Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot3 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions

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Resource Profile: ResearchStudySupport

Usages:

• Examples for this Profile: DocumentReference/367832 and DocumentReference/367833

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	C	0..*	DocumentReference	A reference to a document Constraints: docRef-1, docRef-2
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url
DocumentReference.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error | unknown Binding: DocumentReferenceStatus (required): The status of the document reference.
DocumentReference.type	Σ This element is included in summaries.	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Research Study Document Types Value Set (extensible)
DocumentReference.context	Σ This element is included in summaries. C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Encounter the document reference is part of
DocumentReference.content	Σ This element is included in summaries.	1..*	BackboneElement	Document referenced
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.content.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.status	Base	required	DocumentReferenceStatus	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.type	Base	extensible	Research Study Document Types Value Set	📦1.0.0-ballot3	This IG

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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter	facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present	practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.type		0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Research Study Document Types Value Set (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.type	Base	extensible	Research Study Document Types Value Set	📦1.0.0-ballot3	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: docRef-1, docRef-2
DocumentReference.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
DocumentReference.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
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url
DocumentReference.identifier	Σ This element is included in summaries.	0..*	Identifier	Business identifiers for the document
DocumentReference.version	Σ This element is included in summaries.	0..1	string	An explicitly assigned identifier of a variation of the content in the DocumentReference
DocumentReference.basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | CoverageEligibilityRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | VisionPrescription)	Activity that caused this document to be created
DocumentReference.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error | unknown Binding: DocumentReferenceStatus (required): The status of the document reference.
DocumentReference.docStatus	Σ This element is included in summaries.	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
DocumentReference.modality	Σ This element is included in summaries.	0..*	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
DocumentReference.type	Σ This element is included in summaries.	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Research Study Document Types Value Set (extensible)
DocumentReference.category	Σ This element is included in summaries.	0..*	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
DocumentReference.subject	Σ This element is included in summaries.	0..1	Reference(Resource)	Who/what is the subject of the document
DocumentReference.context	Σ This element is included in summaries. C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Encounter the document reference is part of
DocumentReference.event		0..*	CodeableReference(Resource)	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
DocumentReference.related		0..*	BackboneElement	Related resources with this document reference not represented elsewhere
DocumentReference.related.id		0..1	string	Unique id for inter-element referencing
DocumentReference.related.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.related.code		0..1	CodeableConcept	Type of relationship to target resource Binding: AssociatedReferenceType (example): The type of relationship between the documents.
DocumentReference.related.target		1..1	Reference(Resource)	Target of the reference
DocumentReference.bodyStructure	Σ This element is included in summaries.	0..*	CodeableReference(BodyStructure)	Body structure included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body Structures
DocumentReference.facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
DocumentReference.practiceSetting	Σ This element is included in summaries. C	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).
DocumentReference.period	Σ This element is included in summaries.	0..1	Period	Time of service that is being documented
DocumentReference.date	Σ This element is included in summaries.	0..1	dateTime	When this document reference was created
DocumentReference.author	Σ This element is included in summaries.	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam | Group)	Who and/or what authored the document
DocumentReference.attester		0..*	BackboneElement	Attests to accuracy of the document
DocumentReference.attester.id		0..1	string	Unique id for inter-element referencing
DocumentReference.attester.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.attester.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.attester.mode		1..1	CodeableConcept	personal | professional | legal | official Binding: Composition Attestation Mode (preferred): The way in which a person authenticated a document.
DocumentReference.attester.time		0..1	dateTime	When the document was attested
DocumentReference.attester.party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization | Group)	Who attested the document
DocumentReference.custodian		0..1	Reference(Organization)	Organization which maintains the document
DocumentReference.relatesTo	Σ This element is included in summaries.	0..*	BackboneElement	Relationships to other document references and their lifecycle changes
DocumentReference.relatesTo.id		0..1	string	Unique id for inter-element referencing
DocumentReference.relatesTo.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.relatesTo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.relatesTo.code	Σ This element is included in summaries.	1..1	CodeableConcept	The relationship type with another document Binding: Document Relationship Type (extensible): The type of relationship between the documents.
DocumentReference.relatesTo.target	Σ This element is included in summaries.	1..1	Reference(DocumentReference)	Target of the relationship
DocumentReference.description	Σ This element is included in summaries.	0..1	markdown	Human-readable description
DocumentReference.securityLabel	Σ This element is included in summaries.	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
DocumentReference.content	Σ This element is included in summaries.	1..*	BackboneElement	Document referenced
DocumentReference.content.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.content.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.content.profile	Σ This element is included in summaries.	0..*	BackboneElement	Content profile rules for the document
DocumentReference.content.profile.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.profile.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.content.profile.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.content.profile.value[x]	Σ This element is included in summaries.	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
DocumentReference.content.profile.value[x].valueCoding			Coding
DocumentReference.content.profile.value[x].valueUri			uri
DocumentReference.content.profile.value[x].valueCanonical			canonical(Any)
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.language	Base	required	All Languages	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.docStatus	Base	required	Composition Status	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.modality	Base	extensible	Modality	⏿2025.3.20250714	tx.fhir.org
DocumentReference.type	Base	extensible	Research Study Document Types Value Set	📦1.0.0-ballot3	This IG
DocumentReference.category	Base	example	Referenced Item Category Value Set	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.event	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.5
DocumentReference.related.​code	Base	example	Associated Reference Type	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.bodyStructure	Base	example	SNOMED CT Body Structures	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.facilityType	Base	example	Facility Type Code Value Set	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.practiceSetting	Base	example	Practice Setting Code Value Set	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.attester.​mode	Base	preferred	Composition Attestation Mode	📦1.0.0	THO v7.5
DocumentReference.relatesTo.​code	Base	extensible	Document Relationship Type	📦1.0.0	THO v7.5
DocumentReference.securityLabel	Base	example	Example set of Security Labels	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.content.​profile.value[x]	Base	preferred	HL7 ValueSet of Format Codes for use with Document Sharing	📦2.1.0	THO v7.5

