RIVO-Noord Zorgviewer Implementation Guide
1.8.0 - CI build Netherlands flag

RIVO-Noord Zorgviewer Implementation Guide, published by RIVO-NN HL7NL. This guide is not an authorized publication; it is the continuous build for version 1.8.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/RIVO-Noord/zorgviewer-ig/ and changes regularly. See the Directory of published versions

Resource Profile: DocumentReference - Detailed Descriptions

Active as of 2024-11-19

Definitions for the DocumentReference resource profile.

Guidance on how to interpret the contents of this table can be found here

0. DocumentReference
Invariantszv-dr-1: Only status is current final documents are expected. (status='current')
2. DocumentReference.status
Must Supporttrue
4. DocumentReference.type
BindingUnless not suitable, these codes SHALL be taken from Document Class & Type waardelijst
(extensible to http://hl7.nl/fhir/zorgviewer/ValueSet/DocumentLOINCCodelist)
Must Supporttrue
6. DocumentReference.class
BindingUnless not suitable, these codes SHALL be taken from Document Class & Type waardelijst
(extensible to http://hl7.nl/fhir/zorgviewer/ValueSet/DocumentLOINCCodelist)
Must Supporttrue
8. DocumentReference.author
Comments

Expect the references Practitioner to have his Organization

Must Supporttrue
10. DocumentReference.description
Must Supporttrue
12. DocumentReference.content
14. DocumentReference.content.attachment
Must Supporttrue
Invariantszv-dr-2: Only pdf documents are expected through the url (contentType='application/pdf')
16. DocumentReference.content.attachment.contentType
Must Supporttrue
18. DocumentReference.content.attachment.url
Control1..?
Must Supporttrue
20. DocumentReference.context
22. DocumentReference.context.period
24. DocumentReference.context.period.start
Must Supporttrue

Guidance on how to interpret the contents of this table can be found here

0. DocumentReference
Definition

A reference to a document.

ShortA reference to a document
Comments

Usually, this is used for documents other than those defined by FHIR.

Control0..*
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
dom-4: 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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
zv-dr-1: Only status is current final documents are expected. (status='current')
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
dom-4: 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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
2. DocumentReference.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

Control0..1
Typeuri
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
4. DocumentReference.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Alternate Namesextensions, user content
6. DocumentReference.masterIdentifier
Definition

Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document.

ShortMaster Version Specific Identifier
Comments

See ITI TF-2x: Z.9.1.1 Identifier and CDA root plus extension.


CDA Document Id extension and root.

Control10..1
TypeIdentifier
Must Supporttrue
Summarytrue
Requirements

The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).

8. DocumentReference.identifier
Definition

Other identifiers associated with the document, including version independent identifiers.

ShortOther identifiers for the document
Comments

When the DocumentReference.identifier carries the entryUUID then the DocumentReference.identifier use shall be ‘official’.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Must Supporttrue
Summarytrue
10. DocumentReference.status
Definition

The status of this document reference.

Shortcurrent | superseded | entered-in-error
Comments

approved -> status=current deprecated -> status=superseded


This is the status of the DocumentReference object, which might be independent from the docStatus element.

This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

Control1..1
BindingThe codes SHALL be taken from DocumentReferenceStatushttp://hl7.org/fhir/ValueSet/document-reference-status
(required to http://hl7.org/fhir/ValueSet/document-reference-status)

The status of the document reference.

Typecode
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
12. DocumentReference.docStatus
Definition

The status of the underlying document.

Shortpreliminary | final | appended | amended | entered-in-error
Comments

These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.


The document that is pointed to might be in various lifecycle states.

Control0..01
BindingThe codes SHALL be taken from CompositionStatushttp://hl7.org/fhir/ValueSet/composition-status
(required to http://hl7.org/fhir/ValueSet/composition-status)

Status of the underlying document.

Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
14. DocumentReference.type
Definition

Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

ShortKind of document (LOINC if possible)
Comments

Key metadata element describing the document, used in searching/filtering.

Control1..1
BindingUnless not suitable, these codes SHALL be taken from The codes SHOULD be taken from Document Class & Type waardelijsthttp://hl7.org/fhir/ValueSet/c80-doc-typecodes
(extensible to http://hl7.nl/fhir/zorgviewer/ValueSet/DocumentLOINCCodelist)
TypeCodeableConcept
Must Supporttrue
Summarytrue
16. DocumentReference.class
Definition

A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

ShortCategorization of document
Comments

This is a metadata field from XDS/MHD.

