Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-ballot - STU 2.2 - Ballot

Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions

## Resource Profile: PAS Document Reference

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-documentreference | Version: 2.2.0-ballot
Standards status: Trial-use Active as of 2026-01-30 | Maturity Level: 3 | Computable Name: PASDocumentReference
Other Identifiers: OID:2.16.840.1.113883.4.642.40.24.42.81

PAS constraints on US Core DocumentReference to require the document content to be included and not referenced externally.

Usages:

- Refer to this Profile: PAS Claim Update and PAS Claim
- Examples for this Profile: DocumentReference/DocumentReferenceExample

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile(7.0.0) | A reference to a document
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: USCoreDocumentReferenceType (7.0.0) (required): All LOINC values whose SCALE is "Doc" in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
Additional Bindings | Purpose
USCoreClinicalNoteType (7.0.0) | Min Binding
Slices for category | S Σ | 1..* | CodeableConcept | Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category:uscore | Σ | 0..* | CodeableConcept | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Categorization of document Binding: USCoreDocumentReferenceCategory (7.0.0) (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0) S | Practitioner | Group | Device) | Who/what is the subject of the document
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core Practitioner Profile(7.0.0) S | US Core Organization Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | Who and/or what authored the document
content | S Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: us-core-6
contentType | S Σ | 0..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
data | S C | 1..1 | base64Binary | Data inline, base64ed
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: HL7FormatCodes (2.1.0) (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..1 | Reference(US Core Encounter Profile(7.0.0)) | Context of the document content
period | S Σ | 0..1 | Period | Time of service that is being documented
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📦4.0.1 | FHIR Std.
DocumentReference.type | Base | required | US Core DocumentReference Type | 📍7.0.0 | US Core v7.0
DocumentReference.category | Base | example | Document Class Value Set | 📦4.0.1 | FHIR Std.
DocumentReference.category:uscore | Base | required | US Core DocumentReference Category | 📍7.0.0 | US Core v7.0
DocumentReference.content.​attachment.contentType | Base | required | MimeType | 📍4.0.1 | FHIR Std.
DocumentReference.content.​format | Base | extensible | HL7 ValueSet of Format Codes for use with Document Sharing | 📍2.1.0 | THO v7.0

#### Constraints

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile(7.0.0) | A reference to a document
content |  |  |  |
attachment |  |  |  |
data |  | 1..1 | base64Binary | Data inline, base64ed
url |  | 0..0 |  | Uri where the data can be found
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile(7.0.0) | A reference to a document
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | Σ | 0..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: USCoreDocumentReferenceType (7.0.0) (required): All LOINC values whose SCALE is "Doc" in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
Additional Bindings | Purpose
USCoreClinicalNoteType (7.0.0) | Min Binding
Slices for category | S Σ | 1..* | CodeableConcept | Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category:uscore | Σ | 0..* | CodeableConcept | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Categorization of document Binding: USCoreDocumentReferenceCategory (7.0.0) (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0) S | Practitioner | Group | Device) | Who/what is the subject of the document
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core Practitioner Profile(7.0.0) S | US Core Organization Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | Who and/or what authored the document
authenticator |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Who/what authenticated the document
custodian |  | 0..1 | Reference(Organization) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..* | BackboneElement | Document referenced
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: us-core-6
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | S Σ | 0..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Example General: en-AU
data | S C | 1..1 | base64Binary | Data inline, base64ed
size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
creation | Σ | 0..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: HL7FormatCodes (2.1.0) (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..1 | Reference(US Core Encounter Profile(7.0.0)) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
facilityType |  | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting |  | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo |  | 0..1 | Reference(Patient) | Patient demographics from source
related |  | 0..* | Reference(Resource) | Related identifiers or resources
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📦4.0.1 | FHIR Std.
DocumentReference.docStatus | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std.
DocumentReference.type | Base | required | US Core DocumentReference Type | 📍7.0.0 | US Core v7.0
DocumentReference.category | Base | example | Document Class Value Set | 📦4.0.1 | FHIR Std.
DocumentReference.category:uscore | Base | required | US Core DocumentReference Category | 📍7.0.0 | US Core v7.0
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📦4.0.1 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | MimeType | 📍4.0.1 | FHIR Std.
DocumentReference.content.​attachment.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
DocumentReference.content.​format | Base | extensible | HL7 ValueSet of Format Codes for use with Document Sharing | 📍2.1.0 | THO v7.0
DocumentReference.context.​event | Base | example | v3 Code System ActCode | 📍3.0.0 | THO v7.0
DocumentReference.context.​facilityType | Base | example | Facility Type Code Value Set | 📦4.0.1 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | example | Practice Setting Code Value Set | 📦4.0.1 | FHIR Std.

