Manifest-based Access to DICOM Objects (MADO)
0.0.1-current - ci-build

Manifest-based Access to DICOM Objects (MADO), published by IHE Radiology Technical Committee. This guide is not an authorized publication; it is the continuous build for version 0.0.1-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/RAD.MADO/ and changes regularly. See the Directory of published versions

## Resource Profile: MADO MHD DocumentReference Profile for FHIR Imaging Manifests

Official URL: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirMinimalDocumentReference | Version: 0.0.1-current
Standards status: Draft | Maturity Level: 1 | Computable Name: MadoFhirMinimalDocumentReference

MADO specific profile for the IHE-MHD Minimal Document Reference for MADO FHIR Manifests that includes the MADO specific content format, the extensions related to body-site and modality, and the definition on where `StudyInstanceUID` and `AccessionNumber` are stored.

Usages:

- Refer to this Profile: MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests
- Examples for this Profile: DocumentReference/DocumentReferenceFHIR and DocumentReference/DocumentReferenceFHIRwithTransform

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.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | MinimalDocumentReference | A reference to a document Constraints: mado-documentreference-masterIdentifier-also-identifier
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:bodysite |  | 0..1 | (Complex) | Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept |  | 1..1 | Extension | The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "concept"
value[x] |  | 0..1 | CodeableConcept | Reference to a concept (by class) Binding: Anatomical Region (extensible)
extension:reference |  | 0..1 | Extension | Reference to a resource (by instance) Constraints: ext-1
url |  | 1..1 | uri | "reference"
extension:_datatype |  | 0..1 | (Complex) | Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/_datatype"
value[x] |  | 1..1 | string | Value of extension Fixed Value: CodeableReference
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality |  | 1..1 | CodeableConcept | Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier | Σ | 1..1 | UniqueIdIdentifier | The identifier of the FHIR bundle manifest.
Slices for identifier | S Σ | 0..* | Identifier | Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID | S Σ | 0..* | EntryUUIDIdentifier | Other identifiers for the document
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: MHD DocumentReference status codes (required)
type | S Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category | S Σ | 0..1 | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | S Σ | 0..1 | Reference(Patient) | Who/what is the subject of the document
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson) | Who and/or what authored the document
Slices for relatesTo | S Σ | 0..* | BackboneElement | Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:All Slices |  |  |  | Content/Rules for all slices
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
relatesTo:kosReference | S Σ | 0..1 | BackboneElement | Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
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. Required Pattern: transforms
target | Σ | 1..1 | Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests) | Target of the relationship
securityLabel | S Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | Σ | 1..1 | BackboneElement | Document referenced
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:profile |  | 1..* | (Complex) | Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile Constraints: ext-1
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:value[x] |  | 1..1 | Extension | Extension Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "value[x]"
Slices for value[x] |  | 0..1 |  | Code|uri|canonical Slice: Unordered, Open by type:$this Binding: R5_v3_HL7FormatCodes_for_R4 (0.0.1-snapshot-2) (preferred): Document Format Codes.
valueCoding |  |  | Coding |
valueUri |  |  | uri |
valueCanonical |  |  | canonical(Any) |
value[x]:valueCanonical |  | 0..1 | canonical() | Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile"
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | Σ | 1..1 | Attachment | Where to access the document
contentType | Σ | 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. Required Pattern: application/fhir+json
language | S Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Example General: en-AU
url | Σ | 1..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
creation | S Σ | 0..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred) 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://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
context | Σ | 1..1 | BackboneElement | The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
period | S Σ | 0..1 | Period | Time of service that is being documented
facilityType | S | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | S | 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 | S | 0..1 | Reference(Patient) | Patient demographics from source
Slices for related |  | 1..* | Reference(Resource) | Related identifiers or resources Slice: Unordered, Open by profile:identifier
related:study-instance-uid |  | 1..1 | MadoReferencedStudyInstanceUidIdentifier(Resource) | The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number |  | 0..1 | Reference(ServiceRequest: Requested Procedure for Imaging Study) | Related identifiers or resources
identifier | Σ | 0..1 | MadoAccessionNumberIdentifier | SHALL contain the identifier for the referenced ServiceRequest that contains the Accession Number Identifier when present.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.extension:bodysite.​extension:concept.value[x] | Base | extensible | Anatomical Region | 📦0.0.1-current | This IG
DocumentReference.status | Base | required | MHD DocumentReference status codes | 📦4.2.4-current | Mobile access to Health Documents vnull
DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo:kosReference.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
DocumentReference.content.​extension:profile.extension:value[x].​value[x] | Base | preferred | Cross-version VS for R5.HL7FormatCodes for use in FHIR R4 | 📍0.0.1-snapshot-2 | FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 v0.0
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 | preferred | IHE ValueSet of Format Codes for use with Document Sharing | 📦1.5.1-current | IHE FormatCode Vocabulary vnull
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()`
mado-documentreference-masterIdentifier-also-identifier | error | DocumentReference | masterIdentifier, when used, need to be present as an identifier as well | `masterIdentifier.exists() implies identifier.where( %resource.masterIdentifier.system = system and %resource.masterIdentifier.value = value ).exists()`