Control0..1
BindingUnless not suitable, these codes SHALL be taken from For example codes, see Document Class & Type waardelijsthttp://hl7.org/fhir/ValueSet/c80-doc-classcodes
(extensible to http://hl7.nl/fhir/zorgviewer/ValueSet/DocumentLOINCCodelist)
TypeCodeableConcept
Must Supporttrue
Summarytrue
Requirements

Helps humans to assess whether the document is of interest when viewing a list of documents.

Alternate Nameskind
18. DocumentReference.subject
Definition

Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

ShortWho/what is the subject of the document
Comments

Not a contained resource. URL Points to an existing Patient Resource representing the XDS Affinity Domain Patient.

Control0..1
TypeReference(Patient, Practitioner, Group, Device)referenced, bundled
Must Supporttrue
Summarytrue
20. DocumentReference.created
Definition

When the document was created.

ShortDocument creation time
Comments

Creation time is used for tracking, organizing versions and searching. This is the creation time of the document, not the source material on which it is based.

Control0..01
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
22. DocumentReference.indexed
Definition

When the document reference was created.

ShortWhen this document reference was created
Comments

Referencing/indexing time is used for tracking, organizing versions and searching.

Control1..1
Typeinstant
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
24. DocumentReference.author
Definition

Identifies who is responsible for adding the information to the document.

ShortWho and/or what authored the document
Comments

Expect the references Practitioner to have his Organization


Not necessarily who did the actual data entry (i.e. typist) it in or who was the source (informant).

Control0..*
TypeReference(Practitioner, Organization, Device, Patient, RelatedPerson)contained
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
26. DocumentReference.custodian
Definition

Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

ShortOrganization which maintains the document
Comments

These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.


Identifies the logical organization to go to find the current version, where to report issues, etc. This is different from the physical location of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

Control0..01
TypeReference(Organization)
Summarytrue
28. DocumentReference.relatesTo
Definition

Relationships that this document has with other document references that already exist.

ShortRelationships to other documents
Comments

See ITI TF-2c: 3.65.4.1.2.3


This element is labeled as a modifier because documents that append to other documents are incomplete on their own.

Control0..*
TypeBackboneElement
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
30. DocumentReference.relatesTo.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Summarytrue
Alternate Namesextensions, user content, modifiers
32. DocumentReference.relatesTo.code
Definition

The type of relationship that this document has with anther document.

Shortreplaces | transforms | signs | appends
Comments

If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

Control1..1
BindingThe codes SHALL be taken from DocumentRelationshipTypehttp://hl7.org/fhir/ValueSet/document-relationship-type
(required to http://hl7.org/fhir/ValueSet/document-relationship-type)

The type of relationship between documents.

Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
34. DocumentReference.relatesTo.target
Definition

The target document of this relationship.

ShortTarget of the relationship
Control1..1
TypeReference(DocumentReference)
Summarytrue
36. DocumentReference.description
Definition

Human-readable description of the source document. This is sometimes known as the "title".

ShortHuman-readable description (title)
Comments

What the document is about, rather than a terse summary of the document. It is commonly the case that records do not have a title and are collectively referred to by the display name of Record code (e.g. a "consultation" or "progress note").

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

Helps humans to assess whether the document is of interest.

38. DocumentReference.securityLabel
Definition

A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.

ShortDocument security-tags
Comments

Note: This is NOT the DocumentReference.meta, as that holds the meta tags for the DocumentReference itself.


The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce. In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.

Control0..*
BindingUnless not suitable, these codes SHALL be taken from All Security Labelshttp://hl7.org/fhir/ValueSet/security-labels
(extensible to http://hl7.org/fhir/ValueSet/security-labels)

Security Labels from the Healthcare Privacy and Security Classification System.

TypeCodeableConcept
Must Supporttrue
Summarytrue
Requirements

Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

40. DocumentReference.content
Definition

The document and format referenced. There may be multiple content element repetitions, each with a different format.

ShortDocument referenced
Control1..1*
TypeBackboneElement
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
42. DocumentReference.content.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Summarytrue
Alternate Namesextensions, user content, modifiers
44. DocumentReference.content.attachment
Definition

The document or URL of the document along with critical metadata to prove content has integrity.