#### Constraints

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

Summary

Mandatory: 1 element
Prohibited: 1 element

Maturity: 3

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile(7.0.0) | A reference to a document
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: USCoreDocumentReferenceType (7.0.0) (required): All LOINC values whose SCALE is "Doc" in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
Additional Bindings | Purpose
USCoreClinicalNoteType (7.0.0) | Min Binding
Slices for category | S Σ | 1..* | CodeableConcept | Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category:uscore | Σ | 0..* | CodeableConcept | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Categorization of document Binding: USCoreDocumentReferenceCategory (7.0.0) (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0) S | Practitioner | Group | Device) | Who/what is the subject of the document
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core Practitioner Profile(7.0.0) S | US Core Organization Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | Who and/or what authored the document
content | S Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: us-core-6
contentType | S Σ | 0..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
data | S C | 1..1 | base64Binary | Data inline, base64ed
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: HL7FormatCodes (2.1.0) (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..1 | Reference(US Core Encounter Profile(7.0.0)) | Context of the document content
period | S Σ | 0..1 | Period | Time of service that is being documented
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📦4.0.1 | FHIR Std.
DocumentReference.type | Base | required | US Core DocumentReference Type | 📍7.0.0 | US Core v7.0
DocumentReference.category | Base | example | Document Class Value Set | 📦4.0.1 | FHIR Std.
DocumentReference.category:uscore | Base | required | US Core DocumentReference Category | 📍7.0.0 | US Core v7.0
DocumentReference.content.​attachment.contentType | Base | required | MimeType | 📍4.0.1 | FHIR Std.
DocumentReference.content.​format | Base | extensible | HL7 ValueSet of Format Codes for use with Document Sharing | 📍2.1.0 | THO v7.0

#### Constraints

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

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile(7.0.0) | A reference to a document
content |  |  |  |
attachment |  |  |  |
data |  | 1..1 | base64Binary | Data inline, base64ed
url |  | 0..0 |  | Uri where the data can be found
Documentation for this format

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile(7.0.0) | A reference to a document
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | Σ | 0..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: USCoreDocumentReferenceType (7.0.0) (required): All LOINC values whose SCALE is "Doc" in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
Additional Bindings | Purpose
USCoreClinicalNoteType (7.0.0) | Min Binding
Slices for category | S Σ | 1..* | CodeableConcept | Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category:uscore | Σ | 0..* | CodeableConcept | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Categorization of document Binding: USCoreDocumentReferenceCategory (7.0.0) (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0) S | Practitioner | Group | Device) | Who/what is the subject of the document
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core Practitioner Profile(7.0.0) S | US Core Organization Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | Who and/or what authored the document
authenticator |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Who/what authenticated the document
custodian |  | 0..1 | Reference(Organization) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..* | BackboneElement | Document referenced
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: us-core-6
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | S Σ | 0..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Example General: en-AU
data | S C | 1..1 | base64Binary | Data inline, base64ed
size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
creation | Σ | 0..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: HL7FormatCodes (2.1.0) (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..1 | Reference(US Core Encounter Profile(7.0.0)) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
facilityType |  | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting |  | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo |  | 0..1 | Reference(Patient) | Patient demographics from source
related |  | 0..* | Reference(Resource) | Related identifiers or resources
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📦4.0.1 | FHIR Std.
DocumentReference.docStatus | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std.
DocumentReference.type | Base | required | US Core DocumentReference Type | 📍7.0.0 | US Core v7.0
DocumentReference.category | Base | example | Document Class Value Set | 📦4.0.1 | FHIR Std.
DocumentReference.category:uscore | Base | required | US Core DocumentReference Category | 📍7.0.0 | US Core v7.0
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📦4.0.1 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | MimeType | 📍4.0.1 | FHIR Std.
DocumentReference.content.​attachment.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
DocumentReference.content.​format | Base | extensible | HL7 ValueSet of Format Codes for use with Document Sharing | 📍2.1.0 | THO v7.0
DocumentReference.context.​event | Base | example | v3 Code System ActCode | 📍3.0.0 | THO v7.0
DocumentReference.context.​facilityType | Base | example | Facility Type Code Value Set | 📦4.0.1 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | example | Practice Setting Code Value Set | 📦4.0.1 | FHIR Std.

#### Constraints

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

Summary

Mandatory: 1 element
Prohibited: 1 element

Maturity: 3

Other representations of profile: CSV, Excel, Schematron