Mobile access to Health Documents (MHD)
5.0.0-current - ci-build International flag

Mobile access to Health Documents (MHD), published by IHE IT Infrastructure Technical Committee. This guide is not an authorized publication; it is the continuous build for version 5.0.0-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/ITI.MHD/ and changes regularly. See the Directory of published versions

Resource Profile: MHD DocumentReference for Simplified Publish

Official URL: https://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.SimplifiedPublish.DocumentReference Version: 5.0.0-current
Active as of 2025-10-13 Computable Name: SimplifiedPublishDocumentReference

A profile on the DocumentReference resource for MHD Simplified Publish constraints.

Simplified Publish

  • Similar to Minimal Metadata constraints
    • must be status current
    • must have a patient indicated
  • uses attachment.data to carry the document, rather than attachment.url
    • so that the Simplified Publish is a simple POST of the DocumentReference
    • Document Recipient is expected to extract the .data, use .url

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 C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:sourcePatientInfo S 0..1 Reference(Patient) Source Patient Information
URL: http://hl7.org/fhir/StructureDefinition/documentreference-sourcepatient
... Slices for identifier SΣ 1..1 Identifier Business identifiers for the document
Slice: Unordered, Open by value:use
.... identifier:uniqueId SΣ 1..1 UniqueIdIdentifier Business identifiers for the document
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Required Pattern: usual
..... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value ΣC 1..1 string The value that is unique
Example General: 123456
... status ?!Σ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
Required Pattern: current
... type SΣ 0..1 CodeableConcept Kind of document (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
... category SΣ 0..1 CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
... subject Σ 1..1 Reference(Patient) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... facilityType SC 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
... practiceSetting SC 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).
... period SΣ 0..1 Period Time of service that is being documented
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
... attester 0..1 BackboneElement Attests to accuracy of the document
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... mode 1..1 CodeableConcept personal | professional | legal | official
Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
.... party 1..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the document
... relatesTo SΣ 0..* BackboneElement Relationships to other documents
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept The relationship type with another document
Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... securityLabel SΣ 0..* CodeableConcept Document security-tags
Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
... content Σ 1..1 BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment Σ 1..1 Attachment Where to access the document
..... contentType ΣC 1..1 code Mime type of the content, with charset etc.
Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Example General: text/plain; charset=UTF-8, image/png
..... language SΣ 0..1 code Human language of the content (BCP-47)
Binding: AllLanguages (required): IETF language tag for a human language.
Additional BindingsPurpose
CommonLanguages Starter

Example General: en-AU
..... data C 1..1 base64Binary The document is contained in the .data element, base64 encoded
..... creation SΣ 0..1 dateTime Date attachment was first created
.... profile SΣ 0..1 BackboneElement Content profile rules for the document
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... Slices for value[x] Σ 1..1 Coding Code|uri|canonical
Slice: Unordered, Closed by type:$this
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
...... value[x]:valueCoding Σ 1..1 Coding Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.identifier:uniqueId.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.type Base preferred FHIR Document Type Codes 📍5.0.0 FHIR Std.
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.facilityType Base example Facility Type Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.practiceSetting Base example Practice Setting Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.attester.​mode Base preferred Composition Attestation Mode 📍5.0.0 FHIR Std.
DocumentReference.relatesTo.​code Base extensible Document Relationship Type 📍5.0.0 FHIR Std.
DocumentReference.securityLabel Base example Example set of Security Labels 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.content.​profile.value[x]:valueCoding Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error DocumentReference If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error DocumentReference If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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()
docRef-1 warning DocumentReference facilityType SHALL only be present if context is not an encounter facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2 warning DocumentReference practiceSetting SHALL only be present if context is not present practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from DocumentReference

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:sourcePatientInfo S 0..1 Reference(Patient) Source Patient Information
URL: http://hl7.org/fhir/StructureDefinition/documentreference-sourcepatient
... modifierExtension 0..0
... Slices for identifier S 1..1 Identifier Business identifiers for the document
Slice: Unordered, Open by value:use
.... identifier:uniqueId S 1..1 UniqueIdIdentifier Business identifiers for the document
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
... status 1..1 code current | superseded | entered-in-error
Required Pattern: current
... docStatus 0..0
... type S 0..1 CodeableConcept Kind of document (LOINC if possible)
... category S 0..1 CodeableConcept Categorization of document
... subject 1..1 Reference(Patient) Who/what is the subject of the document
... event
.... concept 1..1 CodeableConcept Reference to a concept (by class)
... facilityType S 0..1 CodeableConcept Kind of facility where patient was seen
... practiceSetting S 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty)
... period S 0..1 Period Time of service that is being documented
... date S 0..1 instant When this document reference was created
... author S 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
... attester 0..1 BackboneElement Attests to accuracy of the document
.... party 1..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the document
... relatesTo S 0..* BackboneElement Relationships to other documents
... securityLabel S 0..* CodeableConcept Document security-tags
... content 1..1 BackboneElement Document referenced
.... attachment
..... contentType 1..1 code Mime type of the content, with charset etc.
..... language S 0..1 code Human language of the content (BCP-47)
..... data 1..1 base64Binary The document is contained in the .data element, base64 encoded
..... url 0..0
..... creation S 0..1 dateTime Date attachment was first created
.... profile S 0..1 BackboneElement Content profile rules for the document
..... Slices for value[x] 1..1 Coding Code|uri|canonical
Slice: Unordered, Open by type:$this
...... value[x]:valueCoding 1..1 Coding Code|uri|canonical