ShortWhere to access the document
Control1..1
TypeAttachment
Must Supporttrue
Summarytrue
Invariantszv-dr-2: Only pdf documents are expected through the url (contentType='application/pdf')
46. DocumentReference.content.attachment.contentType
Definition

Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

ShortMime type of the content, with charset etc.
Control10..1
BindingThe codes SHALL be taken from mimetypeshttp://hl7.org/fhir/ValueSet/mimetypes
(required to http://hl7.org/fhir/ValueSet/mimetypes)

The mime type of an attachment. Any valid mime type is allowed.

Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

Processors of the data need to be able to know how to interpret the data.

Example<br/><b>General</b>:text/plain; charset=UTF-8, image/png
48. DocumentReference.content.attachment.language
Definition

The human language of the content. The value can be any valid value according to BCP 47.

ShortHuman language of the content (BCP-47)
Control0..1
BindingUnless not suitable, these codes SHALL be taken from Common Languageshttp://hl7.org/fhir/ValueSet/languages
(extensible to http://hl7.org/fhir/ValueSet/languages)

A human language.

Additional BindingsPurpose
All LanguagesMax Binding
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

Users need to be able to choose between the languages in a set of attachments.

Example<br/><b>General</b>:en-AU
50. DocumentReference.content.attachment.data
Definition

The actual data of the attachment - a sequence of bytes. In XML, represented using base64.

ShortData inline, base64ed
Comments

These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.


The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

Control0..01
Typebase64Binary
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Requirements

The data needs to able to be transmitted inline.

52. DocumentReference.content.attachment.url
Definition

An alternative location where the data can be accessed.

ShortUri where the data can be found
Comments

If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

Control10..1
Typeuri
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

The data needs to be transmitted by reference.

Example<br/><b>General</b>:http://www.acme.com/logo-small.png
54. DocumentReference.content.attachment.creation
Definition

The date that the attachment was first created.

ShortDate attachment was first created
Comments

These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.

Control0..01
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

This is often tracked as an integrity issue for use of the attachment.

56. DocumentReference.content.format
Definition

An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

ShortFormat/content rules for the document
Comments

Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

Control0..1
BindingThe codes SHOULD be taken from IHE ValueSet of Format Codes for use with Document Sharinghttp://hl7.org/fhir/ValueSet/formatcodes
(preferred to http://ihe.net/fhir/ValueSet/IHE.formatcode.vs)
TypeCoding
Must Supporttrue
Summarytrue
58. DocumentReference.context
Definition

The clinical context in which the document was prepared.

ShortClinical context of document
Comments

These values are primarily added to help with searching for interesting/relevant documents.

Control0..1
TypeBackboneElement
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
60. DocumentReference.context.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Summarytrue
Alternate Namesextensions, user content, modifiers
62. DocumentReference.context.period
Definition

The time period over which the service that is described by the document was provided.

ShortTime of service that is being documented
Control0..1
TypePeriod
Must Supporttrue
Summarytrue
64. DocumentReference.context.period.start
Definition

The start of the period. The boundary is inclusive.

ShortStarting time with inclusive boundary
Comments

If the low element is missing, the meaning is that the low boundary is not known.

Control0..1
This element is affected by the following invariants: per-1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
66. DocumentReference.context.facilityType
Definition

The kind of facility where the patient was seen.

ShortKind of facility where patient was seen
Control0..1
BindingFor example codes, see Facility Type Code Value Sethttp://hl7.org/fhir/ValueSet/c80-facilitycodes
(example to http://hl7.org/fhir/ValueSet/c80-facilitycodes)

XDS Facility Type.

TypeCodeableConcept
Must Supporttrue
Summarytrue
68. DocumentReference.context.practiceSetting
Definition

This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.

ShortAdditional details about where the content was created (e.g. clinical specialty)
Comments

The value set for this content has an example binding because it is a value set decided by community policy. Other examples exist for consideration: * HITSP created the table HITSP/C80 Table 2-148 Clinical Specialty Value Set (a value set based upon SNOMED CT which is referenced by Direct (XDR and XDM for Direct Messaging Specification, Version 1), as well as Nationwide Health Information Network (NHIN). Query for Documents, Web Service Interface Specification, V 3.0, 07/27/2011 * ELGA (Austria) (ELGA CDA Implementie-rungsleitfäden Registrierung von CDA Dokumenten für ELGA mit IHE Cross-Enterprise Document Sharing: XDS Metadaten (XDSDocumentEntry), [1.2.40.0.34.7.6.3] * XDS Connect-a-thon practiceSettingCode.

