Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile	A reference to a document dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use ele-1: All FHIR elements must have a @value or children
identifier:image	SΣ	0..1	Identifier	Other identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children Required Pattern: secondary
system	ΣC	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} ele-1: All FHIR elements must have a @value or children TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	{firstImageId} ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:study	SΣ	0..1	Identifier	Other identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children Required Pattern: usual
system	ΣC	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} ele-1: All FHIR elements must have a @value or children TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	{studyId} ele-1: All FHIR elements must have a @value or children Example General: 123456
status	?!SΣ	1..1	code	May indicate entered-in-error Binding: DocumentReferenceStatus (required) ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding ele-1: All FHIR elements must have a @value or children
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system ele-1: All FHIR elements must have a @value or children
coding:LO	Σ	1..1	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://loinc.org
code	Σ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children Required Pattern: 56446-8
coding:CPT	Σ	0..1	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://www.ama-assn.org/go/cpt
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. ele-1: All FHIR elements must have a @value or children
category:All Slices				Content/Rules for all slices
text	Σ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
category:us-core	SΣ	0..*	CodeableConcept	Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes. ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who/what is the subject of the document ele-1: All FHIR elements must have a @value or children
date	SΣ	0..1	instant	When this document reference was created ele-1: All FHIR elements must have a @value or children
custodian	S	0..1	Reference(Organization)	Organization which maintains the document ele-1: All FHIR elements must have a @value or children
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children
content	SΣ	1..1	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	SΣC	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. ele-1: All FHIR elements must have a @value or children Example General: text/plain; charset=UTF-8, image/png
url	SΣC	1..1	url	Uri where the data can be found ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/logo-small.png
title	SΣ	0..1	string	Label to display in place of the data ele-1: All FHIR elements must have a @value or children Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created ele-1: All FHIR elements must have a @value or children
context	SΣ	0..1	BackboneElement	Clinical context of document ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
encounter	S	0..1	Reference(US Core Encounter Profile)	Context of the document content ele-1: All FHIR elements must have a @value or children
related	S	0..*	Reference(Location) {c}	Related identifiers or resources ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.identifier:image.use	required	Pattern: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:study.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status from the FHIR Standard
DocumentReference.type	required	USCoreDocumentReferenceType http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type Additional Bindings Purpose US Core Clinical Note Type Min Binding
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.category:us-core	required	USCoreDocumentReferenceCategory http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
TOid-startswithoid	error	DocumentReference.identifier:image.system, DocumentReference.identifier:study.system	ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} : value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile	A reference to a document
meta
security		0..*	Coding	Security Labels applied to this resource
masterIdentifier		0..0
Slices for identifier		0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:image		0..1	Identifier	Other identifiers for the document
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: secondary
system	C	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
value		0..1	string	{firstImageId}
identifier:study		0..1	Identifier	Other identifiers for the document
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: usual
system	C	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
value		0..1	string	{studyId}
status		1..1	code	May indicate entered-in-error
docStatus		0..0
type
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LO		1..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code		0..1	code	Symbol in syntax defined by the system Required Pattern: 56446-8
coding:CPT		0..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: http://www.ama-assn.org/go/cpt
text	S	0..1	string	Plain text representation of the concept
category		1..*	CodeableConcept	Categorization of document
text		0..1	string	Plain text representation of the concept
subject		1..1	Reference(US Core Patient Profile)	Who/what is the subject of the document
date		0..1	instant	When this document reference was created
author		0..0
authenticator		0..0
custodian	S	0..1	Reference(Organization)	Organization which maintains the document
display		0..1	string	Text alternative for the resource
relatesTo		0..0
description		0..0
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		0..0
data		0..0
url		1..1	url	Uri where the data can be found
size		0..0
hash		0..0
title	S	0..1	string	Label to display in place of the data
creation	S	0..1	dateTime	Date attachment was first created
format		0..0
context
event		0..0
period		0..0
facilityType		0..0
practiceSetting		0..0
sourcePatientInfo		0..0
related	S	0..*	Reference(Location) {c}	Related identifiers or resources
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
TOid-startswithoid	error	DocumentReference.identifier:image.system, DocumentReference.identifier:study.system	ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} : value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile	A reference to a document
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
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:image	SΣ	0..1	Identifier	Other identifiers for 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
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: secondary
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	ΣC	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	{firstImageId} 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)
identifier:study	SΣ	0..1	Identifier	Other identifiers for 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
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: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	ΣC	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	{studyId} 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)
status	?!SΣ	1..1	code	May indicate entered-in-error Binding: DocumentReferenceStatus (required)
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LO	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: 56446-8
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:CPT	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://www.ama-assn.org/go/cpt
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category: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 Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
category:us-core	SΣ	0..*	CodeableConcept	Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes.
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who/what is the subject of the document
date	SΣ	0..1	instant	When this document reference was created
custodian	S	0..1	Reference(Organization)	Organization which maintains 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
reference	ΣC	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
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	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	SΣC	1..1	Attachment	Where to access the document us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
url	SΣC	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
title	SΣ	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
context	SΣ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..1	Reference(US Core Encounter Profile)	Context of the document content
related	S	0..*	Reference(Location) {c}	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
DocumentReference.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier:image.use	required	Pattern: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:image.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.identifier:study.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:study.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status from the FHIR Standard
DocumentReference.type	required	USCoreDocumentReferenceType http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type Additional Bindings Purpose US Core Clinical Note Type Min Binding
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.category:us-core	required	USCoreDocumentReferenceCategory http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.custodian.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
TOid-startswithoid	error	DocumentReference.identifier:image.system, DocumentReference.identifier:study.system	ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} : value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Summary

