Report (CZ))
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                26. DocumentReference.extension:basedOn/imorderaccession
                                                Slice NamebasedOn/imorderaccession
                                                Definition

                                                An Extension

                                                ShortExtension
                                                Control0..1
                                                This element is affected by the following invariants: ele-1
                                                TypeExtension(Extension Definition for DocumentReference.basedOn for Version 5.0) (Extension Type: Reference(Appointment, AppointmentResponse, CarePlan, Claim, CommunicationRequest, Contract, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription))
                                                Is Modifierfalse
                                                Summaryfalse
                                                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())
                                                28. DocumentReference.extension:basedOn/imorderaccession.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
                                                30. DocumentReference.extension:basedOn/imorderaccession.extension
                                                Definition

                                                An Extension

                                                ShortExtension
                                                Control0..0
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                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 DocumentReference.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 32. DocumentReference.extension:basedOn/imorderaccession.url
                                                  Definition

                                                  Source of the definition for the extension code - a logical name or a URL.

                                                  Shortidentifies the meaning of the extension
                                                  Comments

                                                  The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                  Control1..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.basedOn
                                                  34. DocumentReference.extension:basedOn/imorderaccession.value[x]
                                                  Definition

                                                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                  ShortValue of extension
                                                  Control1..1
                                                  TypeReference(Service Request: Imaging Report (CZ))
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  36. DocumentReference.extension:basedOn/imorderaccession.value[x].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
                                                  38. DocumentReference.extension:basedOn/imorderaccession.value[x].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 DocumentReference.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 40. DocumentReference.extension:basedOn/imorderaccession.value[x].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.

                                                    Control0..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()))
                                                    42. DocumentReference.extension:basedOn/imorderaccession.value[x].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()))
                                                    44. DocumentReference.extension:basedOn/imorderaccession.value[x].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)
                                                    Control1..1
                                                    TypeIdentifier(Imaging Accession Number Identifier)
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    46. DocumentReference.extension:basedOn/imorderaccession.value[x].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()))
                                                    48. DocumentReference.extension:modality
                                                    Slice Namemodality
                                                    Definition

                                                    Extension to backport DocumentReference.modality in R4.

                                                    ShortDocumentReference.modality extension for R4
                                                    Control1..1
                                                    This element is affected by the following invariants: ele-1
                                                    TypeExtension(DocumentReference.modality extension for R4) (Extension Type: CodeableConcept)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    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())
                                                    50. DocumentReference.extension:modality.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
                                                    52. DocumentReference.extension:modality.extension
                                                    Definition

                                                    An Extension

                                                    ShortExtension
                                                    Control0..0
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    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 DocumentReference.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 54. DocumentReference.extension:modality.url
                                                      Definition

                                                      Source of the definition for the extension code - a logical name or a URL.

                                                      Shortidentifies the meaning of the extension
                                                      Comments

                                                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                      Control1..1
                                                      Typeuri
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      Fixed Valuehttps://hl7.cz/fhir/img/StructureDefinition/modality-cz
                                                      56. DocumentReference.extension:modality.value[x]
                                                      Definition

                                                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                      ShortValue of extension
                                                      Control1..1
                                                      TypeCodeableConcept
                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      58. DocumentReference.extension:modality.value[x].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
                                                      60. DocumentReference.extension:modality.value[x].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 DocumentReference.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 62. DocumentReference.extension:modality.value[x].coding
                                                        Definition

                                                        A reference to a code defined by a terminology system.

                                                        ShortCode defined by a terminology system
                                                        Comments

                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                        Control0..*
                                                        BindingThe codes SHOULD be taken from CZ Modality
                                                        (preferred to https://hl7.cz/fhir/img/ValueSet/cz-modality-vs)
                                                        TypeCoding
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Requirements

                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        64. DocumentReference.extension:modality.value[x].text
                                                        Definition

                                                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                        ShortPlain text representation of the concept
                                                        Comments

                                                        Very often the text is the same as a displayName of one of the codings.

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

                                                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        66. DocumentReference.extension:note
                                                        Slice Namenote
                                                        Definition

                                                        Additional notes that apply to this resource or element.

                                                        ShortAdditional notes that apply to this resource or element.
                                                        Comments

                                                        This extension SHALL NOT be used if the resource already has standard 'note' element (or equivalent) of type Annotation on the same element

                                                        Control0..1
                                                        TypeExtension(Note) (Extension Type: Annotation)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        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. DocumentReference.extension:view
                                                        Slice Nameview
                                                        Definition

                                                        This cross version extension includes the FHIR R4 version of the Media.view field which has at this point in time (April 18, 2025), not yet been included in the extension pack.