Control0..1
BindingFor example codes, see Practice Setting Code Value Sethttp://hl7.org/fhir/ValueSet/c80-practice-codes
(example to http://hl7.org/fhir/ValueSet/c80-practice-codes)

Additional details about where the content was created (e.g. clinical specialty).

TypeCodeableConcept
Must Supporttrue
Summarytrue
Requirements

This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

70. DocumentReference.context.sourcePatientInfo
Definition

The Patient Information as known when the document was published. May be a reference to a version specific, or contained.

ShortPatient demographics from source
Comments

Contained Patient resource with Patient.identifier.use element set to ‘usual’.

Indicates that the data within the XDS document entry be represented as a contained resource. See Section 4.5.4.4.7

Control0..1
TypeReference(Patient)contained
Must Supporttrue
Summarytrue

Guidance on how to interpret the contents of this table can be found here

0. DocumentReference
Definition

A reference to a document.

ShortA reference to a document
Comments

Usually, this is used for documents other than those defined by FHIR.

Control0..*
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
dom-4: 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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
zv-dr-1: Only status is current final documents are expected. (status='current')
2. DocumentReference.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

ShortLogical id of this artifact
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Control0..1
Typeid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
4. DocumentReference.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

ShortMetadata about the resource
Control0..1
TypeMeta
Summarytrue
6. DocumentReference.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

Control0..1
Typeuri
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
8. DocumentReference.language
Definition

The base language in which the resource is written.

ShortLanguage of the resource content
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Control0..1
BindingUnless not suitable, these codes SHALL be taken from Common Languages
(extensible to http://hl7.org/fhir/ValueSet/languages)

A human language.

Additional BindingsPurpose
All LanguagesMax Binding
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
10. DocumentReference.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

ShortText summary of the resource, for human interpretation
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

Control0..1
This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
12. DocumentReference.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
14. DocumentReference.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional Content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Alternate Namesextensions, user content
16. DocumentReference.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Alternate Namesextensions, user content
18. DocumentReference.masterIdentifier
Definition

Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document.

ShortMaster Version Specific Identifier
Comments

See ITI TF-2x: Z.9.1.1 Identifier and CDA root plus extension.

Control1..1
TypeIdentifier
Must Supporttrue
Summarytrue
Requirements

The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).

20. DocumentReference.identifier
Definition

Other identifiers associated with the document, including version independent identifiers.

ShortOther identifiers for the document
Comments

When the DocumentReference.identifier carries the entryUUID then the DocumentReference.identifier use shall be ‘official’.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Must Supporttrue
Summarytrue
22. DocumentReference.status
Definition

The status of this document reference.

Shortcurrent | superseded | entered-in-error
Comments

approved -> status=current deprecated -> status=superseded

Control1..1
BindingThe codes SHALL be taken from DocumentReferenceStatus
(required to http://hl7.org/fhir/ValueSet/document-reference-status)

The status of the document reference.

Typecode
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
24. DocumentReference.docStatus
Definition

The status of the underlying document.

Shortpreliminary | final | appended | amended | entered-in-error
Comments

These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.

Control0..0
BindingThe codes SHALL be taken from CompositionStatus
(required to http://hl7.org/fhir/ValueSet/composition-status)

Status of the underlying document.

Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
26. DocumentReference.type
Definition

Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

ShortKind of document (LOINC if possible)
Comments

Key metadata element describing the document, used in searching/filtering.

Control1..1
BindingUnless not suitable, these codes SHALL be taken from Document Class & Type waardelijst
(extensible to http://hl7.nl/fhir/zorgviewer/ValueSet/DocumentLOINCCodelist)
TypeCodeableConcept
Must Supporttrue
Summarytrue
28. DocumentReference.class
Definition

A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

ShortCategorization of document
Comments

This is a metadata field from XDS/MHD.

Control0..1
BindingUnless not suitable, these codes SHALL be taken from Document Class & Type waardelijst
(extensible to http://hl7.nl/fhir/zorgviewer/ValueSet/DocumentLOINCCodelist)
TypeCodeableConcept
Must Supporttrue
Summarytrue
Requirements

Helps humans to assess whether the document is of interest when viewing a list of documents.

Alternate Nameskind
30. DocumentReference.subject
Definition

Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

ShortWho/what is the subject of the document
Comments

Not a contained resource. URL Points to an existing Patient Resource representing the XDS Affinity Domain Patient.