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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:sourcePatientInfo S 0..1 Reference(Patient) Source Patient Information
URL: http://hl7.org/fhir/StructureDefinition/documentreference-sourcepatient
... Slices for identifier SΣ 1..1 Identifier Business identifiers for the document
Slice: Unordered, Open by value:use
.... identifier:uniqueId SΣ 1..1 UniqueIdIdentifier Business identifiers for the document
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value ΣC 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... version Σ 0..1 string An explicitly assigned identifer of a variation of the content in the DocumentReference
... basedOn 0..* Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) Procedure that caused this media to be created
... status ?!Σ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
Required Pattern: current
... modality Σ 0..* CodeableConcept Imaging modality used
Binding: Modality . (extensible): Type of acquired data in the instance.
... type SΣ 0..1 CodeableConcept Kind of document (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
... category SΣ 0..1 CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
... subject Σ 1..1 Reference(Patient) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... event 0..* CodeableReference() Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... concept Σ 1..1 CodeableConcept Reference to a concept (by class)
.... reference Σ 0..1 Reference() Reference to a resource (by instance)
... bodySite Σ 0..* CodeableReference(BodyStructure) Body part included
Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
... facilityType SC 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
... practiceSetting SC 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).
... period SΣ 0..1 Period Time of service that is being documented
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
... attester 0..1 BackboneElement Attests to accuracy of the 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
.... mode 1..1 CodeableConcept personal | professional | legal | official
Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
.... time 0..1 dateTime When the document was attested
.... party 1..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the document
... custodian 0..1 Reference(Organization) Organization which maintains the document
... relatesTo SΣ 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 CodeableConcept The relationship type with another document
Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 markdown Human-readable description
... securityLabel SΣ 0..* CodeableConcept Document security-tags
Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
... content Σ 1..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 Σ 1..1 Attachment Where to access the document
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... contentType ΣC 1..1 code Mime type of the content, with charset etc.
Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Example General: text/plain; charset=UTF-8, image/png
..... language SΣ 0..1 code Human language of the content (BCP-47)
Binding: AllLanguages (required): IETF language tag for a human language.
Additional BindingsPurpose
CommonLanguages Starter

Example General: en-AU
..... data C 1..1 base64Binary The document is contained in the .data element, base64 encoded
..... size Σ 0..1 integer64 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 0..1 dateTime Date attachment was first created
..... height 0..1 positiveInt Height of the image in pixels (photo/video)
..... width 0..1 positiveInt Width of the image in pixels (photo/video)
..... frames 0..1 positiveInt Number of frames if > 1 (photo)
..... duration 0..1 decimal Length in seconds (audio / video)
..... pages 0..1 positiveInt Number of printed pages
.... profile SΣ 0..1 BackboneElement Content profile rules for the 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
..... Slices for value[x] Σ 1..1 Coding Code|uri|canonical
Slice: Unordered, Closed by type:$this
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
...... value[x]:valueCoding Σ 1..1 Coding Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.identifier:uniqueId.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:uniqueId.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.modality Base extensible Modality . ⏿2025.3.20250714 tx.fhir.org
DocumentReference.type Base preferred FHIR Document Type Codes 📍5.0.0 FHIR Std.
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.event Base example v3 Code System ActCode 📦3.0.0 THO v6.5
DocumentReference.bodySite Base example SNOMED CT Body Structures 📍5.0.0 FHIR Std.
DocumentReference.facilityType Base example Facility Type Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.practiceSetting Base example Practice Setting Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.attester.​mode Base preferred Composition Attestation Mode 📍5.0.0 FHIR Std.
DocumentReference.relatesTo.​code Base extensible Document Relationship Type 📍5.0.0 FHIR Std.
DocumentReference.securityLabel Base example Example set of Security Labels 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.content.​profile.value[x]:valueCoding Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error DocumentReference If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error DocumentReference If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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()
docRef-1 warning DocumentReference facilityType SHALL only be present if context is not an encounter facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2 warning DocumentReference practiceSetting SHALL only be present if context is not present practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from DocumentReference