                                                        ShortMedia.view extension
                                                        Control0..1
                                                        This element is affected by the following invariants: ele-1
                                                        TypeExtension(Media.view extension) (Extension Type: CodeableConcept)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        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())
                                                        70. DocumentReference.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())
                                                        72. DocumentReference.masterIdentifier
                                                        Definition

                                                        Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document.

                                                        ShortMaster Version Specific Identifier
                                                        Comments

                                                        CDA Document Id extension and root.

                                                        Control0..1
                                                        TypeIdentifier
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Requirements

                                                        The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).

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

                                                        Other identifiers associated with the document, including version independent identifiers.

                                                        ShortOther identifiers for the document
                                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                                        Control0..*
                                                        TypeIdentifier
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        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 DocumentReference.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ $this
                                                        • 76. DocumentReference.identifier:seriesInstanceUid
                                                          Slice NameseriesInstanceUid
                                                          Definition

                                                          Other identifiers associated with the document, including version independent identifiers.

                                                          ShortOther identifiers for the document
                                                          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()))
                                                          78. DocumentReference.identifier:seriesInstanceUid.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
                                                          80. DocumentReference.identifier:seriesInstanceUid.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 DocumentReference.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 82. DocumentReference.identifier:seriesInstanceUid.use
                                                            Definition

                                                            The purpose of this identifier.

                                                            Shortusual | official | temp | secondary | old (If known)
                                                            Comments

                                                            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                            Control0..1
                                                            BindingThe codes SHALL be taken from IdentifierUse
                                                            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                                            Identifies the purpose for this identifier, if known .

                                                            Typecode
                                                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Requirements

                                                            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            84. DocumentReference.identifier:seriesInstanceUid.type
                                                            Definition

                                                            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                            ShortDescription of identifier
                                                            Comments

                                                            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                            Control1..1
                                                            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                                            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            Allows users to make use of identifiers when the identifier system is not known.

                                                            Pattern Value{
                                                              "coding" : [{
                                                                "system" : "https://hl7.cz/fhir/img/CodeSystem/codesystem-missing-dicom-terminology",
                                                                "code" : "00080018"
                                                              }]
                                                            }
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            86. DocumentReference.identifier:seriesInstanceUid.system
                                                            Definition

                                                            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                            ShortThe namespace for the identifier value
                                                            Comments

                                                            Identifier.system is always case sensitive.

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

                                                            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                            Pattern Valueurn:ietf:rfc:3986
                                                            ExampleGeneral: http://www.acme.com/identifiers/patient
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            88. DocumentReference.identifier:seriesInstanceUid.value
                                                            Definition

                                                            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                            ShortThe value that is unique
                                                            Comments

                                                            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                            Control1..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            ExampleGeneral: 123456
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            90. DocumentReference.identifier:seriesInstanceUid.period
                                                            Definition

                                                            Time period during which identifier is/was valid for use.

                                                            ShortTime period when id is/was valid for use
                                                            Control0..1
                                                            TypePeriod
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            92. DocumentReference.identifier:seriesInstanceUid.assigner
                                                            Definition

                                                            Organization that issued/manages the identifier.

                                                            ShortOrganization that issued id (may be just text)
                                                            Comments

                                                            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                            Control0..1
                                                            TypeReference(Organization (CZ core))
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            94. DocumentReference.identifier:sopClassInstanceUid
                                                            Slice NamesopClassInstanceUid
                                                            Definition

                                                            Other identifiers associated with the document, including version independent identifiers.

                                                            ShortOther identifiers for the document
                                                            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()))
                                                            96. DocumentReference.identifier:sopClassInstanceUid.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
                                                            98. DocumentReference.identifier:sopClassInstanceUid.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 DocumentReference.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 100. DocumentReference.identifier:sopClassInstanceUid.use
                                                              Definition

                                                              The purpose of this identifier.

                                                              Shortusual | official | temp | secondary | old (If known)
                                                              Comments

                                                              Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                              Control0..1
                                                              BindingThe codes SHALL be taken from IdentifierUse
                                                              (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                                              Identifies the purpose for this identifier, if known .