This structure is derived from MinimalDocumentReference

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | MinimalDocumentReference | A reference to a document Constraints: mado-documentreference-masterIdentifier-also-identifier
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:bodysite |  | 0..1 | (Complex) | Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite
extension |  | 1..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:concept |  | 1..1 | Extension | The anatomical region of the patient that is the focus of the imaging manifest, concept field is required.
extension |  | 0..0 |  | Extension
value[x] |  | 0..1 | CodeableConcept | Reference to a concept (by class) Binding: Anatomical Region (extensible)
value[x] |  | 0..0 |  | Value of extension
extension:modality |  | 1..1 | CodeableConcept | Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance.
masterIdentifier |  | 1..1 | UniqueIdIdentifier | The identifier of the FHIR bundle manifest.
Slices for relatesTo |  | 0..* | BackboneElement | Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:kosReference |  | 0..1 | BackboneElement | Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
code |  | 1..1 | code | replaces | transforms | signs | appends Required Pattern: transforms
target |  | 1..1 | Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests) | Target of the relationship
content |  |  |  |
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:profile |  | 1..* | (Complex) | Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile
Slices for extension |  |  |  | Content/Rules for all slices
extension:value[x] |  | 1..1 | Extension | Extension
extension |  | 0..0 |  | Extension
Slices for value[x] |  | 0..1 | Coding, uri, canonical() | Code|uri|canonical Slice: Unordered, Open by type:$this
value[x]:valueCanonical |  | 0..1 | canonical() | Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
value[x] |  | 0..0 |  | Value of extension
attachment |  |  |  |
contentType |  | 1..1 | code | Mime type of the content, with charset etc. Required Pattern: application/fhir+json
format |  | 0..1 | Coding | Format/content rules for the document Required Pattern: At least the following
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026
context |  | 1..1 | BackboneElement | The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
Slices for related |  | 1..* | Reference(Resource) | Related identifiers or resources Slice: Unordered, Open by profile:identifier
related:study-instance-uid |  | 1..1 | MadoReferencedStudyInstanceUidIdentifier(Resource) | The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number |  | 0..1 | Reference(ServiceRequest: Requested Procedure for Imaging Study) | Related identifiers or resources
identifier |  | 0..1 | MadoAccessionNumberIdentifier | SHALL contain the identifier for the referenced ServiceRequest that contains the Accession Number Identifier when present.
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.extension:bodysite.​extension:concept.value[x] | Base | extensible | Anatomical Region | 📦0.0.1-current | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
mado-documentreference-masterIdentifier-also-identifier | error | DocumentReference | masterIdentifier, when used, need to be present as an identifier as well | `masterIdentifier.exists() implies identifier.where( %resource.masterIdentifier.system = system and %resource.masterIdentifier.value = value ).exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | MinimalDocumentReference | A reference to a document Constraints: mado-documentreference-masterIdentifier-also-identifier
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
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 |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:bodysite |  | 0..1 | (Complex) | Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept |  | 1..1 | Extension | The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "concept"
value[x] |  | 0..1 | CodeableConcept | Reference to a concept (by class) Binding: Anatomical Region (extensible)
extension:reference |  | 0..1 | Extension | Reference to a resource (by instance) Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "reference"
value[x] |  | 0..1 | Reference() | Reference to a resource (by instance)
extension:_datatype |  | 0..1 | (Complex) | Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/_datatype"
value[x] |  | 1..1 | string | Value of extension Fixed Value: CodeableReference
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality |  | 1..1 | CodeableConcept | Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier | Σ | 1..1 | UniqueIdIdentifier | The identifier of the FHIR bundle manifest.
Slices for identifier | S Σ | 0..* | Identifier | Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID | S Σ | 0..* | EntryUUIDIdentifier | Other identifiers for the document
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: MHD DocumentReference status codes (required)
type | S Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category | S Σ | 0..1 | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | S Σ | 0..1 | Reference(Patient) | Who/what is the subject of the document
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson) | Who and/or what authored the document