Summary

Mandatory: 6 elements(3 nested mandatory elements)
Must-Support: 15 elements
Prohibited: 3 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of DocumentReference.identifier
  • The element 1 is sliced based on the value of DocumentReference.content.profile.value[x]

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:sourcePatientInfo S 0..1 Reference(Patient) Source Patient Information
URL: http://hl7.org/fhir/StructureDefinition/documentreference-sourcepatient
... Slices for identifier SΣ 1..1 Identifier Business identifiers for the document
Slice: Unordered, Open by value:use
.... identifier:uniqueId SΣ 1..1 UniqueIdIdentifier Business identifiers for the document
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Required Pattern: usual
..... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value ΣC 1..1 string The value that is unique
Example General: 123456
... status ?!Σ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
Required Pattern: current
... type SΣ 0..1 CodeableConcept Kind of document (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
... category SΣ 0..1 CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
... subject Σ 1..1 Reference(Patient) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... facilityType SC 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
... practiceSetting SC 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).
... period SΣ 0..1 Period Time of service that is being documented
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
... attester 0..1 BackboneElement Attests to accuracy of the document
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... mode 1..1 CodeableConcept personal | professional | legal | official
Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
.... party 1..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the document
... relatesTo SΣ 0..* BackboneElement Relationships to other documents
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept The relationship type with another document
Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... securityLabel SΣ 0..* CodeableConcept Document security-tags
Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
... content Σ 1..1 BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment Σ 1..1 Attachment Where to access the document
..... contentType ΣC 1..1 code Mime type of the content, with charset etc.
Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Example General: text/plain; charset=UTF-8, image/png
..... language SΣ 0..1 code Human language of the content (BCP-47)
Binding: AllLanguages (required): IETF language tag for a human language.
Additional BindingsPurpose
CommonLanguages Starter

Example General: en-AU
..... data C 1..1 base64Binary The document is contained in the .data element, base64 encoded
..... creation SΣ 0..1 dateTime Date attachment was first created
.... profile SΣ 0..1 BackboneElement Content profile rules for the document
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... Slices for value[x] Σ 1..1 Coding Code|uri|canonical
Slice: Unordered, Closed by type:$this
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
...... value[x]:valueCoding Σ 1..1 Coding Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.identifier:uniqueId.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.type Base preferred FHIR Document Type Codes 📍5.0.0 FHIR Std.
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.facilityType Base example Facility Type Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.practiceSetting Base example Practice Setting Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.attester.​mode Base preferred Composition Attestation Mode 📍5.0.0 FHIR Std.
DocumentReference.relatesTo.​code Base extensible Document Relationship Type 📍5.0.0 FHIR Std.
DocumentReference.securityLabel Base example Example set of Security Labels 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.content.​profile.value[x]:valueCoding Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error DocumentReference If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error DocumentReference If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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()
docRef-1 warning DocumentReference facilityType SHALL only be present if context is not an encounter facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2 warning DocumentReference practiceSetting SHALL only be present if context is not present practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from DocumentReference

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:sourcePatientInfo S 0..1 Reference(Patient) Source Patient Information
URL: http://hl7.org/fhir/StructureDefinition/documentreference-sourcepatient
... modifierExtension 0..0
... Slices for identifier S 1..1 Identifier Business identifiers for the document
Slice: Unordered, Open by value:use
.... identifier:uniqueId S 1..1 UniqueIdIdentifier Business identifiers for the document
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
... status 1..1 code current | superseded | entered-in-error
Required Pattern: current
... docStatus 0..0
... type S 0..1 CodeableConcept Kind of document (LOINC if possible)
... category S 0..1 CodeableConcept Categorization of document
... subject 1..1 Reference(Patient) Who/what is the subject of the document
... event
.... concept 1..1 CodeableConcept Reference to a concept (by class)
... facilityType S 0..1 CodeableConcept Kind of facility where patient was seen
... practiceSetting S 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty)
... period S 0..1 Period Time of service that is being documented
... date S 0..1 instant When this document reference was created
... author S 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
... attester 0..1 BackboneElement Attests to accuracy of the document
.... party 1..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the document
... relatesTo S 0..* BackboneElement Relationships to other documents
... securityLabel S 0..* CodeableConcept Document security-tags
... content 1..1 BackboneElement Document referenced
.... attachment
..... contentType 1..1 code Mime type of the content, with charset etc.
..... language S 0..1 code Human language of the content (BCP-47)
..... data 1..1 base64Binary The document is contained in the .data element, base64 encoded
..... url 0..0
..... creation S 0..1 dateTime Date attachment was first created
.... profile S 0..1 BackboneElement Content profile rules for the document
..... Slices for value[x] 1..1 Coding Code|uri|canonical
Slice: Unordered, Open by type:$this
...... value[x]:valueCoding 1..1 Coding Code|uri|canonical