                                                              Typecode
                                                              Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

                                                              Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              102. DocumentReference.identifier:sopClassInstanceUid.type
                                                              Definition

                                                              A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                              ShortDescription of identifier
                                                              Comments

                                                              This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                              Control1..1
                                                              BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                              (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                                              A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Requirements

                                                              Allows users to make use of identifiers when the identifier system is not known.

                                                              Pattern Value{
                                                                "coding" : [{
                                                                  "system" : "http://dicom.nema.org/resources/ontology/DCM",
                                                                  "code" : "112002"
                                                                }]
                                                              }
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              104. DocumentReference.identifier:sopClassInstanceUid.system
                                                              Definition

                                                              Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                              ShortThe namespace for the identifier value
                                                              Comments

                                                              Identifier.system is always case sensitive.

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

                                                              There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                              Pattern Valueurn:ietf:rfc:3986
                                                              ExampleGeneral: http://www.acme.com/identifiers/patient
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              106. DocumentReference.identifier:sopClassInstanceUid.value
                                                              Definition

                                                              The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                              ShortThe value that is unique
                                                              Comments

                                                              If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                              Control1..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              ExampleGeneral: 123456
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              108. DocumentReference.identifier:sopClassInstanceUid.period
                                                              Definition

                                                              Time period during which identifier is/was valid for use.

                                                              ShortTime period when id is/was valid for use
                                                              Control0..1
                                                              TypePeriod
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              110. DocumentReference.identifier:sopClassInstanceUid.assigner
                                                              Definition

                                                              Organization that issued/manages the identifier.

                                                              ShortOrganization that issued id (may be just text)
                                                              Comments

                                                              The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                              Control0..1
                                                              TypeReference(Organization (CZ core))
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              112. DocumentReference.status
                                                              Definition

                                                              The status of this document reference.

                                                              Shortcurrent | superseded | entered-in-error
                                                              Comments

                                                              This is the status of the DocumentReference object, which might be independent from the docStatus element.

                                                              This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

                                                              Control1..1
                                                              BindingThe codes SHALL be taken from DocumentReferenceStatus
                                                              (required to http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1)

                                                              The status of the document reference.

                                                              Typecode
                                                              Is Modifiertrue because This element is labelled 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
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              114. DocumentReference.docStatus
                                                              Definition

                                                              The status of the underlying document.

                                                              Shortpreliminary | final | amended | entered-in-error
                                                              Comments

                                                              The document that is pointed to might be in various lifecycle states.

                                                              Control0..1
                                                              BindingThe codes SHALL be taken from CompositionStatus
                                                              (required to http://hl7.org/fhir/ValueSet/composition-status|4.0.1)

                                                              Status of the underlying document.

                                                              Typecode
                                                              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()))
                                                              116. DocumentReference.type
                                                              Definition

                                                              Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

                                                              ShortKind of document (LOINC if possible)
                                                              Comments

                                                              Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.

                                                              Control0..1
                                                              BindingThe codes SHOULD be taken from DocumentTypeValueSet
                                                              (preferred to http://hl7.org/fhir/ValueSet/c80-doc-typecodes)

                                                              Precise type of clinical document.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              118. DocumentReference.category
                                                              Definition

                                                              A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

                                                              ShortCategorization of document
                                                              Comments

                                                              Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

                                                              Control1..*
                                                              BindingFor example codes, see DocumentClassValueSet
                                                              (example to http://hl7.org/fhir/ValueSet/document-classcodes)

                                                              High-level kind of a clinical document at a macro level.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Alternate Namesclaxs
                                                              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 DocumentReference.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • profile @ $this
                                                              • 120. DocumentReference.category:imkeyimages
                                                                Slice Nameimkeyimages
                                                                Definition

                                                                A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

                                                                ShortCategorization of document
                                                                Comments

                                                                Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

                                                                Control1..1
                                                                BindingFor example codes, see DocumentClassValueSet
                                                                (example to http://hl7.org/fhir/ValueSet/document-classcodes)

                                                                High-level kind of a clinical document at a macro level.

                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                Alternate Namesclaxs
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                122. DocumentReference.category:imkeyimages.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
                                                                124. DocumentReference.category:imkeyimages.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 DocumentReference.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 126. DocumentReference.category:imkeyimages.coding
                                                                  Definition

                                                                  A reference to a code defined by a terminology system.