authenticator |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Who/what authenticated the document
custodian |  | 0..1 | Reference(Organization) | Organization which maintains the document
Slices for relatesTo | S Σ | 0..* | BackboneElement | Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:All Slices |  |  |  | Content/Rules for all slices
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
relatesTo:kosReference | S Σ | 0..1 | BackboneElement | Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
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. Required Pattern: transforms
target | Σ | 1..1 | Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | S Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): 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
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:profile |  | 1..* | (Complex) | Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:value[x] |  | 1..1 | Extension | Extension Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "value[x]"
Slices for value[x] |  | 0..1 |  | Code|uri|canonical Slice: Unordered, Open by type:$this Binding: R5_v3_HL7FormatCodes_for_R4 (0.0.1-snapshot-2) (preferred): Document Format Codes.
valueCoding |  |  | Coding |
valueUri |  |  | uri |
valueCanonical |  |  | canonical(Any) |
value[x]:valueCanonical |  | 0..1 | canonical() | Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile"
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 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | Σ | 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. Required Pattern: application/fhir+json
language | S Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Example General: en-AU
url | Σ | 1..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 | S Σ | 0..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred) 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://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
context | Σ | 1..1 | BackboneElement | The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
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 |  | 0..* | Reference(Encounter | EpisodeOfCare) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
start | Σ C | 0..1 | dateTime | Starting time with inclusive boundary
end | Σ C | 0..1 | dateTime | End time with inclusive boundary, if not ongoing
facilityType | S | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | S | 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 | S | 0..1 | Reference(Patient) | Patient demographics from source
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
Slices for related |  | 1..* | Reference(Resource) | Related identifiers or resources Slice: Unordered, Open by profile:identifier
related:study-instance-uid |  | 1..1 | MadoReferencedStudyInstanceUidIdentifier(Resource) | The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number |  | 0..1 | Reference(ServiceRequest: Requested Procedure for Imaging Study) | Related identifiers or resources
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | MadoAccessionNumberIdentifier | SHALL contain the identifier for the referenced ServiceRequest that contains the Accession Number Identifier when present.
display | Σ | 0..1 | string | Text alternative for the resource
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.meta.​security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
DocumentReference.meta.​tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std.
DocumentReference.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DocumentReference.extension:bodysite.​extension:concept.value[x] | Base | extensible | Anatomical Region | 📦0.0.1-current | This IG
DocumentReference.status | Base | required | MHD DocumentReference status codes | 📦4.2.4-current | Mobile access to Health Documents vnull
DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo:kosReference.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
DocumentReference.content.​extension:profile.extension:value[x].​value[x] | Base | preferred | Cross-version VS for R5.HL7FormatCodes for use in FHIR R4 | 📍0.0.1-snapshot-2 | FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 v0.0
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 | preferred | IHE ValueSet of Format Codes for use with Document Sharing | 📦1.5.1-current | IHE FormatCode Vocabulary vnull
DocumentReference.context.​event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v7.1
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.
DocumentReference.context.​sourcePatientInfo.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
DocumentReference.context.​related:accession-number.​type | Base | extensible | ResourceType | 📍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()`
mado-documentreference-masterIdentifier-also-identifier | error | DocumentReference | masterIdentifier, when used, need to be present as an identifier as well | `masterIdentifier.exists() implies identifier.where( %resource.masterIdentifier.system = system and %resource.masterIdentifier.value = value ).exists()`

This structure is derived from MinimalDocumentReference

Summary

Mandatory: 7 elements(2 nested mandatory elements)
Prohibited: 4 elements

Structures

This structure refers to these other structures:

- MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests (https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoDicomKosMinimalDocumentReference)
- MADO Referenced Study Instance UID Identifier (https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoReferencedStudyInstanceUidIdentifier)
- Resource (http://hl7.org/fhir/StructureDefinition/Resource|4.0.1)
- ServiceRequest: Requested Procedure for Imaging Study (https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoRequestedProcedureOrder)
- MADO Accession Number Identifier (https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoAccessionNumberIdentifier)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite
- http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality
- http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of DocumentReference.relatesTo
- The element 1 is sliced based on the value of DocumentReference.content.extension.extension.value[x]
- The element 1 is sliced based on the value of DocumentReference.context.related

Maturity: 1

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | MinimalDocumentReference | A reference to a document Constraints: mado-documentreference-masterIdentifier-also-identifier
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:bodysite |  | 0..1 | (Complex) | Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept |  | 1..1 | Extension | The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "concept"
value[x] |  | 0..1 | CodeableConcept | Reference to a concept (by class) Binding: Anatomical Region (extensible)
extension:reference |  | 0..1 | Extension | Reference to a resource (by instance) Constraints: ext-1
url |  | 1..1 | uri | "reference"
extension:_datatype |  | 0..1 | (Complex) | Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/_datatype"
value[x] |  | 1..1 | string | Value of extension Fixed Value: CodeableReference
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality |  | 1..1 | CodeableConcept | Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier | Σ | 1..1 | UniqueIdIdentifier | The identifier of the FHIR bundle manifest.
Slices for identifier | S Σ | 0..* | Identifier | Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID | S Σ | 0..* | EntryUUIDIdentifier | Other identifiers for the document
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: MHD DocumentReference status codes (required)
type | S Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category | S Σ | 0..1 | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | S Σ | 0..1 | Reference(Patient) | Who/what is the subject of the document
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson) | Who and/or what authored the document
Slices for relatesTo | S Σ | 0..* | BackboneElement | Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:All Slices |  |  |  | Content/Rules for all slices
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
relatesTo:kosReference | S Σ | 0..1 | BackboneElement | Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
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. Required Pattern: transforms
target | Σ | 1..1 | Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests) | Target of the relationship
securityLabel | S Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | Σ | 1..1 | BackboneElement | Document referenced
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:profile |  | 1..* | (Complex) | Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile Constraints: ext-1
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:value[x] |  | 1..1 | Extension | Extension Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "value[x]"
Slices for value[x] |  | 0..1 |  | Code|uri|canonical Slice: Unordered, Open by type:$this Binding: R5_v3_HL7FormatCodes_for_R4 (0.0.1-snapshot-2) (preferred): Document Format Codes.
valueCoding |  |  | Coding |
valueUri |  |  | uri |
valueCanonical |  |  | canonical(Any) |
value[x]:valueCanonical |  | 0..1 | canonical() | Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile"
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | Σ | 1..1 | Attachment | Where to access the document
contentType | Σ | 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. Required Pattern: application/fhir+json
language | S Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Example General: en-AU
url | Σ | 1..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
creation | S Σ | 0..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred) 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://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
context | Σ | 1..1 | BackboneElement | The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
period | S Σ | 0..1 | Period | Time of service that is being documented
facilityType | S | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | S | 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 | S | 0..1 | Reference(Patient) | Patient demographics from source
Slices for related |  | 1..* | Reference(Resource) | Related identifiers or resources Slice: Unordered, Open by profile:identifier
related:study-instance-uid |  | 1..1 | MadoReferencedStudyInstanceUidIdentifier(Resource) | The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number |  | 0..1 | Reference(ServiceRequest: Requested Procedure for Imaging Study) | Related identifiers or resources
identifier | Σ | 0..1 | MadoAccessionNumberIdentifier | SHALL contain the identifier for the referenced ServiceRequest that contains the Accession Number Identifier when present.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.extension:bodysite.​extension:concept.value[x] | Base | extensible | Anatomical Region | 📦0.0.1-current | This IG
DocumentReference.status | Base | required | MHD DocumentReference status codes | 📦4.2.4-current | Mobile access to Health Documents vnull
DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo:kosReference.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
DocumentReference.content.​extension:profile.extension:value[x].​value[x] | Base | preferred | Cross-version VS for R5.HL7FormatCodes for use in FHIR R4 | 📍0.0.1-snapshot-2 | FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 v0.0
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 | preferred | IHE ValueSet of Format Codes for use with Document Sharing | 📦1.5.1-current | IHE FormatCode Vocabulary vnull
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()`
mado-documentreference-masterIdentifier-also-identifier | error | DocumentReference | masterIdentifier, when used, need to be present as an identifier as well | `masterIdentifier.exists() implies identifier.where( %resource.masterIdentifier.system = system and %resource.masterIdentifier.value = value ).exists()`

