PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - STU 2 – Ballot United States of America flag

PACIO Advance Healthcare Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-pacio-adi/ and changes regularly. See the Directory of published versions

Resource Profile: ADI Document Reference

Official URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-DocumentReference Version: 2.0.0-ballot
Standards status: Trial-use Maturity Level: 2 Computable Name: ADIDocumentReference

This profile defines constraints that represent the information needed to register an advance directive information document on a FHIR server.

Conformance:

Advance healthcare directive documents are identified using a unique setId identifier which is used to identify any document considered to be a version of one logical document. The  versionNumber field is a string value generated by determining the Epoc Unix timestamp associated with the UTC time of the document’s creation accurate to the milisecond. VersionNumber is used to establish the order of successive replacement documents. Best practice for systems that support distributed document creation and updating is to populate the versionNumber with the timestamp created from the date/time when the version of the document is created in the system (accurate to the milisecond). Note: this may or may not be equivalent to the timestamp integer for Composition.date. the versionNumber timestamp always will be equivalent to the Bundle.timestamp for the document.

Each individual advance healthcare directive document also contains a system independent globally unique identifier which can be use to identify a specific document without referencing its versionNumber. This unique document identifier is carried in the DocumentReference.masterIdentifier.

For documents created within a system will follow the pattern that the timestamp-label versionNumber will be equivalent to the timestamp of the Composition.date and the Bundle.timestamp. However, for unstructured historical documents uploaded into a system, the timestamp-label versionNumber will be equivalent to the timestamp of the timestamp of the system dateTime when the document was uploaded (“system origination date”). For uploaded documents, Composition.date also will reflect the system origination date. The creation date of the original document, if it is available, is carried in the DocumentReference.content.attachment.creation field. Note: the DocumentReference.content.attachment.creation may only contain the year, month, and day when the document was completed, as additional dateTime specificity may not be available.

A document’s status (conveyed in DocumentReference.docStatus) is considered to be “completed” when all the needed “completion activities” have been completed. For example, if an advance directive document requires signature and notarization or witnessing, then the document status is not “completed” until those activities have completed. The completion date of the document is the date of the completion of the final completion activity. A document’s revocation status is carried separately in an extension field called extension:DocumentRevokeStatus.

The DocumentReference.category field carries standard LOINC document ontology codes used to classify all type of advance healthcare document types. LOINC 42348-3 | Advance healthcare directives is the category used for all types of advance healthcare directive documents. An additional category of LOINC 81334-5 | Personal advance care plan, classifies the document as patient authored and an additional category of LOINC 93037-0 | Portable medical order, classifies the document as patient authored. The DocumentReference.type element carries a standard LOINC document ontology codes for one of the specific advance healthcare directive document types in this domain of documents.

The DocumentReference resource for a specific document may offer that document in a variety of formats from PDF to CDA to FHIR. The DocumentReference.content.format carries a formatCode which indicates the format of each available content attachment.

A DocumentReference resource may include context information to indicate if particular encounters are relevant for the document.

If a document has a relevant temporal context such as an effective as of date or expiration date, that information is expressed in the DocumentReference.context.period.start and DocumentReference.context.period.end.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreADIDocumentReferenceProfile A reference to a document
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:authenticationTime S 0..1 dateTime Authentication Time
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
.... extension:DocumentRevokeStatus S 0..1 code Revoke Status
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
Binding: ADI Document Revoke Status (required)
.... extension:DocumentReferenceVersionNumber S 0..1 string Version Number
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... docStatus Σ 0..1 code preliminary | final | amended | entered-in-error
Binding: ADI Composition Status (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: Advance Healthcare Directive Document Types Grouper . (extensible): Advance Directives Content Type
.... Slices for coding Σ 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:cdaDocument SΣ 0..1 Coding CDA Document Type Coding

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
Required Pattern: PACP Structured Body CDA Document
..... coding:fhirADIBundle SΣ 0..1 Coding FHIR PACP Bundle Type Coding