Mandatory: 5 elements(3 nested mandatory elements)
Must-Support: 6 elements
Prohibited: 16 elements

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.type.coding

Maturity: 2

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile	A reference to a document dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use ele-1: All FHIR elements must have a @value or children
identifier:image	SΣ	0..1	Identifier	Other identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children Required Pattern: secondary
system	ΣC	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} ele-1: All FHIR elements must have a @value or children TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	{firstImageId} ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:study	SΣ	0..1	Identifier	Other identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children Required Pattern: usual
system	ΣC	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} ele-1: All FHIR elements must have a @value or children TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	{studyId} ele-1: All FHIR elements must have a @value or children Example General: 123456
status	?!SΣ	1..1	code	May indicate entered-in-error Binding: DocumentReferenceStatus (required) ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding ele-1: All FHIR elements must have a @value or children
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system ele-1: All FHIR elements must have a @value or children
coding:LO	Σ	1..1	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://loinc.org
code	Σ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children Required Pattern: 56446-8
coding:CPT	Σ	0..1	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://www.ama-assn.org/go/cpt
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. ele-1: All FHIR elements must have a @value or children
category:All Slices				Content/Rules for all slices
text	Σ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
category:us-core	SΣ	0..*	CodeableConcept	Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes. ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who/what is the subject of the document ele-1: All FHIR elements must have a @value or children
date	SΣ	0..1	instant	When this document reference was created ele-1: All FHIR elements must have a @value or children
custodian	S	0..1	Reference(Organization)	Organization which maintains the document ele-1: All FHIR elements must have a @value or children
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children
content	SΣ	1..1	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	SΣC	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. ele-1: All FHIR elements must have a @value or children Example General: text/plain; charset=UTF-8, image/png
url	SΣC	1..1	url	Uri where the data can be found ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/logo-small.png
title	SΣ	0..1	string	Label to display in place of the data ele-1: All FHIR elements must have a @value or children Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created ele-1: All FHIR elements must have a @value or children
context	SΣ	0..1	BackboneElement	Clinical context of document ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
encounter	S	0..1	Reference(US Core Encounter Profile)	Context of the document content ele-1: All FHIR elements must have a @value or children
related	S	0..*	Reference(Location) {c}	Related identifiers or resources ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.identifier:image.use	required	Pattern: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:study.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status from the FHIR Standard
DocumentReference.type	required	USCoreDocumentReferenceType http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type Additional Bindings Purpose US Core Clinical Note Type Min Binding
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.category:us-core	required	USCoreDocumentReferenceCategory http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
TOid-startswithoid	error	DocumentReference.identifier:image.system, DocumentReference.identifier:study.system	ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} : value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile	A reference to a document
meta
security		0..*	Coding	Security Labels applied to this resource
masterIdentifier		0..0
Slices for identifier		0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:image		0..1	Identifier	Other identifiers for the document
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: secondary
system	C	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
value		0..1	string	{firstImageId}
identifier:study		0..1	Identifier	Other identifiers for the document
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: usual
system	C	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
value		0..1	string	{studyId}
status		1..1	code	May indicate entered-in-error
docStatus		0..0
type
