PACIO Transitions of Care Implementation Guide
1.0.0 - STU 1 United States of America flag

PACIO Transitions of Care Implementation Guide, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-transitions-of-care-ig/ and changes regularly. See the Directory of published versions

Resource Profile: Transition of Care Document Reference

Official URL: http://hl7.org/fhir/us/pacio-toc/StructureDefinition/TOC-DocumentReference Version: 1.0.0
Standards status: Trial-use Maturity Level: 2 Computable Name: TOCDocumentReference
Other Identifiers: OID:2.16.840.1.113883.4.642.40.70.42.3

This profile defines constraints that represent the information needed for a Transition of Care document on a FHIR server.

Representation Guidance

The TOC DocumentReference requires a reference that will link all of the FHIR resources related to the transfer summary. This url reference will be to the TOC Bundle and captured in the DocumentReference.content.attachment.url element.

The FHIR resourceType in this reference url will depend upon the TOC bundle:

  1. If the TOC Bundle type is #document - then the DocumentReference.content.attachment.url is the TOC document bundle.
  2. If the TOC Bundle to send is #transaction - then the is the TOC Composition resource within the transaction bundle.

Reference the TOC Bundle profile description for further details on the bundle types.

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..* USCoreDocumentReferenceProfile(8.0.1) A reference to a document
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:PointOfContactExtension S 0..1 Reference(US Core RelatedPerson Profile(8.0.1) | US Core Practitioner Profile(8.0.1) | US Core PractitionerRole Profile(8.0.1)) Point of Contact
URL: http://hl7.org/fhir/us/pacio-toc/StructureDefinition/point-of-contact-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: USCoreDocumentReferenceType (9.0.0) (required): All LOINC values whose SCALE is "Doc" in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
Additional BindingsPurpose
USCoreClinicalNoteType (9.0.0) Min Binding

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... 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://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 18761-7
..... display 1..1 string Representation defined by the system
Fixed Value: Transfer Summary Note
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 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: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
.... category:uscore Σ 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Categorization of document
Binding: USCoreDocumentReferenceCategory (9.0.0) (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile(8.0.1)) 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(8.0.1) | US Core Organization Profile(8.0.1) | US Core Patient Profile(8.0.1)) Who and/or what authored the document
... custodian S 0..1 Reference(US Core Organization Profile(8.0.1)) 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..1 Reference(US Core Encounter Profile(8.0.1)) 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.type Base required US Core DocumentReference Type 📍9.0.0 US Core v9.0
DocumentReference.category Base example Document Class Value Set 📍4.0.1 FHIR Std.
DocumentReference.category:uscore Base required US Core DocumentReference Category 📍9.0.0 US Core v9.0
DocumentReference.content.​attachment.contentType Base required MimeType 📍4.0.1 FHIR Std.
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📍2.1.0 THO v7.3

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 USCoreDocumentReferenceProfile

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreDocumentReferenceProfile(8.0.1) A reference to a document
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:PointOfContactExtension S 0..1 Reference(US Core RelatedPerson Profile(8.0.1) | US Core Practitioner Profile(8.0.1) | US Core PractitionerRole Profile(8.0.1)) Point of Contact
URL: http://hl7.org/fhir/us/pacio-toc/StructureDefinition/point-of-contact-extension
... identifier 0..* Identifier Contains a specialized identifier for the setId used to identify a specific logical document.
... type 1..1 CodeableConcept Kind of document (LOINC if possible)
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 18761-7
..... display 1..1 string Representation defined by the system
Fixed Value: Transfer Summary Note
... date 1..1 instant When this document reference was created
... author 0..* Reference(US Core PractitionerRole Profile(8.0.1) | US Core Organization Profile(8.0.1) | US Core Patient Profile(8.0.1)) Who and/or what authored the document
... custodian S 0..1 Reference(US Core Organization Profile(8.0.1)) 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
.... encounter 0..1 Reference(US Core Encounter Profile(8.0.1)) Context of the document content

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreDocumentReferenceProfile(8.0.1) 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:PointOfContactExtension S 0..1 Reference(US Core RelatedPerson Profile(8.0.1) | US Core Practitioner Profile(8.0.1) | US Core PractitionerRole Profile(8.0.1)) Point of Contact
URL: http://hl7.org/fhir/us/pacio-toc/StructureDefinition/point-of-contact-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: CompositionStatus (required): Status of the underlying document.
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: USCoreDocumentReferenceType (9.0.0) (required): All LOINC values whose SCALE is "Doc" in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
Additional BindingsPurpose
USCoreClinicalNoteType (9.0.0) Min Binding