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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter	facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present	practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())

This structure is derived from DocumentReference

Summary

Maturity: 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: docRef-1, docRef-2
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url
DocumentReference.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error | unknown Binding: DocumentReferenceStatus (required): The status of the document reference.
DocumentReference.type	Σ This element is included in summaries.	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Research Study Document Types Value Set (extensible)
DocumentReference.context	Σ This element is included in summaries. C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Encounter the document reference is part of
DocumentReference.content	Σ This element is included in summaries.	1..*	BackboneElement	Document referenced
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.content.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.status	Base	required	DocumentReferenceStatus	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.type	Base	extensible	Research Study Document Types Value Set	📦1.0.0-ballot3	This IG

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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter	facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present	practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())

Differential View

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.type		0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Research Study Document Types Value Set (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.type	Base	extensible	Research Study Document Types Value Set	📦1.0.0-ballot3	This IG

Snapshot ViewView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: docRef-1, docRef-2
DocumentReference.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
DocumentReference.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
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url
DocumentReference.identifier	Σ This element is included in summaries.	0..*	Identifier	Business identifiers for the document
DocumentReference.version	Σ This element is included in summaries.	0..1	string	An explicitly assigned identifier of a variation of the content in the DocumentReference
DocumentReference.basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | CoverageEligibilityRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | VisionPrescription)	Activity that caused this document to be created
DocumentReference.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error | unknown Binding: DocumentReferenceStatus (required): The status of the document reference.
DocumentReference.docStatus	Σ This element is included in summaries.	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
DocumentReference.modality	Σ This element is included in summaries.	0..*	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
DocumentReference.type	Σ This element is included in summaries.	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Research Study Document Types Value Set (extensible)
DocumentReference.category	Σ This element is included in summaries.	0..*	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
DocumentReference.subject	Σ This element is included in summaries.	0..1	Reference(Resource)	Who/what is the subject of the document
DocumentReference.context	Σ This element is included in summaries. C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Encounter the document reference is part of
DocumentReference.event		0..*	CodeableReference(Resource)	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
DocumentReference.related		0..*	BackboneElement	Related resources with this document reference not represented elsewhere
DocumentReference.related.id		0..1	string	Unique id for inter-element referencing
DocumentReference.related.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.related.code		0..1	CodeableConcept	Type of relationship to target resource Binding: AssociatedReferenceType (example): The type of relationship between the documents.
DocumentReference.related.target		1..1	Reference(Resource)	Target of the reference
DocumentReference.bodyStructure	Σ This element is included in summaries.	0..*	CodeableReference(BodyStructure)	Body structure included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body Structures
DocumentReference.facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
DocumentReference.practiceSetting	Σ This element is included in summaries. C	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).
DocumentReference.period	Σ This element is included in summaries.	0..1	Period	Time of service that is being documented