                                                                  ShortCode defined by a terminology system
                                                                  Comments

                                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                  Control1..*
                                                                  TypeCoding
                                                                  Is Modifierfalse
                                                                  Summarytrue
                                                                  Requirements

                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                  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 DocumentReference.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ $this
                                                                  • 128. DocumentReference.category:imkeyimages.coding:keyimagecode
                                                                    Slice Namekeyimagecode
                                                                    Definition

                                                                    A reference to a code defined by a terminology system.

                                                                    ShortCode defined by a terminology system
                                                                    Comments

                                                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                    Control1..1
                                                                    TypeCoding
                                                                    Is Modifierfalse
                                                                    Summarytrue
                                                                    Requirements

                                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                                    Pattern Value{
                                                                      "system" : "http://loinc.org",
                                                                      "code" : "55113-5",
                                                                      "display" : "Key images Document Radiology"
                                                                    }
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    130. DocumentReference.category:imkeyimages.text
                                                                    Definition

                                                                    A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                    ShortPlain text representation of the concept
                                                                    Comments

                                                                    Very often the text is the same as a displayName of one of the codings.

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

                                                                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

                                                                    Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

                                                                    ShortWho/what is the subject of the document
                                                                    Control1..1
                                                                    TypeReference(Patient (CZ core), Patient: Animal (CZ))
                                                                    Is Modifierfalse
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    134. DocumentReference.date
                                                                    Definition

                                                                    When the document reference was created.

                                                                    ShortWhen this document reference was created
                                                                    Comments

                                                                    Referencing/indexing time is used for tracking, organizing versions and searching.

                                                                    Control0..1
                                                                    Typeinstant
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Alternate Namesindexed
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    136. DocumentReference.author
                                                                    Definition

                                                                    Identifies who is responsible for adding the information to the document.

                                                                    ShortWho and/or what authored the document
                                                                    Comments

                                                                    Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

                                                                    Control0..*
                                                                    TypeReference(Practitioner (CZ core), Practitioner Role (CZ core), Organization (CZ core), Device: Performer/Observer (CZ), Medical Device (CZ), Patient (CZ core), Related Person (CZ core))
                                                                    Is Modifierfalse
                                                                    Summarytrue
                                                                    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 DocumentReference.author. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • profile @ $this
                                                                    • 138. DocumentReference.author:performer
                                                                      Slice Nameperformer
                                                                      Definition

                                                                      Identifies who is responsible for adding the information to the document.

                                                                      ShortWho and/or what authored the document
                                                                      Comments

                                                                      Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

                                                                      Control0..*
                                                                      TypeReference(Practitioner Role (CZ core))
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      140. DocumentReference.authenticator
                                                                      Definition

                                                                      Which person or organization authenticates that this document is valid.

                                                                      ShortWho/what authenticated the document
                                                                      Comments

                                                                      Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

                                                                      Control0..1
                                                                      TypeReference(Practitioner (CZ core), Practitioner Role (CZ core), Organization (CZ core))
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      142. DocumentReference.custodian
                                                                      Definition

                                                                      Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

                                                                      ShortOrganization which maintains the document
                                                                      Comments

                                                                      Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

                                                                      Control0..1
                                                                      TypeReference(Organization (CZ core))
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      144. DocumentReference.relatesTo
                                                                      Definition

                                                                      Relationships that this document has with other document references that already exist.

                                                                      ShortRelationships to other documents
                                                                      Comments

                                                                      This element is labeled as a modifier because documents that append to other documents are incomplete on their own.

                                                                      Control0..*
                                                                      TypeBackboneElement
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      146. DocumentReference.relatesTo.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
                                                                      148. DocumentReference.relatesTo.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())
                                                                      150. DocumentReference.relatesTo.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())
                                                                      152. DocumentReference.relatesTo.code
                                                                      Definition

                                                                      The type of relationship that this document has with anther document.

                                                                      Shortreplaces | transforms | signs | appends
                                                                      Comments

                                                                      If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

                                                                      Control1..1
                                                                      BindingThe codes SHALL be taken from DocumentRelationshipType
                                                                      (required to http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1)

                                                                      The type of relationship between documents.

                                                                      Typecode
                                                                      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()))
                                                                      154. DocumentReference.relatesTo.target
                                                                      Definition

                                                                      The target document of this relationship.

                                                                      ShortTarget of the relationship
                                                                      Control1..1
                                                                      TypeReference(DocumentReference)
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      156. DocumentReference.description
                                                                      Definition

                                                                      Human-readable description of the source document.