Control0..1
TypeReference(Patient)referenced, bundled
Must Supporttrue
Summarytrue
32. DocumentReference.created
Definition

When the document was created.

ShortDocument creation time
Comments

Creation time is used for tracking, organizing versions and searching. This is the creation time of the document, not the source material on which it is based.

Control0..0
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
34. DocumentReference.indexed
Definition

When the document reference was created.

ShortWhen this document reference was created
Comments

Referencing/indexing time is used for tracking, organizing versions and searching.

Control1..1
Typeinstant
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
36. DocumentReference.author
Definition

Identifies who is responsible for adding the information to the document.

ShortWho and/or what authored the document
Comments

Expect the references Practitioner to have his Organization

Control0..*
TypeReference(Practitioner, Organization)contained
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
38. DocumentReference.authenticator
Definition

Which person or organization authenticates that this document is valid.

ShortWho/what authenticated the document
Comments

Contained resource

Control0..1
TypeReference
Must Supportfalse
Summarytrue
40. DocumentReference.custodian
Definition

Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

ShortOrganization which maintains the document
Comments

These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.

Control0..0
TypeReference(Organization)
Summarytrue
42. DocumentReference.relatesTo
Definition

Relationships that this document has with other document references that already exist.

ShortRelationships to other documents
Comments

See ITI TF-2c: 3.65.4.1.2.3

Control0..*
TypeBackboneElement
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
44. DocumentReference.relatesTo.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Shortxml:id (or equivalent in JSON)
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
46. DocumentReference.relatesTo.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional Content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Alternate Namesextensions, user content
48. DocumentReference.relatesTo.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Summarytrue
Alternate Namesextensions, user content, modifiers
50. DocumentReference.relatesTo.code
Definition

The type of relationship that this document has with anther document.

Shortreplaces | transforms | signs | appends
Comments

If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

Control1..1
BindingThe codes SHALL be taken from DocumentRelationshipType
(required to http://hl7.org/fhir/ValueSet/document-relationship-type)

The type of relationship between documents.

Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
52. DocumentReference.relatesTo.target
Definition

The target document of this relationship.

ShortTarget of the relationship
Control1..1
TypeReference(DocumentReference)
Summarytrue
54. DocumentReference.description
Definition

Human-readable description of the source document. This is sometimes known as the "title".

ShortHuman-readable description (title)
Comments

What the document is about, rather than a terse summary of the document. It is commonly the case that records do not have a title and are collectively referred to by the display name of Record code (e.g. a "consultation" or "progress note").

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

Helps humans to assess whether the document is of interest.

56. DocumentReference.securityLabel
Definition

A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.

ShortDocument security-tags
Comments

Note: This is NOT the DocumentReference.meta, as that holds the meta tags for the DocumentReference itself.

Control0..*
BindingUnless not suitable, these codes SHALL be taken from All Security Labels
(extensible to http://hl7.org/fhir/ValueSet/security-labels)

Security Labels from the Healthcare Privacy and Security Classification System.

TypeCodeableConcept
Must Supporttrue
Summarytrue
Requirements

Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

58. DocumentReference.content
Definition

The document and format referenced. There may be multiple content element repetitions, each with a different format.

ShortDocument referenced
Control1..1
TypeBackboneElement
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
60. DocumentReference.content.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Shortxml:id (or equivalent in JSON)
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
62. DocumentReference.content.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional Content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Alternate Namesextensions, user content
64. DocumentReference.content.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Summarytrue
Alternate Namesextensions, user content, modifiers
66. DocumentReference.content.attachment
Definition

The document or URL of the document along with critical metadata to prove content has integrity.

ShortWhere to access the document
Control1..1
TypeAttachment
Must Supporttrue
Summarytrue
Invariantszv-dr-2: Only pdf documents are expected through the url (contentType='application/pdf')
68. DocumentReference.content.attachment.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Shortxml:id (or equivalent in JSON)
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
70. DocumentReference.content.attachment.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional Content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Alternate Namesextensions, user content
SlicingThis element introduces a set of slices on DocumentReference.content.attachment.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 72. DocumentReference.content.attachment.contentType
    Definition

    Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

    ShortMime type of the content, with charset etc.
    Control1..1
    BindingThe codes SHALL be taken from mimetypes
    (required to http://hl7.org/fhir/ValueSet/mimetypes)

    The mime type of an attachment. Any valid mime type is allowed.