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: urn:ietf:rfc:3986
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
Required Pattern: pacp-structuredBody:1.3
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
.... category:adi SΣ 0..* CodeableConcept Categorization of ADI document"
Binding: Advance Healthcare Directive Categories LOINC . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile S) Who/what is the subject of the document
... date SΣ 1..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) Who and/or what authored the document
... authenticator S 0..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) Who/what authenticated the document
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... content SΣ 1..* BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
Constraints: us-core-6
..... contentType SΣ 1..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 SC 0..1 base64Binary Data inline, base64ed
..... url SΣC 0..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... creation SΣ 1..1 dateTime Date attachment was first created
.... format SΣ 0..1 Coding Format/content rules for the document
Binding: HL7FormatCodes (2.1.0) (extensible)
... context SΣ 0..1 BackboneElement Clinical context of document
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... encounter S 0..* Reference(US Core Encounter Profile) Context of the document content
.... period SΣ 0..1 Period Time of service that is being documented

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.status Base required DocumentReferenceStatus 📦4.0.1 FHIR Std.
DocumentReference.docStatus Base required ADI Composition Status 📦2.0.0-ballot This IG
DocumentReference.type Base extensible Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
DocumentReference.category Base extensible US Core DocumentReference Category 📍8.0.0 US Core v8.0
DocumentReference.category:adi Base required Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
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()

This structure is derived from USCoreADIDocumentReferenceProfile

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreADIDocumentReferenceProfile A reference to a document
... Slices for extension Content/Rules for all slices
.... extension:DocumentRevokeStatus S 0..1 code Revoke Status
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
Binding: ADI Document Revoke Status (required)
.... extension:DocumentReferenceVersionNumber S 0..1 string Version Number
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
... docStatus 0..1 code preliminary | final | amended | entered-in-error
Binding: ADI Composition Status (required)
... type
.... Slices for coding 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:cdaDocument S 0..1 Coding CDA Document Type Coding
Required Pattern: At least the following
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 0..1 string Representation defined by the system
Required Pattern: PACP Structured Body CDA Document
..... coding:fhirADIBundle S 0..1 Coding FHIR PACP Bundle Type Coding
Required Pattern: At least the following
...... system 1..1 uri Identity of the terminology system
Fixed Value: urn:ietf:rfc:3986
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 0..1 string Representation defined by the system
Required Pattern: pacp-structuredBody:1.3
... subject 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
... date 1..1 instant When this document reference was created
... author 0..* Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) Who and/or what authored the document
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... content
.... attachment
..... contentType 1..1 code Mime type of the content, with charset etc.
..... creation S 1..1 dateTime Date attachment was first created
... context S 0..1 BackboneElement Clinical context of document
.... encounter S 0..* Reference(US Core Encounter Profile) Context of the document content
.... period S 0..1 Period Time of service that is being documented

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
DocumentReference.docStatus Base required ADI Composition Status 📦2.0.0-ballot This IG
DocumentReference.category Base extensible US Core DocumentReference Category 📍8.0.0 US Core v8.0
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreADIDocumentReferenceProfile 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
... 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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:authenticationTime S 0..1 dateTime Authentication Time
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
.... extension:DocumentRevokeStatus S 0..1 code Revoke Status
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
Binding: ADI Document Revoke Status (required)
.... extension:DocumentReferenceVersionNumber S 0..1 string Version Number
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... masterIdentifier Σ 0..1 Identifier Master Version Specific Identifier
... identifier SΣ 0..* Identifier Other identifiers for the document
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... docStatus Σ 0..1 code preliminary | final | amended | entered-in-error
Binding: ADI Composition Status (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: Advance Healthcare Directive Document Types Grouper . (extensible): Advance Directives Content Type
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:cdaDocument SΣ 0..1 Coding CDA Document Type Coding

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
Required Pattern: PACP Structured Body CDA Document
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... coding:fhirADIBundle SΣ 0..1 Coding FHIR PACP Bundle Type Coding

