RIVO-Noord Zorgviewer Implementation Guide
1.21.0 - CI build

RIVO-Noord Zorgviewer Implementation Guide, published by RIVO-NN HL7NL. This guide is not an authorized publication; it is the continuous build for version 1.21.0 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 2025-10-28

Definitions for the DocumentReference resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

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

0. DocumentReference
Definition | A reference to a document. This is the base resource type for everything.
Short | A reference to a documentBase Resource
Comments | Usually, this is used for documents other than those defined by FHIR.
Control | 0..*
Invariants | 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()`) zv-dr-1: Only documents with status 'current' (final documents) are expected. (`status='current'`)
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.
Short | A 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.
Control | 0..1
Type | uri
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Alternate Names | extensions, 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.
Short | Master Version Specific Identifier
Comments | See ITI TF-2x: Z.9.1.1 Identifier and CDA root plus extension. CDA Document Id extension and root.
Control | 10..1
Type | Identifier
Must Support | true
Summary | true
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.
Short | Other identifiers for the document
Comments | When the DocumentReference.identifier carries the entryUUID then the DocumentReference.identifier use shall be ‘official’.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Must Support | true
Summary | true
10. DocumentReference.status
Definition | The status of this document reference.
Short | current | 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.
Control | 1..1
Binding | The codes SHALL be taken from DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|3.0.2 (required to `http://hl7.org/fhir/ValueSet/document-reference-status` ) The status of the document reference.
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
12. DocumentReference.docStatus
Definition | The status of the underlying document.
Short | preliminary | 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.
Control | 0..01
Binding | The codes SHALL be taken from CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|3.0.2 (required to `http://hl7.org/fhir/ValueSet/composition-status` ) Status of the underlying document.
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Short | Kind of document (LOINC if possible)
Comments | Key metadata element describing the document, used in searching/filtering.
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from The codes SHOULD be taken from Document Class & Type waardelijst http://hl7.org/fhir/ValueSet/c80-doc-typecodes|20091109 (extensible to `http://fhir.hl7.nl/zorgviewer/ValueSet/DocumentLOINCCodelist` )
Type | CodeableConcept
Must Support | true
Summary | true
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.
Short | Categorization of document
Comments | This is a metadata field from XDS/MHD.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from For example codes, see Document Class & Type waardelijst http://hl7.org/fhir/ValueSet/c80-doc-classcodes|20091109 (extensible to `http://fhir.hl7.nl/zorgviewer/ValueSet/DocumentLOINCCodelist` )
Type | CodeableConcept
Must Support | true
Summary | true
Requirements | Helps humans to assess whether the document is of interest when viewing a list of documents.
Alternate Names | kind
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).
Short | Who/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.
Control | 0..1
Type | Reference(Patient, Practitioner, Group, Device)referenced, bundled
Must Support | true
Summary | true
20. DocumentReference.created
Definition | When the document was created.
Short | Document 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.
Control | 0..01
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
22. DocumentReference.indexed
Definition | When the document reference was created.
Short | When this document reference was created
Comments | Referencing/indexing time is used for tracking, organizing versions and searching.
Control | 1..1
Type | instant
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
24. DocumentReference.author
Definition | Identifies who is responsible for adding the information to the document.
Short | Who 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).
Control | 0..*
Type | Reference(Practitioner, Organization, Device, Patient, RelatedPerson)contained
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
26. DocumentReference.custodian
Definition | Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.
Short | Organization 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.
Control | 0..01
Type | Reference(Organization)
Summary | true
28. DocumentReference.relatesTo
Definition | Relationships that this document has with other document references that already exist.
Short | Relationships 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.
Control | 0..*
Type | BackboneElement
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Must Support | true
Summary | true
Invariants | ele-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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
32. DocumentReference.relatesTo.code
Definition | The type of relationship that this document has with anther document.
Short | replaces | transforms | signs | appends
Comments | If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.
Control | 1..1
Binding | The codes SHALL be taken from DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|3.0.2 (required to `http://hl7.org/fhir/ValueSet/document-relationship-type` ) The type of relationship between documents.