Differential View

This structure is derived from MinimalDocumentReference

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | MinimalDocumentReference | A reference to a document Constraints: mado-documentreference-masterIdentifier-also-identifier
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:bodysite |  | 0..1 | (Complex) | Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite
extension |  | 1..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:concept |  | 1..1 | Extension | The anatomical region of the patient that is the focus of the imaging manifest, concept field is required.
extension |  | 0..0 |  | Extension
value[x] |  | 0..1 | CodeableConcept | Reference to a concept (by class) Binding: Anatomical Region (extensible)
value[x] |  | 0..0 |  | Value of extension
extension:modality |  | 1..1 | CodeableConcept | Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance.
masterIdentifier |  | 1..1 | UniqueIdIdentifier | The identifier of the FHIR bundle manifest.
Slices for relatesTo |  | 0..* | BackboneElement | Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:kosReference |  | 0..1 | BackboneElement | Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
code |  | 1..1 | code | replaces | transforms | signs | appends Required Pattern: transforms
target |  | 1..1 | Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests) | Target of the relationship
content |  |  |  |
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:profile |  | 1..* | (Complex) | Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile
Slices for extension |  |  |  | Content/Rules for all slices
extension:value[x] |  | 1..1 | Extension | Extension
extension |  | 0..0 |  | Extension
Slices for value[x] |  | 0..1 | Coding, uri, canonical() | Code|uri|canonical Slice: Unordered, Open by type:$this
value[x]:valueCanonical |  | 0..1 | canonical() | Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
value[x] |  | 0..0 |  | Value of extension
attachment |  |  |  |
contentType |  | 1..1 | code | Mime type of the content, with charset etc. Required Pattern: application/fhir+json
format |  | 0..1 | Coding | Format/content rules for the document Required Pattern: At least the following
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026
context |  | 1..1 | BackboneElement | The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
Slices for related |  | 1..* | Reference(Resource) | Related identifiers or resources Slice: Unordered, Open by profile:identifier
related:study-instance-uid |  | 1..1 | MadoReferencedStudyInstanceUidIdentifier(Resource) | The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number |  | 0..1 | Reference(ServiceRequest: Requested Procedure for Imaging Study) | Related identifiers or resources
identifier |  | 0..1 | MadoAccessionNumberIdentifier | SHALL contain the identifier for the referenced ServiceRequest that contains the Accession Number Identifier when present.
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.extension:bodysite.​extension:concept.value[x] | Base | extensible | Anatomical Region | 📦0.0.1-current | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
mado-documentreference-masterIdentifier-also-identifier | error | DocumentReference | masterIdentifier, when used, need to be present as an identifier as well | `masterIdentifier.exists() implies identifier.where( %resource.masterIdentifier.system = system and %resource.masterIdentifier.value = value ).exists()`