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: urn:ietf:rfc:3986
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
Required Pattern: pacp-structuredBody:1.3
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
.... category:adi SΣ 0..* CodeableConcept Categorization of ADI document"
Binding: Advance Healthcare Directive Categories LOINC . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile S) Who/what is the subject of the document
... date SΣ 1..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) Who and/or what authored the document
... authenticator S 0..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) Who/what authenticated the document
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... relatesTo Σ 0..* BackboneElement Relationships to other documents
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 string Human-readable description
... securityLabel Σ 0..* CodeableConcept Document security-tags
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
... content SΣ 1..* BackboneElement Document referenced
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
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 SΣ 1..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 BindingsPurpose
AllLanguages Max Binding

Example General: en-AU
..... data SC 0..1 base64Binary Data inline, base64ed
..... url SΣC 0..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... 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 SΣ 1..1 dateTime Date attachment was first created
.... format SΣ 0..1 Coding Format/content rules for the document
Binding: HL7FormatCodes (2.1.0) (extensible)
... context SΣ 0..1 BackboneElement Clinical context of document
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... encounter S 0..* Reference(US Core Encounter Profile) Context of the document content
.... event 0..* CodeableConcept Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
.... period SΣ 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

doco 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 ADI Composition Status 📦2.0.0-ballot This IG
DocumentReference.type Base extensible Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
DocumentReference.category Base extensible US Core DocumentReference Category 📍8.0.0 US Core v8.0
DocumentReference.category:adi Base required Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
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()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreADIDocumentReferenceProfile A reference to a document
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:authenticationTime S 0..1 dateTime Authentication Time
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
.... extension:DocumentRevokeStatus S 0..1 code Revoke Status
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
Binding: ADI Document Revoke Status (required)
.... extension:DocumentReferenceVersionNumber S 0..1 string Version Number
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... docStatus Σ 0..1 code preliminary | final | amended | entered-in-error
Binding: ADI Composition Status (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: Advance Healthcare Directive Document Types Grouper . (extensible): Advance Directives Content Type
.... Slices for coding Σ 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:cdaDocument SΣ 0..1 Coding CDA Document Type Coding

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
Required Pattern: PACP Structured Body CDA Document
..... coding:fhirADIBundle SΣ 0..1 Coding FHIR PACP Bundle Type Coding

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: urn:ietf:rfc:3986
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
Required Pattern: pacp-structuredBody:1.3
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
.... category:adi SΣ 0..* CodeableConcept Categorization of ADI document"
Binding: Advance Healthcare Directive Categories LOINC . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile S) Who/what is the subject of the document
... date SΣ 1..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) Who and/or what authored the document
... authenticator S 0..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) Who/what authenticated the document
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... content SΣ 1..* BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
Constraints: us-core-6
..... contentType SΣ 1..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 SC 0..1 base64Binary Data inline, base64ed
..... url SΣC 0..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... creation SΣ 1..1 dateTime Date attachment was first created
.... format SΣ 0..1 Coding Format/content rules for the document
Binding: HL7FormatCodes (2.1.0) (extensible)
... context SΣ 0..1 BackboneElement Clinical context of document
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... encounter S 0..* Reference(US Core Encounter Profile) Context of the document content
.... period SΣ 0..1 Period Time of service that is being documented

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.status Base required DocumentReferenceStatus 📦4.0.1 FHIR Std.
DocumentReference.docStatus Base required ADI Composition Status 📦2.0.0-ballot This IG
DocumentReference.type Base extensible Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
DocumentReference.category Base extensible US Core DocumentReference Category 📍8.0.0 US Core v8.0
DocumentReference.category:adi Base required Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
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