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
34. DocumentReference.relatesTo.target
Definition | The target document of this relationship.
Short | Target of the relationship
Control | 1..1
Type | Reference(DocumentReference)
Summary | true
36. DocumentReference.description
Definition | Human-readable description of the source document. This is sometimes known as the "title".
Short | Human-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").
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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.
Short | Document 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.
Control | 0..*
Binding | Unless not suitable, these codes SHALL be taken from All Security Labels http://hl7.org/fhir/ValueSet/security-labels|3.0.2 (extensible to `http://hl7.org/fhir/ValueSet/security-labels` ) Security Labels from the Healthcare Privacy and Security Classification System.
Type | CodeableConcept
Must Support | true
Summary | true
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.
Short | Document referenced
Control | 1..1*
Type | BackboneElement
Must Support | true
Summary | true
Invariants | ele-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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
44. DocumentReference.content.attachment
Definition | The document or URL of the document along with critical metadata to prove content has integrity.
Short | Where to access the document
Control | 1..1
Type | Attachment
Must Support | true
Summary | true
Invariants | zv-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.
Short | Mime type of the content, with charset etc.
Control | 10..1
Binding | The codes SHALL be taken from http://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.
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Processors of the data need to be able to know how to interpret the data.
Example | General: 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.
Short | Human language of the content (BCP-47)
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Common Languages http://hl7.org/fhir/ValueSet/languages|3.0.2 (extensible to `http://hl7.org/fhir/ValueSet/languages` ) A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Users need to be able to choose between the languages in a set of attachments.
Example | General: en-AU
50. DocumentReference.content.attachment.data
Definition | The actual data of the attachment - a sequence of bytes. In XML, represented using base64.
Short | Data 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.
Control | 0..01
Type | base64Binary
Primitive Value | This 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.
Short | Uri 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.
Control | 10..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | The data needs to be transmitted by reference.
Example | General: http://www.acme.com/logo-small.png
54. DocumentReference.content.attachment.creation
Definition | The date that the attachment was first created.
Short | Date attachment was first created
Comments | These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.
Control | 0..01
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Short | Format/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.
Control | 0..1
Binding | The codes SHOULD be taken from IHE ValueSet of Format Codes for use with Document Sharing http://hl7.org/fhir/ValueSet/formatcodes|20150326 (preferred to `http://ihe.net/fhir/ValueSet/IHE.formatcode.vs` ) Document Format Codes.
Type | Coding
Must Support | true
Summary | true
58. DocumentReference.context
Definition | The clinical context in which the document was prepared.
Short | Clinical context of document
Comments | These values are primarily added to help with searching for interesting/relevant documents.
Control | 0..1
Type | BackboneElement
Must Support | false
Summary | true
Invariants | ele-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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
62. DocumentReference.context.period
Definition | The time period over which the service that is described by the document was provided.
Short | Time of service that is being documented
Control | 0..1
Type | Period
Must Support | true
Summary | true
64. DocumentReference.context.period.start
Definition | The start of the period. The boundary is inclusive.
Short | Starting time with inclusive boundary
Comments | If the low element is missing, the meaning is that the low boundary is not known.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
66. DocumentReference.context.facilityType
Definition | The kind of facility where the patient was seen.
Short | Kind of facility where patient was seen
Control | 0..1
Binding | For example codes, see Facility Type Code Value Set http://hl7.org/fhir/ValueSet/c80-facilitycodes|20091109 (example to `http://hl7.org/fhir/ValueSet/c80-facilitycodes` ) XDS Facility Type.
Type | CodeableConcept
Must Support | true
Summary | true
68. DocumentReference.context.practiceSetting
Definition | This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.
Short | Additional 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.
Control | 0..1
Binding | For example codes, see Practice Setting Code Value Set http://hl7.org/fhir/ValueSet/c80-practice-codes|20091109 (example to `http://hl7.org/fhir/ValueSet/c80-practice-codes` ) Additional details about where the content was created (e.g. clinical specialty).
Type | CodeableConcept
Must Support | true
Summary | true
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.
Short | Patient 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
Control | 0..1
Type | Reference(Patient)contained
Must Support | true
Summary | true