                                                                      ShortHuman-readable description
                                                                      Comments

                                                                      What the document is about, a terse summary of the document.

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

                                                                      Helps humans to assess whether the document is of interest.

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

                                                                      A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.

                                                                      ShortDocument security-tags
                                                                      Comments

                                                                      The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce.

                                                                      In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.

                                                                      Control0..*
                                                                      BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                                                      (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                                                                      Security Labels from the Healthcare Privacy and Security Classification System.

                                                                      TypeCodeableConcept
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      Requirements

                                                                      Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

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

                                                                      The document and format referenced. There may be multiple content element repetitions, each with a different format.

                                                                      ShortDocument referenced
                                                                      Control1..*
                                                                      TypeBackboneElement
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      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 DocumentReference.content. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ extension.value
                                                                      • 162. DocumentReference.content.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
                                                                        164. DocumentReference.content.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())
                                                                        166. DocumentReference.content.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())
                                                                        168. DocumentReference.content.attachment
                                                                        Definition

                                                                        The document or URL of the document along with critical metadata to prove content has integrity.

                                                                        ShortWhere to access the document
                                                                        Control1..1
                                                                        TypeAttachment
                                                                        Is Modifierfalse
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        170. DocumentReference.content.format
                                                                        Definition

                                                                        An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                                                                        ShortFormat/content rules for the document
                                                                        Comments

                                                                        Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

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

                                                                        Document Format Codes.

                                                                        TypeCoding
                                                                        Is Modifierfalse
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        172. DocumentReference.content:thumbnail
                                                                        Slice Namethumbnail
                                                                        Definition

                                                                        The document and format referenced. There may be multiple content element repetitions, each with a different format.

                                                                        ShortDocument referenced
                                                                        Control0..1
                                                                        TypeBackboneElement
                                                                        Is Modifierfalse
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        174. DocumentReference.content:thumbnail.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
                                                                        176. DocumentReference.content:thumbnail.extension
                                                                        Definition

                                                                        An Extension

                                                                        ShortExtension
                                                                        Control1..*
                                                                        TypeExtension
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        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 DocumentReference.content.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 178. DocumentReference.content:thumbnail.extension:thumbnail
                                                                          Slice Namethumbnail
                                                                          Definition

                                                                          True or False indicating whether the content is a thumbnail.

                                                                          ShortThumbnail state
                                                                          Control1..1
                                                                          TypeExtension(DocumentReference Thumbnail) (Extension Type: boolean)
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          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())
                                                                          180. DocumentReference.content:thumbnail.extension:thumbnail.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
                                                                          This element is affected by the following invariants: ele-1
                                                                          Typeid
                                                                          Is Modifierfalse
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Summaryfalse
                                                                          182. DocumentReference.content:thumbnail.extension:thumbnail.extension
                                                                          Definition

                                                                          An Extension

                                                                          ShortExtension
                                                                          Control0..0
                                                                          TypeExtension
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          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 DocumentReference.content.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ url
                                                                          • 184. DocumentReference.content:thumbnail.extension:thumbnail.url
                                                                            Definition

                                                                            Source of the definition for the extension code - a logical name or a URL.

                                                                            Shortidentifies the meaning of the extension
                                                                            Comments

                                                                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                            Control1..1
                                                                            Typeuri
                                                                            Is Modifierfalse
                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                            Summaryfalse
                                                                            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
                                                                            186. DocumentReference.content:thumbnail.extension:thumbnail.value[x]
                                                                            Definition

                                                                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                            ShortValue of extension
                                                                            Control1..1
                                                                            This element is affected by the following invariants: ext-1
                                                                            Typeboolean
                                                                            [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
                                                                            Summaryfalse
                                                                            Pattern Valuetrue
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            188. DocumentReference.content:thumbnail.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())
                                                                            190. DocumentReference.content:thumbnail.attachment
                                                                            Definition

                                                                            The document or URL of the document along with critical metadata to prove content has integrity.

                                                                            ShortWhere to access the document
                                                                            Control1..1
                                                                            TypeAttachment
                                                                            Is Modifierfalse
                                                                            Summarytrue
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            192. DocumentReference.content:thumbnail.format
                                                                            Definition

                                                                            An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                                                                            ShortFormat/content rules for the document
                                                                            Comments

                                                                            Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

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

                                                                            Document Format Codes.