    Typecode
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    Processors of the data need to be able to know how to interpret the data.

    Example<br/><b>General</b>:text/plain; charset=UTF-8, image/png
    74. DocumentReference.content.attachment.language
    Definition

    The human language of the content. The value can be any valid value according to BCP 47.

    ShortHuman language of the content (BCP-47)
    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from Common Languages
    (extensible to http://hl7.org/fhir/ValueSet/languages)

    A human language.

    Additional BindingsPurpose
    All LanguagesMax Binding
    Typecode
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    Users need to be able to choose between the languages in a set of attachments.

    Example<br/><b>General</b>:en-AU
    76. DocumentReference.content.attachment.data
    Definition

    The actual data of the attachment - a sequence of bytes. In XML, represented using base64.

    ShortData inline, base64ed
    Comments

    These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.

    Control0..0
    Typebase64Binary
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Requirements

    The data needs to able to be transmitted inline.

    78. DocumentReference.content.attachment.url
    Definition

    An alternative location where the data can be accessed.

    ShortUri where the data can be found
    Comments

    If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

    Control1..1
    Typeuri
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    The data needs to be transmitted by reference.

    Example<br/><b>General</b>:http://www.acme.com/logo-small.png
    80. DocumentReference.content.attachment.size
    Definition

    The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

    ShortNumber of bytes of content (if url provided)
    Comments

    The size is calculated on the data prior to base64 encoding, if the data is base64 encoded.

    Control0..1
    TypeunsignedInt
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

    82. DocumentReference.content.attachment.hash
    Definition

    The calculated hash of the data using SHA-1. Represented using base64.

    ShortHash of the data (sha-1, base64ed)
    Comments

    The IHE Document Sharing metadata element hash holds the SHA1 hash of the document. The hash is encoded in FHIR in base64Binary, whereas in XDS hexbinary is used. The hash is calculated on the data prior to base64 encoding, if the data is base64 encoded.

    Control0..1
    Typebase64Binary
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Included so that applications can verify that the contents of a location have not changed and so that a signature of the content can implicitly sign the content of an image without having to include the data in the instance or reference the url in the signature.

    84. DocumentReference.content.attachment.title
    Definition

    A label or set of text to display in place of the data.

    ShortLabel to display in place of the data
    Control0..1
    Typestring
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

    Example<br/><b>General</b>:Official Corporate Logo
    86. DocumentReference.content.attachment.creation
    Definition

    The date that the attachment was first created.

    ShortDate attachment was first created
    Comments

    These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.

    Control0..0
    TypedateTime
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    This is often tracked as an integrity issue for use of the attachment.

    88. DocumentReference.content.format
    Definition

    An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

    ShortFormat/content rules for the document
    Comments

    Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

    Control0..1
    BindingThe codes SHOULD be taken from IHE ValueSet of Format Codes for use with Document Sharing
    (preferred to http://ihe.net/fhir/ValueSet/IHE.formatcode.vs)
    TypeCoding
    Must Supporttrue
    Summarytrue
    90. DocumentReference.context
    Definition

    The clinical context in which the document was prepared.

    ShortClinical context of document
    Comments

    These values are primarily added to help with searching for interesting/relevant documents.

    Control0..1
    TypeBackboneElement
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    92. DocumentReference.context.id
    Definition

    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

    Shortxml:id (or equivalent in JSON)
    Control0..1
    Typestring
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    94. DocumentReference.context.extension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortAdditional Content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Alternate Namesextensions, user content
    96. DocumentReference.context.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
    Summarytrue
    Alternate Namesextensions, user content, modifiers
    98. DocumentReference.context.encounter
    Definition

    Describes the clinical encounter or type of care that the document content is associated with.

    ShortContext of the document content
    Comments

    When referenceIdList contains an encounter, and a FHIR Encounter is available, it may be referenced.

    Control0..1
    TypeReference(Encounter)
    Must Supportfalse
    Summarytrue
    100. DocumentReference.context.event
    Definition

    This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.

    ShortMain clinical acts documented
    Comments

    An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation.

    Control0..*
    BindingFor example codes, see ActCode
    (example to http://hl7.org/fhir/ValueSet/v3-ActCode)

    This list of codes represents the main clinical acts being documented.

    TypeCodeableConcept
    Must Supportfalse
    Summarytrue
    102. DocumentReference.context.period
    Definition

    The time period over which the service that is described by the document was provided.