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

0. DocumentReference
Invariants | zv-dr-1: Only documents with status 'current' (final documents) are expected. (`status='current'`)
2. DocumentReference.status
Must Support | true
4. DocumentReference.type
Binding | Unless not suitable, these codes SHALL be taken from Document Class & Type waardelijst (extensible to `http://fhir.hl7.nl/zorgviewer/ValueSet/DocumentLOINCCodelist` )
Must Support | true
6. DocumentReference.class
Binding | Unless not suitable, these codes SHALL be taken from Document Class & Type waardelijst (extensible to `http://fhir.hl7.nl/zorgviewer/ValueSet/DocumentLOINCCodelist` )
Must Support | true
8. DocumentReference.author
Comments | Expect the references Practitioner to have his Organization
Must Support | true
10. DocumentReference.description
Must Support | true
12. DocumentReference.content
14. DocumentReference.content.attachment
Must Support | true
Invariants | zv-dr-2: Only pdf documents are expected through the url (`contentType='application/pdf'`)
16. DocumentReference.content.attachment.contentType
Must Support | true
18. DocumentReference.content.attachment.url
Control | 1..?
Must Support | true
20. DocumentReference.context
22. DocumentReference.context.period
24. DocumentReference.context.period.start
Must Support | true

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

0. DocumentReference
Definition | A reference to a document.
Short | A reference to a document
Comments | Usually, this is used for documents other than those defined by FHIR.
Control | 0..*
Invariants | 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()`) zv-dr-1: Only documents with status '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.
Short | Logical 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.
Control | 0..1
Type | id
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Summary | true
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.
Short | A 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.
Control | 0..1
Type | uri
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
8. DocumentReference.language
Definition | The base language in which the resource is written.
Short | Language 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).
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Common Languages (extensible to `http://hl7.org/fhir/ValueSet/languages` ) A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Type | code
Primitive Value | This 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.
Short | Text 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.
Control | 0..1 This element is affected by the following invariants: dom-1
Type | Narrative
Alternate Names | narrative, 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.
Short | Contained, 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.
Control | 0..*
Type | Resource
Alternate Names | inline 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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, 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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Alternate Names | extensions, 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.
Short | Master Version Specific Identifier
Comments | See ITI TF-2x: Z.9.1.1 Identifier and CDA root plus extension.
Control | 1..1
Type | Identifier
Must Support | true
Summary | true
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.
Short | Other identifiers for the document
Comments | When the DocumentReference.identifier carries the entryUUID then the DocumentReference.identifier use shall be ‘official’.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Must Support | true
Summary | true
22. DocumentReference.status
Definition | The status of this document reference.
Short | current | superseded | entered-in-error
Comments | approved -> status=current deprecated -> status=superseded
Control | 1..1
Binding | The codes SHALL be taken from DocumentReferenceStatus (required to `http://hl7.org/fhir/ValueSet/document-reference-status` ) The status of the document reference.
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
24. DocumentReference.docStatus
Definition | The status of the underlying document.
Short | preliminary | final | appended | amended | entered-in-error
Comments | These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.
Control | 0..0
Binding | The codes SHALL be taken from CompositionStatus (required to `http://hl7.org/fhir/ValueSet/composition-status` ) Status of the underlying document.
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Short | Kind of document (LOINC if possible)
Comments | Key metadata element describing the document, used in searching/filtering.
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from Document Class & Type waardelijst (extensible to `http://fhir.hl7.nl/zorgviewer/ValueSet/DocumentLOINCCodelist` )
Type | CodeableConcept
Must Support | true
Summary | true
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.
Short | Categorization of document
Comments | This is a metadata field from XDS/MHD.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Document Class & Type waardelijst (extensible to `http://fhir.hl7.nl/zorgviewer/ValueSet/DocumentLOINCCodelist` )
Type | CodeableConcept
Must Support | true
Summary | true
Requirements | Helps humans to assess whether the document is of interest when viewing a list of documents.
Alternate Names | kind
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).
Short | Who/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.
Control | 0..1
Type | Reference(Patient)referenced, bundled
Must Support | true
Summary | true
32. DocumentReference.created
Definition | When the document was created.
Short | Document 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.
Control | 0..0
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
34. DocumentReference.indexed
Definition | When the document reference was created.
Short | When this document reference was created
Comments | Referencing/indexing time is used for tracking, organizing versions and searching.
Control | 1..1
Type | instant
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
36. DocumentReference.author
Definition | Identifies who is responsible for adding the information to the document.
Short | Who and/or what authored the document
Comments | Expect the references Practitioner to have his Organization
Control | 0..*
Type | Reference(Practitioner, Organization)contained
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
38. DocumentReference.authenticator
Definition | Which person or organization authenticates that this document is valid.
Short | Who/what authenticated the document
Comments | Contained resource
Control | 0..1
Type | Reference
Must Support | false
Summary | true
40. DocumentReference.custodian
Definition | Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.
Short | Organization which maintains the document
Comments | These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.
Control | 0..0
Type | Reference(Organization)
Summary | true
42. DocumentReference.relatesTo
Definition | Relationships that this document has with other document references that already exist.
Short | Relationships to other documents
Comments | See ITI TF-2c: 3.65.4.1.2.3
Control | 0..*
Type | BackboneElement
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Must Support | true
Summary | true
Invariants | ele-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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In 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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, 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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
50. DocumentReference.relatesTo.code
Definition | The type of relationship that this document has with anther document.
Short | replaces | transforms | signs | appends
Comments | If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.
Control | 1..1
Binding | The codes SHALL be taken from DocumentRelationshipType (required to `http://hl7.org/fhir/ValueSet/document-relationship-type` ) The type of relationship between documents.
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
52. DocumentReference.relatesTo.target
Definition | The target document of this relationship.
Short | Target of the relationship
Control | 1..1
Type | Reference(DocumentReference)
Summary | true
54. DocumentReference.description