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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:sourcePatientInfo S 0..1 Reference(Patient) Source Patient Information
URL: http://hl7.org/fhir/StructureDefinition/documentreference-sourcepatient
... Slices for identifier SΣ 1..1 Identifier Business identifiers for the document
Slice: Unordered, Open by value:use
.... identifier:uniqueId SΣ 1..1 UniqueIdIdentifier Business identifiers for the document
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value ΣC 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... version Σ 0..1 string An explicitly assigned identifer of a variation of the content in the DocumentReference
... basedOn 0..* Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) Procedure that caused this media to be created
... status ?!Σ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
Required Pattern: current
... modality Σ 0..* CodeableConcept Imaging modality used
Binding: Modality . (extensible): Type of acquired data in the instance.
... type SΣ 0..1 CodeableConcept Kind of document (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
... category SΣ 0..1 CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
... subject Σ 1..1 Reference(Patient) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... event 0..* CodeableReference() Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... concept Σ 1..1 CodeableConcept Reference to a concept (by class)
.... reference Σ 0..1 Reference() Reference to a resource (by instance)
... bodySite Σ 0..* CodeableReference(BodyStructure) Body part included
Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
... facilityType SC 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
... practiceSetting SC 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).
... period SΣ 0..1 Period Time of service that is being documented
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
... attester 0..1 BackboneElement Attests to accuracy of the 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
.... mode 1..1 CodeableConcept personal | professional | legal | official
Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
.... time 0..1 dateTime When the document was attested
.... party 1..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the document
... custodian 0..1 Reference(Organization) Organization which maintains the document
... relatesTo SΣ 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 CodeableConcept The relationship type with another document
Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 markdown Human-readable description
... securityLabel SΣ 0..* CodeableConcept Document security-tags
Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
... content Σ 1..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 Σ 1..1 Attachment Where to access the document
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... contentType ΣC 1..1 code Mime type of the content, with charset etc.
Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Example General: text/plain; charset=UTF-8, image/png
..... language SΣ 0..1 code Human language of the content (BCP-47)
Binding: AllLanguages (required): IETF language tag for a human language.
Additional BindingsPurpose
CommonLanguages Starter

Example General: en-AU
..... data C 1..1 base64Binary The document is contained in the .data element, base64 encoded
..... size Σ 0..1 integer64 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 0..1 dateTime Date attachment was first created
..... height 0..1 positiveInt Height of the image in pixels (photo/video)
..... width 0..1 positiveInt Width of the image in pixels (photo/video)
..... frames 0..1 positiveInt Number of frames if > 1 (photo)
..... duration 0..1 decimal Length in seconds (audio / video)
..... pages 0..1 positiveInt Number of printed pages
.... profile SΣ 0..1 BackboneElement Content profile rules for the 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
..... Slices for value[x] Σ 1..1 Coding Code|uri|canonical
Slice: Unordered, Closed by type:$this
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
...... value[x]:valueCoding Σ 1..1 Coding Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.identifier:uniqueId.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:uniqueId.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.modality Base extensible Modality . ⏿2025.3.20250714 tx.fhir.org
DocumentReference.type Base preferred FHIR Document Type Codes 📍5.0.0 FHIR Std.
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.event Base example v3 Code System ActCode 📦3.0.0 THO v6.5
DocumentReference.bodySite Base example SNOMED CT Body Structures 📍5.0.0 FHIR Std.
DocumentReference.facilityType Base example Facility Type Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.practiceSetting Base example Practice Setting Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.attester.​mode Base preferred Composition Attestation Mode 📍5.0.0 FHIR Std.
DocumentReference.relatesTo.​code Base extensible Document Relationship Type 📍5.0.0 FHIR Std.
DocumentReference.securityLabel Base example Example set of Security Labels 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.content.​profile.value[x]:valueCoding Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error DocumentReference If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error DocumentReference If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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()
docRef-1 warning DocumentReference facilityType SHALL only be present if context is not an encounter facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2 warning DocumentReference practiceSetting SHALL only be present if context is not present practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from DocumentReference

Summary

Mandatory: 6 elements(3 nested mandatory elements)
Must-Support: 15 elements
Prohibited: 3 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of DocumentReference.identifier
  • The element 1 is sliced based on the value of DocumentReference.content.profile.value[x]

 

Other representations of profile: CSV, Excel, Schematron