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 healthcare directive document on a FHIR server.

Note: while the conformance defined below is developed the for Advance Healthcare Directive Interoperability use case, this document management approach can be utilized for all types of documents under management through a FHIR server.

Conformance:

The DocumentReference Resources on a FHIR server function as a sort of "card catalog" or indexing system that makes it easy to find and access information made available through the FHIR server.

Each DocumentReference Resource contains information about the index card itself, used to facilitate searchability ("DocumentReference Metadata"), and information about the document the index card is making findable ("Document Metadata"). This makes understanding document management via FHIR a complex, multidimensional situation where it is necessary to understand the difference between these two types of information in each DocumentReference Resource.

The information below summarizes the purpose of key fields in the DocumentReference Resources divided between DocumentReference Metadata and Document Metadata.

DocumentReference Key Metadata

Element Description
DocumentReference.meta The meta data fields of the DocumentReference contain information like id, lastUpdated, and versionId which describe the DocumentReference Resource itself.
DocumentReference.status Tells the status of the index information in the document registration system itself.
DocumentReference.relatesTo A linking pointer that allows one index card to point to a different index card to manage information within the indexing system through relationships such as replaces and signs.

In document exchange, the relatesTo.target may utilize a contained DocumentReference which specifies the MasterIdentifier of the related document to enable a recipient system to utilize the relationship information.
DocumentReference.date When this DocumentReference was created.

Document Metadata

Element Description
DocumentReference.masterIdentifier The meta data fields of the DocumentReference contain information like id, lastUpdated, and versionId which describe the DocumentReference Resource itself.
DocumentReference.identifier Contains a specialized identifier for the setId used to identify a specific logical document.
DocumentReference.extension:
DocumentReferenceVersionNumber		 VersionNumber is used to establish the order of successive representations (versions) of a single logical document.

In systems that support federated creation and use of documents, such as for advance healthcare directives, 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 millisecond.
DocumentReference.relatesTo A linking pointer that allows one index card to point to a different index card to manage information within the indexing system that enables the system to represent the relationships between documents such as replaces and signs.
DocumentReference.DocStatus The status of the document. Many document registries only provide access to completed documents.
DocumentReference.extension:
DocumentRevokeStatus		 Used to indicate when a completed document has subsequently been voided ("cancelled"), deprecated ("deprecated"), or marked as entered-in-error ("entered-in-error"). This often involved creating a new version of the logic document which carries a watermark indicating its revocation status. The Document Metadata and DocumentReference Metadata enables the revocation to be a transparent action that is readily visible in the indexing system.
DocumentReference.category The broad domain classifications for the type of document. The category ontology may be specific to the document registry. Use of standardized categories facilitates easier interoperability. Multiple categories may apply.
DocumentReference.type The specific type classification for the type of document. Use of standardized document types facilitates easier interoperability. Although a single type is required, the coding permits more granular types to also be included in use cases where that is helpful.
DocumentReference.description May include the title of the document or a more generalized description for normalizing documents in the indexing system or a combination of the two.
DocumentReference.content.attachment Each available document is carried in the attachment parameter of the DocumentReference index card.
DocumentReference.content.format The format code tells which IG the attachment is conformant to. This helps document seekers determine which attachment suits their use.
DocumentReference.content.attachment.
contentType		 contentType tells the media type of the attachment.
DocumentReference.content.attachment.
data		 data enables the attachment to be included when the index card is accessed
DocumentReference.content.attachment.
url		 url enables the attachment to be located elsewhere so it only is accessed when wanted, making the index card a smaller object use just for finding the desired information before retrieving it.
DocumentReference.content.attachment.
title		 Title matches the title of the attachment. If the attachment has a specific title, the exact title will be used in the DocumentReference index card. If the attachment doesn't have a specific title, the title may be something generalized but useful for identifying the attachment if it is stored or used elsewhere.
DocumentReference.content.attachment.
creation		 The system origination date associated with the attachment.
DocumentReference.extension:
authenticationTime		 The date/time when the document was considered completed, i.e. the date/time when all completion requirements were met.

In the case of scanned documents this information may not be available, or it may only be known to the date with no time information include.
DocumentReference.context.period.start Context information is relative to the document management system holding the information.