DocumentReference.date	Σ This element is included in summaries.	0..1	dateTime	When this document reference was created
DocumentReference.author	Σ This element is included in summaries.	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam | Group)	Who and/or what authored the document
DocumentReference.attester		0..*	BackboneElement	Attests to accuracy of the document
DocumentReference.attester.id		0..1	string	Unique id for inter-element referencing
DocumentReference.attester.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.attester.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.attester.mode		1..1	CodeableConcept	personal | professional | legal | official Binding: Composition Attestation Mode (preferred): The way in which a person authenticated a document.
DocumentReference.attester.time		0..1	dateTime	When the document was attested
DocumentReference.attester.party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization | Group)	Who attested the document
DocumentReference.custodian		0..1	Reference(Organization)	Organization which maintains the document
DocumentReference.relatesTo	Σ This element is included in summaries.	0..*	BackboneElement	Relationships to other document references and their lifecycle changes
DocumentReference.relatesTo.id		0..1	string	Unique id for inter-element referencing
DocumentReference.relatesTo.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.relatesTo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.relatesTo.code	Σ This element is included in summaries.	1..1	CodeableConcept	The relationship type with another document Binding: Document Relationship Type (extensible): The type of relationship between the documents.
DocumentReference.relatesTo.target	Σ This element is included in summaries.	1..1	Reference(DocumentReference)	Target of the relationship
DocumentReference.description	Σ This element is included in summaries.	0..1	markdown	Human-readable description
DocumentReference.securityLabel	Σ This element is included in summaries.	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
DocumentReference.content	Σ This element is included in summaries.	1..*	BackboneElement	Document referenced
DocumentReference.content.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.content.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.content.profile	Σ This element is included in summaries.	0..*	BackboneElement	Content profile rules for the document
DocumentReference.content.profile.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.profile.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.content.profile.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Slice: Unordered, Open by value:url
DocumentReference.content.profile.value[x]	Σ This element is included in summaries.	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
DocumentReference.content.profile.value[x].valueCoding			Coding
DocumentReference.content.profile.value[x].valueUri			uri
DocumentReference.content.profile.value[x].valueCanonical			canonical(Any)
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.language	Base	required	All Languages	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.docStatus	Base	required	Composition Status	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.modality	Base	extensible	Modality	⏿2025.3.20250714	tx.fhir.org
DocumentReference.type	Base	extensible	Research Study Document Types Value Set	📦1.0.0-ballot3	This IG
DocumentReference.category	Base	example	Referenced Item Category Value Set	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.event	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.5
DocumentReference.related.​code	Base	example	Associated Reference Type	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.bodyStructure	Base	example	SNOMED CT Body Structures	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.facilityType	Base	example	Facility Type Code Value Set	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.practiceSetting	Base	example	Practice Setting Code Value Set	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.attester.​mode	Base	preferred	Composition Attestation Mode	📦1.0.0	THO v7.5
DocumentReference.relatesTo.​code	Base	extensible	Document Relationship Type	📦1.0.0	THO v7.5
DocumentReference.securityLabel	Base	example	Example set of Security Labels	📍6.0.0-snapshot1	FHIR Std.
DocumentReference.content.​profile.value[x]	Base	preferred	HL7 ValueSet of Format Codes for use with Document Sharing	📦2.1.0	THO v7.5

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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter	facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present	practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())

This structure is derived from DocumentReference

Summary

Maturity: 1

Other representations of profile: CSV, Excel, Schematron