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... 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://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 18761-7
..... display 1..1 string Representation defined by the system
Fixed Value: Transfer Summary Note
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 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: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
.... category:uscore Σ 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Categorization of document
Binding: USCoreDocumentReferenceCategory (9.0.0) (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile(8.0.1)) 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(8.0.1) | US Core Organization Profile(8.0.1) | US Core Patient Profile(8.0.1)) Who and/or what authored the document
... authenticator 0..1 Reference(Practitioner | PractitionerRole | Organization) Who/what authenticated the document
... custodian S 0..1 Reference(US Core Organization Profile(8.0.1)) 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..1 Reference(US Core Encounter Profile(8.0.1)) Context of the document content
.... event 0..* CodeableConcept Main clinical acts documented
Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented.
.... period 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 CompositionStatus 📍4.0.1 FHIR Std.
DocumentReference.type Base required US Core DocumentReference Type 📍9.0.0 US Core v9.0
DocumentReference.category Base example Document Class Value Set 📍4.0.1 FHIR Std.
DocumentReference.category:uscore Base required US Core DocumentReference Category 📍9.0.0 US Core v9.0
DocumentReference.relatesTo.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
DocumentReference.securityLabel Base extensible SecurityLabels 📍4.0.1 FHIR Std.
DocumentReference.content.​attachment.contentType Base required MimeType 📍4.0.1 FHIR Std.
DocumentReference.content.​attachment.language Base preferred Common Languages 📍4.0.1 FHIR Std.
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📍2.1.0 THO v7.3
DocumentReference.context.​event Base example v3 Code System ActCode 📍3.0.0 THO v7.3
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..* USCoreDocumentReferenceProfile(8.0.1) A reference to a document
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:PointOfContactExtension S 0..1 Reference(US Core RelatedPerson Profile(8.0.1) | US Core Practitioner Profile(8.0.1) | US Core PractitionerRole Profile(8.0.1)) Point of Contact
URL: http://hl7.org/fhir/us/pacio-toc/StructureDefinition/point-of-contact-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: USCoreDocumentReferenceType (9.0.0) (required): All LOINC values whose SCALE is "Doc" in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
Additional BindingsPurpose
USCoreClinicalNoteType (9.0.0) Min Binding

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... 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://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 18761-7
..... display 1..1 string Representation defined by the system
Fixed Value: Transfer Summary Note
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 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: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
.... category:uscore Σ 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Categorization of document
Binding: USCoreDocumentReferenceCategory (9.0.0) (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile(8.0.1)) 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(8.0.1) | US Core Organization Profile(8.0.1) | US Core Patient Profile(8.0.1)) Who and/or what authored the document
... custodian S 0..1 Reference(US Core Organization Profile(8.0.1)) 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..1 Reference(US Core Encounter Profile(8.0.1)) 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.type Base required US Core DocumentReference Type 📍9.0.0 US Core v9.0
DocumentReference.category Base example Document Class Value Set 📍4.0.1 FHIR Std.
DocumentReference.category:uscore Base required US Core DocumentReference Category 📍9.0.0 US Core v9.0
DocumentReference.content.​attachment.contentType Base required MimeType 📍4.0.1 FHIR Std.
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📍2.1.0 THO v7.3

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 USCoreDocumentReferenceProfile

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreDocumentReferenceProfile(8.0.1) A reference to a document
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:PointOfContactExtension S 0..1 Reference(US Core RelatedPerson Profile(8.0.1) | US Core Practitioner Profile(8.0.1) | US Core PractitionerRole Profile(8.0.1)) Point of Contact
URL: http://hl7.org/fhir/us/pacio-toc/StructureDefinition/point-of-contact-extension
... identifier 0..* Identifier Contains a specialized identifier for the setId used to identify a specific logical document.
... type 1..1 CodeableConcept Kind of document (LOINC if possible)
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 18761-7
..... display 1..1 string Representation defined by the system
Fixed Value: Transfer Summary Note
... date 1..1 instant When this document reference was created
... author 0..* Reference(US Core PractitionerRole Profile(8.0.1) | US Core Organization Profile(8.0.1) | US Core Patient Profile(8.0.1)) Who and/or what authored the document
... custodian S 0..1 Reference(US Core Organization Profile(8.0.1)) 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
.... encounter 0..1 Reference(US Core Encounter Profile(8.0.1)) Context of the document content

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* USCoreDocumentReferenceProfile(8.0.1) 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:PointOfContactExtension S 0..1 Reference(US Core RelatedPerson Profile(8.0.1) | US Core Practitioner Profile(8.0.1) | US Core PractitionerRole Profile(8.0.1)) Point of Contact
URL: http://hl7.org/fhir/us/pacio-toc/StructureDefinition/point-of-contact-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: CompositionStatus (required): Status of the underlying document.
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: USCoreDocumentReferenceType (9.0.0) (required): All LOINC values whose SCALE is "Doc" in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
Additional BindingsPurpose
USCoreClinicalNoteType (9.0.0) Min Binding

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... 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://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 18761-7
..... display 1..1 string Representation defined by the system
Fixed Value: Transfer Summary Note
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 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: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
.... category:uscore Σ 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Categorization of document
Binding: USCoreDocumentReferenceCategory (9.0.0) (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile(8.0.1)) 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(8.0.1) | US Core Organization Profile(8.0.1) | US Core Patient Profile(8.0.1)) Who and/or what authored the document
... authenticator 0..1 Reference(Practitioner | PractitionerRole | Organization) Who/what authenticated the document
... custodian S 0..1 Reference(US Core Organization Profile(8.0.1)) 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..1 Reference(US Core Encounter Profile(8.0.1)) Context of the document content
.... event 0..* CodeableConcept Main clinical acts documented
Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented.
.... period 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 CompositionStatus 📍4.0.1 FHIR Std.
DocumentReference.type Base required US Core DocumentReference Type 📍9.0.0 US Core v9.0
DocumentReference.category Base example Document Class Value Set 📍4.0.1 FHIR Std.
DocumentReference.category:uscore Base required US Core DocumentReference Category 📍9.0.0 US Core v9.0
DocumentReference.relatesTo.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
DocumentReference.securityLabel Base extensible SecurityLabels 📍4.0.1 FHIR Std.
DocumentReference.content.​attachment.contentType Base required MimeType 📍4.0.1 FHIR Std.
DocumentReference.content.​attachment.language Base preferred Common Languages 📍4.0.1 FHIR Std.
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📍2.1.0 THO v7.3
DocumentReference.context.​event Base example v3 Code System ActCode 📍3.0.0 THO v7.3
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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