In the case of Advance Healthcare Directives, a national registry may consider the authenticationTime the relevant period.start for the document. Or it may consider the origination time of the document in the registry (content.creationTime) to be the period.start.

In document exchange, the date the document was originated on the recipient's system may be considered the relevant context.period.start for the document in the context of their medical/legal record for the patient. Or they may prefer to use the authenticationTime as the context.period.start.
DocumentReference.context.period.end Period.end holds the expiration date for the document if one exists in the document or is applied in the context of use.
DocumentReference.context.encounter Context information is relative to the document management system holding the information.

In the case of Advance Healthcare Directives, a national registry may not include a relevant encounter.

In document exchange, a healthcare organization how is retrieving/receiving an Advance Healthcare Directive may choose to associate the document with the specific encounter which was associated with the access and use of the information.

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
... contained 0..* Resource Used to communicate the DocumentReference for a superseded document referenced in DocumentReference.relatesTo.target.
... 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
... identifier SΣ 0..* Identifier Contains a specialized identifier for the setId used to identify a specific logical 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
.... 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 | ADI Practitioner Role) The attester or authenticator of the advance directive.
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... description Σ 0..1 string the associated document title(s) in the description is a best practice that improves searchability.
... 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) An encounter where the associated document was considered relevant.
.... period SΣ 0..1 Period the span of time that is relevant for the advance healthcare document

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
... contained 0..* Resource Used to communicate the DocumentReference for a superseded document referenced in DocumentReference.relatesTo.target.
... 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
... identifier 0..* Identifier Contains a specialized identifier for the setId used to identify a specific logical document.
... 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
... category 1..* CodeableConcept Categorization of document
Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
... 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
... authenticator 0..1 Reference(US Core Practitioner Profile | US Core Organization Profile | ADI Practitioner Role) The attester or authenticator of the advance directive.
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... description 0..1 string the associated document title(s) in the description is a best practice that improves searchability.
... 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) An encounter where the associated document was considered relevant.
.... period S 0..1 Period the span of time that is relevant for the advance healthcare document

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 Used to communicate the DocumentReference for a superseded document referenced in DocumentReference.relatesTo.target.
... 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 Contains a specialized identifier for the setId used to identify a specific logical 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 | ADI Practitioner Role) The attester or authenticator of the advance directive.
... 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 the associated document title(s) in the description is a best practice that improves searchability.
... 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) An encounter where the associated document was considered relevant.
.... 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 the span of time that is relevant for the advance healthcare document
.... 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
... contained 0..* Resource Used to communicate the DocumentReference for a superseded document referenced in DocumentReference.relatesTo.target.
... 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
... identifier SΣ 0..* Identifier Contains a specialized identifier for the setId used to identify a specific logical 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
.... 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 | ADI Practitioner Role) The attester or authenticator of the advance directive.
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... description Σ 0..1 string the associated document title(s) in the description is a best practice that improves searchability.
... 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) An encounter where the associated document was considered relevant.
.... period SΣ 0..1 Period the span of time that is relevant for the advance healthcare document

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
... contained 0..* Resource Used to communicate the DocumentReference for a superseded document referenced in DocumentReference.relatesTo.target.
... 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
... identifier 0..* Identifier Contains a specialized identifier for the setId used to identify a specific logical document.
... 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
... category 1..* CodeableConcept Categorization of document
Binding: USCoreDocumentReferenceCategory (8.0.0) (extensible)
... 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
... authenticator 0..1 Reference(US Core Practitioner Profile | US Core Organization Profile | ADI Practitioner Role) The attester or authenticator of the advance directive.
... custodian S 0..1 Reference(US Core Organization Profile) Organization which maintains the document
... description 0..1 string the associated document title(s) in the description is a best practice that improves searchability.
... 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) An encounter where the associated document was considered relevant.
.... period S 0..1 Period the span of time that is relevant for the advance healthcare document

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 Used to communicate the DocumentReference for a superseded document referenced in DocumentReference.relatesTo.target.
... 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 Contains a specialized identifier for the setId used to identify a specific logical 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 | ADI Practitioner Role) The attester or authenticator of the advance directive.
... 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 the associated document title(s) in the description is a best practice that improves searchability.
... 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) An encounter where the associated document was considered relevant.
.... 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 the span of time that is relevant for the advance healthcare document
.... 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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