                                                                            TypeCoding
                                                                            Is Modifierfalse
                                                                            Summarytrue
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            194. DocumentReference.content:content
                                                                            Slice Namecontent
                                                                            Definition

                                                                            The document and format referenced. There may be multiple content element repetitions, each with a different format.

                                                                            ShortDocument referenced
                                                                            Control1..1
                                                                            TypeBackboneElement
                                                                            Is Modifierfalse
                                                                            Summarytrue
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            196. DocumentReference.content:content.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
                                                                            198. DocumentReference.content:content.extension
                                                                            Definition

                                                                            An Extension

                                                                            ShortExtension
                                                                            Control1..*
                                                                            TypeExtension
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            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 DocumentReference.content.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                            • value @ url
                                                                            • 200. DocumentReference.content:content.extension:thumbnail
                                                                              Slice Namethumbnail
                                                                              Definition

                                                                              True or False indicating whether the content is a thumbnail.

                                                                              ShortThumbnail state
                                                                              Control1..1
                                                                              TypeExtension(DocumentReference Thumbnail) (Extension Type: boolean)
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              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())
                                                                              202. DocumentReference.content:content.extension:thumbnail.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
                                                                              This element is affected by the following invariants: ele-1
                                                                              Typeid
                                                                              Is Modifierfalse
                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                              Summaryfalse
                                                                              204. DocumentReference.content:content.extension:thumbnail.extension
                                                                              Definition

                                                                              An Extension

                                                                              ShortExtension
                                                                              Control0..0
                                                                              TypeExtension
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              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 DocumentReference.content.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 206. DocumentReference.content:content.extension:thumbnail.url
                                                                                Definition

                                                                                Source of the definition for the extension code - a logical name or a URL.

                                                                                Shortidentifies the meaning of the extension
                                                                                Comments

                                                                                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                                                                Control1..1
                                                                                Typeuri
                                                                                Is Modifierfalse
                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                Summaryfalse
                                                                                Fixed Valuehttp://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
                                                                                208. DocumentReference.content:content.extension:thumbnail.value[x]
                                                                                Definition

                                                                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                ShortValue of extension
                                                                                Control1..1
                                                                                This element is affected by the following invariants: ext-1
                                                                                Typeboolean
                                                                                [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
                                                                                Summaryfalse
                                                                                Pattern Valuefalse
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                210. DocumentReference.content:content.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())
                                                                                212. DocumentReference.content:content.attachment
                                                                                Definition

                                                                                The document or URL of the document along with critical metadata to prove content has integrity.

                                                                                ShortWhere to access the document
                                                                                Control1..1
                                                                                TypeAttachment
                                                                                Is Modifierfalse
                                                                                Summarytrue
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                214. DocumentReference.content:content.attachment.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
                                                                                216. DocumentReference.content:content.attachment.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 DocumentReference.content.attachment.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                • value @ url
                                                                                • 218. DocumentReference.content:content.attachment.contentType
                                                                                  Definition

                                                                                  Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

                                                                                  ShortMime type of the content, with charset etc.
                                                                                  Control0..1
                                                                                  BindingThe codes SHALL be taken from Mime Types
                                                                                  (required to http://hl7.org/fhir/ValueSet/mimetypes|4.0.1)

                                                                                  The mime type of an attachment. Any valid mime type is allowed.

                                                                                  Typecode
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Processors of the data need to be able to know how to interpret the data.

                                                                                  ExampleGeneral: text/plain; charset=UTF-8, image/png
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  220. DocumentReference.content:content.attachment.language
                                                                                  Definition

                                                                                  The human language of the content. The value can be any valid value according to BCP 47.

                                                                                  ShortHuman language of the content (BCP-47)
                                                                                  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
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Users need to be able to choose between the languages in a set of attachments.

                                                                                  ExampleGeneral: en-AU
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  222. DocumentReference.content:content.attachment.data
                                                                                  Definition

                                                                                  The actual data of the attachment - a sequence of bytes, base64 encoded.

                                                                                  ShortData inline, base64ed
                                                                                  Comments

                                                                                  The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

                                                                                  Control0..1
                                                                                  Typebase64Binary
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The data needs to able to be transmitted inline.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  224. DocumentReference.content:content.attachment.url
                                                                                  Definition

                                                                                  A location where the data can be accessed.

                                                                                  ShortUri where the data can be found
                                                                                  Comments

                                                                                  If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

                                                                                  The data needs to be transmitted by reference.