    ShortTime of service that is being documented
    Control0..1
    TypePeriod
    Must Supporttrue
    Summarytrue
    104. DocumentReference.context.period.id
    Definition

    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

    Shortxml:id (or equivalent in JSON)
    Control0..1
    Typestring
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    106. DocumentReference.context.period.extension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortAdditional Content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Alternate Namesextensions, user content
    SlicingThis element introduces a set of slices on DocumentReference.context.period.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 108. DocumentReference.context.period.start
      Definition

      The start of the period. The boundary is inclusive.

      ShortStarting time with inclusive boundary
      Comments

      If the low element is missing, the meaning is that the low boundary is not known.

      Control0..1
      This element is affected by the following invariants: per-1
      TypedateTime
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      110. DocumentReference.context.period.end
      Definition

      The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

      ShortEnd time with inclusive boundary, if not ongoing
      Comments

      The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

      Control0..1
      This element is affected by the following invariants: per-1
      TypedateTime
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
      112. DocumentReference.context.facilityType
      Definition

      The kind of facility where the patient was seen.

      ShortKind of facility where patient was seen
      Control0..1
      BindingFor example codes, see Facility Type Code Value Set
      (example to http://hl7.org/fhir/ValueSet/c80-facilitycodes)

      XDS Facility Type.

      TypeCodeableConcept
      Must Supporttrue
      Summarytrue
      114. DocumentReference.context.practiceSetting
      Definition

      This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.

      ShortAdditional details about where the content was created (e.g. clinical specialty)
      Comments

      The value set for this content has an example binding because it is a value set decided by community policy. Other examples exist for consideration: * HITSP created the table HITSP/C80 Table 2-148 Clinical Specialty Value Set (a value set based upon SNOMED CT which is referenced by Direct (XDR and XDM for Direct Messaging Specification, Version 1), as well as Nationwide Health Information Network (NHIN). Query for Documents, Web Service Interface Specification, V 3.0, 07/27/2011 * ELGA (Austria) (ELGA CDA Implementie-rungsleitfäden Registrierung von CDA Dokumenten für ELGA mit IHE Cross-Enterprise Document Sharing: XDS Metadaten (XDSDocumentEntry), [1.2.40.0.34.7.6.3] * XDS Connect-a-thon practiceSettingCode.

      Control0..1
      BindingFor example codes, see Practice Setting Code Value Set
      (example to http://hl7.org/fhir/ValueSet/c80-practice-codes)

      Additional details about where the content was created (e.g. clinical specialty).

      TypeCodeableConcept
      Must Supporttrue
      Summarytrue
      Requirements

      This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

      116. DocumentReference.context.sourcePatientInfo
      Definition

      The Patient Information as known when the document was published. May be a reference to a version specific, or contained.

      ShortPatient demographics from source
      Comments

      Contained Patient resource with Patient.identifier.use element set to ‘usual’.

      Indicates that the data within the XDS document entry be represented as a contained resource. See Section 4.5.4.4.7

      Control0..1
      TypeReference
      Must Supporttrue
      Summarytrue
      118. DocumentReference.context.related
      Definition

      Related identifiers or resources associated with the DocumentReference.

      ShortRelated identifiers or resources
      Comments

      May be identifiers or resources that caused the DocumentReference or referenced Document to be created.

      Control0..*
      TypeBackboneElement
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
      120. DocumentReference.context.related.id
      Definition

      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      Shortxml:id (or equivalent in JSON)
      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      122. DocumentReference.context.related.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional Content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Alternate Namesextensions, user content
      124. DocumentReference.context.related.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      ShortExtensions that cannot be ignored
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
      Summarytrue
      Alternate Namesextensions, user content, modifiers
      126. DocumentReference.context.related.identifier
      Definition

      Related identifier to this DocumentReference. If both id and ref are present they shall refer to the same thing.

      ShortIdentifier of related objects or events
      Comments

      See ITI TF-2x: Appendix E.3.1 on CXi mapping to FHIR Identifier

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1
      TypeIdentifier
      Must Supportfalse
      Summarytrue
      128. DocumentReference.context.related.ref
      Definition

      Related Resource to this DocumentReference. If both id and ref are present they shall refer to the same thing.

      ShortRelated Resource
      Comments

      May be filled with URL pointers to Resources found in referenceIdList

      Control0..1
      TypeReference(Resource)
      Must Supportfalse
      Summarytrue