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | MinimalDocumentReference | A reference to a document Constraints: mado-documentreference-masterIdentifier-also-identifier
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
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 |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:bodysite |  | 0..1 | (Complex) | Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept |  | 1..1 | Extension | The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "concept"
value[x] |  | 0..1 | CodeableConcept | Reference to a concept (by class) Binding: Anatomical Region (extensible)
extension:reference |  | 0..1 | Extension | Reference to a resource (by instance) Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "reference"
value[x] |  | 0..1 | Reference() | Reference to a resource (by instance)
extension:_datatype |  | 0..1 | (Complex) | Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/_datatype"
value[x] |  | 1..1 | string | Value of extension Fixed Value: CodeableReference
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality |  | 1..1 | CodeableConcept | Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier | Σ | 1..1 | UniqueIdIdentifier | The identifier of the FHIR bundle manifest.
Slices for identifier | S Σ | 0..* | Identifier | Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID | S Σ | 0..* | EntryUUIDIdentifier | Other identifiers for the document
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: MHD DocumentReference status codes (required)
type | S Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category | S Σ | 0..1 | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | S Σ | 0..1 | Reference(Patient) | Who/what is the subject of the document
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson) | Who and/or what authored the document
authenticator |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Who/what authenticated the document
custodian |  | 0..1 | Reference(Organization) | Organization which maintains the document
Slices for relatesTo | S Σ | 0..* | BackboneElement | Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:All Slices |  |  |  | Content/Rules for all slices
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
relatesTo:kosReference | S Σ | 0..1 | BackboneElement | Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
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. Required Pattern: transforms
target | Σ | 1..1 | Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | S Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): 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
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:profile |  | 1..* | (Complex) | Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:value[x] |  | 1..1 | Extension | Extension Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "value[x]"
Slices for value[x] |  | 0..1 |  | Code|uri|canonical Slice: Unordered, Open by type:$this Binding: R5_v3_HL7FormatCodes_for_R4 (0.0.1-snapshot-2) (preferred): Document Format Codes.
valueCoding |  |  | Coding |
valueUri |  |  | uri |
valueCanonical |  |  | canonical(Any) |
value[x]:valueCanonical |  | 0..1 | canonical() | Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile"
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 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | Σ | 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. Required Pattern: application/fhir+json
language | S Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Example General: en-AU
url | Σ | 1..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 | S Σ | 0..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred) 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://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
context | Σ | 1..1 | BackboneElement | The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
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 |  | 0..* | Reference(Encounter | EpisodeOfCare) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
start | Σ C | 0..1 | dateTime | Starting time with inclusive boundary
end | Σ C | 0..1 | dateTime | End time with inclusive boundary, if not ongoing
facilityType | S | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | S | 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 | S | 0..1 | Reference(Patient) | Patient demographics from source
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
Slices for related |  | 1..* | Reference(Resource) | Related identifiers or resources Slice: Unordered, Open by profile:identifier
related:study-instance-uid |  | 1..1 | MadoReferencedStudyInstanceUidIdentifier(Resource) | The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number |  | 0..1 | Reference(ServiceRequest: Requested Procedure for Imaging Study) | Related identifiers or resources
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | MadoAccessionNumberIdentifier | SHALL contain the identifier for the referenced ServiceRequest that contains the Accession Number Identifier when present.
display | Σ | 0..1 | string | Text alternative for the resource
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.meta.​security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
DocumentReference.meta.​tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std.
DocumentReference.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DocumentReference.extension:bodysite.​extension:concept.value[x] | Base | extensible | Anatomical Region | 📦0.0.1-current | This IG
DocumentReference.status | Base | required | MHD DocumentReference status codes | 📦4.2.4-current | Mobile access to Health Documents vnull
DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.relatesTo:kosReference.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
DocumentReference.content.​extension:profile.extension:value[x].​value[x] | Base | preferred | Cross-version VS for R5.HL7FormatCodes for use in FHIR R4 | 📍0.0.1-snapshot-2 | FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 v0.0
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 | preferred | IHE ValueSet of Format Codes for use with Document Sharing | 📦1.5.1-current | IHE FormatCode Vocabulary vnull
DocumentReference.context.​event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v7.1
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.
DocumentReference.context.​sourcePatientInfo.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
DocumentReference.context.​related:accession-number.​type | Base | extensible | ResourceType | 📍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()`
mado-documentreference-masterIdentifier-also-identifier | error | DocumentReference | masterIdentifier, when used, need to be present as an identifier as well | `masterIdentifier.exists() implies identifier.where( %resource.masterIdentifier.system = system and %resource.masterIdentifier.value = value ).exists()`

This structure is derived from MinimalDocumentReference

Summary

Mandatory: 7 elements(2 nested mandatory elements)
Prohibited: 4 elements

Structures

This structure refers to these other structures:

- MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests (https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoDicomKosMinimalDocumentReference)
- MADO Referenced Study Instance UID Identifier (https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoReferencedStudyInstanceUidIdentifier)
- Resource (http://hl7.org/fhir/StructureDefinition/Resource|4.0.1)
- ServiceRequest: Requested Procedure for Imaging Study (https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoRequestedProcedureOrder)
- MADO Accession Number Identifier (https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoAccessionNumberIdentifier)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite
- http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality
- http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of DocumentReference.relatesTo
- The element 1 is sliced based on the value of DocumentReference.content.extension.extension.value[x]
- The element 1 is sliced based on the value of DocumentReference.context.related

Maturity: 1

Other representations of profile: CSV, Excel, Schematron