This structure is derived from USCoreADIDocumentReferenceProfile

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreADIDocumentReferenceProfile A reference to a document
... Slices for extension Content/Rules for all slices
.... extension:DocumentRevokeStatus S 0..1 code Revoke Status
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
Binding: ADI Document Revoke Status (required)
.... extension:DocumentReferenceVersionNumber S 0..1 string Version Number
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
... docStatus 0..1 code preliminary | final | amended | entered-in-error
Binding: ADI Composition Status (required)
... type
.... Slices for coding 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:cdaDocument S 0..1 Coding CDA Document Type Coding
Required Pattern: At least the following
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 0..1 string Representation defined by the system
Required Pattern: PACP Structured Body CDA Document
..... coding:fhirADIBundle S 0..1 Coding FHIR PACP Bundle Type Coding
Required Pattern: At least the following
...... system 1..1 uri Identity of the terminology system
Fixed Value: urn:ietf:rfc:3986
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 0..1 string Representation defined by the system
Required Pattern: pacp-structuredBody:1.3
... subject 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
... date 1..1 instant When this document reference was created
... author 0..* Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) Who and/or what authored the document
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... content
.... attachment
..... contentType 1..1 code Mime type of the content, with charset etc.
..... creation S 1..1 dateTime Date attachment was first created
... context S 0..1 BackboneElement Clinical context of document
.... encounter S 0..* Reference(US Core Encounter Profile) Context of the document content
.... period S 0..1 Period Time of service that is being documented

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
DocumentReference.docStatus Base required ADI Composition Status 📦2.0.0-ballot This IG
DocumentReference.category Base extensible US Core DocumentReference Category 📍8.0.0 US Core v8.0

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreADIDocumentReferenceProfile 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
... 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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:authenticationTime S 0..1 dateTime Authentication Time
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
.... extension:DocumentRevokeStatus S 0..1 code Revoke Status
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
Binding: ADI Document Revoke Status (required)
.... extension:DocumentReferenceVersionNumber S 0..1 string Version Number
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-docVersionNumber-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... masterIdentifier Σ 0..1 Identifier Master Version Specific Identifier
... identifier SΣ 0..* Identifier Other identifiers for the document
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... docStatus Σ 0..1 code preliminary | final | amended | entered-in-error
Binding: ADI Composition Status (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: Advance Healthcare Directive Document Types Grouper . (extensible): Advance Directives Content Type
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:cdaDocument SΣ 0..1 Coding CDA Document Type Coding

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: urn:hl7-org:sdwg:pacp-structuredBody:1.3
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
Required Pattern: PACP Structured Body CDA Document
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... coding:fhirADIBundle SΣ 0..1 Coding FHIR PACP Bundle Type Coding

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: urn:ietf:rfc:3986
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
Required Pattern: pacp-structuredBody:1.3
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
.... category:adi SΣ 0..* CodeableConcept Categorization of ADI document"
Binding: Advance Healthcare Directive Categories LOINC . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile S) Who/what is the subject of the document
... date SΣ 1..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core PractitionerRole Profile | US Core Organization Profile | US Core Patient Profile) Who and/or what authored the document
... authenticator S 0..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) Who/what authenticated the document
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... relatesTo Σ 0..* BackboneElement Relationships to other documents
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 string Human-readable description
... securityLabel Σ 0..* CodeableConcept Document security-tags
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
... content SΣ 1..* BackboneElement Document referenced
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
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 SΣ 1..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 BindingsPurpose
AllLanguages Max Binding

Example General: en-AU
..... data SC 0..1 base64Binary Data inline, base64ed
..... url SΣC 0..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... 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 SΣ 1..1 dateTime Date attachment was first created
.... format SΣ 0..1 Coding Format/content rules for the document
Binding: HL7FormatCodes (2.1.0) (extensible)
... context SΣ 0..1 BackboneElement Clinical context of document
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... encounter S 0..* Reference(US Core Encounter Profile) Context of the document content
.... event 0..* CodeableConcept Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
.... period SΣ 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

doco 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 ADI Composition Status 📦2.0.0-ballot This IG
DocumentReference.type Base extensible Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
DocumentReference.category Base extensible US Core DocumentReference Category 📍8.0.0 US Core v8.0
DocumentReference.category:adi Base required Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
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()

 

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