Definition | Human-readable description of the source document. This is sometimes known as the "title".
Short | Human-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").
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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.
Short | Document security-tags
Comments | Note: This is NOT the DocumentReference.meta, as that holds the meta tags for the DocumentReference itself.
Control | 0..*
Binding | Unless 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.
Type | CodeableConcept
Must Support | true
Summary | true
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.
Short | Document referenced
Control | 1..1
Type | BackboneElement
Must Support | true
Summary | true
Invariants | ele-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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In 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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, 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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
66. DocumentReference.content.attachment
Definition | The document or URL of the document along with critical metadata to prove content has integrity.
Short | Where to access the document
Control | 1..1
Type | Attachment
Must Support | true
Summary | true
Invariants | zv-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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In 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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This 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.
Short | Mime type of the content, with charset etc.
Control | 1..1
Binding | The codes SHALL be taken from (required to `http://hl7.org/fhir/ValueSet/mimetypes` ) The mime type of an attachment. Any valid mime type is allowed.
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Processors of the data need to be able to know how to interpret the data.
Example | General: 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.
Short | Human language of the content (BCP-47)
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Common Languages (extensible to `http://hl7.org/fhir/ValueSet/languages` ) A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Users need to be able to choose between the languages in a set of attachments.
Example | General: en-AU
76. DocumentReference.content.attachment.data
Definition | The actual data of the attachment - a sequence of bytes. In XML, represented using base64.
Short | Data inline, base64ed
Comments | These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.
Control | 0..0
Type | base64Binary
Primitive Value | This 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.
Short | Uri 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.
Control | 1..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | The data needs to be transmitted by reference.
Example | General: 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).
Short | Number 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.
Control | 0..1
Type | unsignedInt
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
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.
Short | Hash 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.
Control | 0..1
Type | base64Binary
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
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.
Short | Label to display in place of the data
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
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 | General: Official Corporate Logo
86. DocumentReference.content.attachment.creation
Definition | The date that the attachment was first created.
Short | Date attachment was first created
Comments | These HL7 FHIR STU3 elements are not used in XDS, therefore would not be present.
Control | 0..0
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Short | Format/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.
Control | 0..1
Binding | The 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` ) Document Format Codes.
Type | Coding
Must Support | true
Summary | true
90. DocumentReference.context
Definition | The clinical context in which the document was prepared.
Short | Clinical context of document
Comments | These values are primarily added to help with searching for interesting/relevant documents.
Control | 0..1
Type | BackboneElement
Must Support | false
Summary | true
Invariants | ele-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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In 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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, 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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
98. DocumentReference.context.encounter
Definition | Describes the clinical encounter or type of care that the document content is associated with.
Short | Context of the document content
Comments | When referenceIdList contains an encounter, and a FHIR Encounter is available, it may be referenced.
Control | 0..1
Type | Reference(Encounter)
Must Support | false
Summary | true
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.
Short | Main 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.
Control | 0..*
Binding | For example codes, see ActCode (example to `http://hl7.org/fhir/ValueSet/v3-ActCode` ) This list of codes represents the main clinical acts being documented.
Type | CodeableConcept
Must Support | false
Summary | true
102. DocumentReference.context.period
Definition | The time period over which the service that is described by the document was provided.
Short | Time of service that is being documented
Control | 0..1
Type | Period
Must Support | true
Summary | true
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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In 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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This 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.
Short | Starting time with inclusive boundary
Comments | If the low element is missing, the meaning is that the low boundary is not known.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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.
Short | End 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.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Meaning if Missing | If 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.
Short | Kind of facility where patient was seen
Control | 0..1
Binding | For example codes, see Facility Type Code Value Set (example to `http://hl7.org/fhir/ValueSet/c80-facilitycodes` ) XDS Facility Type.
Type | CodeableConcept
Must Support | true
Summary | true
114. DocumentReference.context.practiceSetting
Definition | This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.
Short | Additional 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.
Control | 0..1
Binding | For 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).
Type | CodeableConcept
Must Support | true
Summary | true
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.
Short | Patient 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
Control | 0..1
Type | Reference
Must Support | true
Summary | true
118. DocumentReference.context.related
Definition | Related identifiers or resources associated with the DocumentReference.
Short | Related identifiers or resources
Comments | May be identifiers or resources that caused the DocumentReference or referenced Document to be created.
Control | 0..*
Type | BackboneElement
Must Support | false
Summary | true
Invariants | ele-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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In 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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, 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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, 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.
Short | Identifier of related objects or events
Comments | See ITI TF-2x: Appendix E.3.1 on CXi mapping to FHIR Identifier
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1
Type | Identifier
Must Support | false
Summary | true
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.
Short | Related Resource
Comments | May be filled with URL pointers to Resources found in referenceIdList
Control | 0..1
Type | Reference(Resource)
Must Support | false
Summary | true