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LO		1..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code		0..1	code	Symbol in syntax defined by the system Required Pattern: 56446-8
coding:CPT		0..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: http://www.ama-assn.org/go/cpt
text	S	0..1	string	Plain text representation of the concept
category		1..*	CodeableConcept	Categorization of document
text		0..1	string	Plain text representation of the concept
subject		1..1	Reference(US Core Patient Profile)	Who/what is the subject of the document
date		0..1	instant	When this document reference was created
author		0..0
authenticator		0..0
custodian	S	0..1	Reference(Organization)	Organization which maintains the document
display		0..1	string	Text alternative for the resource
relatesTo		0..0
description		0..0
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		0..0
data		0..0
url		1..1	url	Uri where the data can be found
size		0..0
hash		0..0
title	S	0..1	string	Label to display in place of the data
creation	S	0..1	dateTime	Date attachment was first created
format		0..0
context
event		0..0
period		0..0
facilityType		0..0
practiceSetting		0..0
sourcePatientInfo		0..0
related	S	0..*	Reference(Location) {c}	Related identifiers or resources
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
TOid-startswithoid	error	DocumentReference.identifier:image.system, DocumentReference.identifier:study.system	ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} : value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile	A reference to a document
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
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:image	SΣ	0..1	Identifier	Other identifiers for 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
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: secondary
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	ΣC	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	{firstImageId} 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)
identifier:study	SΣ	0..1	Identifier	Other identifiers for 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
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: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	ΣC	0..1	uri	urn:oid:2.16.840.1.113883.4.349.4.{stationNbr} TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	{studyId} 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)
status	?!SΣ	1..1	code	May indicate entered-in-error Binding: DocumentReferenceStatus (required)
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LO	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: 56446-8
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:CPT	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://www.ama-assn.org/go/cpt
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category: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 Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
category:us-core	SΣ	0..*	CodeableConcept	Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes.
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who/what is the subject of the document
date	SΣ	0..1	instant	When this document reference was created
custodian	S	0..1	Reference(Organization)	Organization which maintains 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
reference	ΣC	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
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	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	SΣC	1..1	Attachment	Where to access the document us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
url	SΣC	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
title	SΣ	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
context	SΣ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..1	Reference(US Core Encounter Profile)	Context of the document content
related	S	0..*	Reference(Location) {c}	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
DocumentReference.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier:image.use	required	Pattern: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:image.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.identifier:study.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:study.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status from the FHIR Standard
DocumentReference.type	required	USCoreDocumentReferenceType http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type Additional Bindings Purpose US Core Clinical Note Type Min Binding
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.category:us-core	required	USCoreDocumentReferenceCategory http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.custodian.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
TOid-startswithoid	error	DocumentReference.identifier:image.system, DocumentReference.identifier:study.system	ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} : value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Summary

Mandatory: 5 elements(3 nested mandatory elements)
Must-Support: 6 elements
Prohibited: 16 elements

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.type.coding

Maturity: 2