                                                                                  ExampleGeneral: http://www.acme.com/logo-small.png
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  226. DocumentReference.content:content.attachment.size
                                                                                  Definition

                                                                                  The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

                                                                                  ShortNumber of bytes of content (if url provided)
                                                                                  Comments

                                                                                  The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.

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

                                                                                  Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  228. DocumentReference.content:content.attachment.hash
                                                                                  Definition

                                                                                  The calculated hash of the data using SHA-1. Represented using base64.

                                                                                  ShortHash of the data (sha-1, base64ed)
                                                                                  Comments

                                                                                  The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.

                                                                                  Control0..1
                                                                                  Typebase64Binary
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  230. DocumentReference.content:content.attachment.title
                                                                                  Definition

                                                                                  A label or set of text to display in place of the data.

                                                                                  ShortLabel to display in place of the data
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

                                                                                  ExampleGeneral: Official Corporate Logo
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  232. DocumentReference.content:content.attachment.creation
                                                                                  Definition

                                                                                  The date that the attachment was first created.

                                                                                  ShortDate attachment was first created
                                                                                  Control0..1
                                                                                  TypedateTime
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  This is often tracked as an integrity issue for use of the attachment.

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

                                                                                  An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                                                                                  ShortFormat/content rules for the document
                                                                                  Comments

                                                                                  Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

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

                                                                                  Document Format Codes.

                                                                                  TypeCoding
                                                                                  Is Modifierfalse
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  236. DocumentReference.context
                                                                                  Definition

                                                                                  The clinical context in which the document was prepared.

                                                                                  ShortClinical context of document
                                                                                  Comments

                                                                                  These values are primarily added to help with searching for interesting/relevant documents.

                                                                                  Control0..1
                                                                                  TypeBackboneElement
                                                                                  Is Modifierfalse
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  238. DocumentReference.context.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
                                                                                  240. DocumentReference.context.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())
                                                                                  242. DocumentReference.context.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())
                                                                                  244. DocumentReference.context.encounter
                                                                                  Definition

                                                                                  Describes the clinical encounter or type of care that the document content is associated with.

                                                                                  ShortContext of the document content
                                                                                  Control0..*
                                                                                  TypeReference(Encounter, EpisodeOfCare)
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  246. DocumentReference.context.event
                                                                                  Definition

                                                                                  This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.

                                                                                  ShortMain clinical acts documented
                                                                                  Comments

                                                                                  An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation.

                                                                                  Control0..*
                                                                                  BindingFor example codes, see ActCode (3.0.0)
                                                                                  (example to http://terminology.hl7.org/ValueSet/v3-ActCode|3.0.0)

                                                                                  This list of codes represents the main clinical acts being documented.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  248. DocumentReference.context.period
                                                                                  Definition

                                                                                  The time period over which the service that is described by the document was provided.

                                                                                  ShortTime of service that is being documented
                                                                                  Control0..1
                                                                                  TypePeriod
                                                                                  Is Modifierfalse
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  250. DocumentReference.context.facilityType
                                                                                  Definition

                                                                                  The kind of facility where the patient was seen.

                                                                                  ShortKind of facility where patient was seen
                                                                                  Control0..1
                                                                                  BindingFor example codes, see FacilityTypeCodeValueSet
                                                                                  (example to http://hl7.org/fhir/ValueSet/c80-facilitycodes)

                                                                                  XDS Facility Type.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  252. DocumentReference.context.practiceSetting
                                                                                  Definition

                                                                                  This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.

                                                                                  ShortAdditional details about where the content was created (e.g. clinical specialty)
                                                                                  Comments

                                                                                  This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.

                                                                                  Control0..1
                                                                                  BindingFor example codes, see PracticeSettingCodeValueSet
                                                                                  (example to http://hl7.org/fhir/ValueSet/c80-practice-codes)

                                                                                  Additional details about where the content was created (e.g. clinical specialty).

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

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

                                                                                  The Patient Information as known when the document was published. May be a reference to a version specific, or contained.

                                                                                  ShortPatient demographics from source
                                                                                  Control0..1
                                                                                  TypeReference(Patient (CZ core), Patient: Animal (CZ))
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  256. DocumentReference.context.related
                                                                                  Definition

                                                                                  Related identifiers or resources associated with the DocumentReference.

                                                                                  ShortRelated identifiers or resources
                                                                                  Comments

                                                                                  May be identifiers or resources that caused the DocumentReference or referenced Document to be created.

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