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

Official URL: http://fhir.hl7.nl/zorgviewer/StructureDefinition/DocumentReference | Version: 1.21.0
Active as of 2025-10-28 | Computable Name: DocumentReference

Verwijzingen naar document

> Dit Profiel is het resultaat van de vergelijking tussen de zib2017 FHIR Profiel en de implementaties in Epic, Chipsoft, Topicus en Nexus. De elementen die in ieder geval in alle output beschikbaar zullen zijn. Voornamelijk bedoeld voor houvast van een client en voor validatie van output.

### View Definition

ViewDefinition voor Correspondentie

### UI Wireframe

Correspondentie

>< | Bron | Datum | Beschrijving | Auteur | Specialisme | (MimeType) | (Type)
--- | --- | --- | --- | --- | --- | --- | ---
+ | Chipsoft-Bundle | 21-8-2022 | Letter |  | 394802001 | application/pdf | 51852-2
+ | Chipsoft-Bundle | 21-8-2022 | Brief zorginstelling |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 22-4-2024 | Verwijsbrief |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 22-4-2025 | Verwijsbrief |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 22-4-2025 | Letter |  | 394802001 | application/pdf | 51852-2
+ | Chipsoft-Bundle | 17-7-2025 | Medisch beeldvormende techniek per onderzoek |  | 394802001 | application/pdf | 51852-2
+ | Chipsoft-Bundle | 20-7-2025 | Poliklinische consultbrief (OK+Brief) UMCU |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 28-7-2025 | Medisch beeldvormende techniek per onderzoek |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 23-4-2024 | Verwijsbrief |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 23-4-2024 | Verwijsbrief |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 23-4-2024 | Verwijsbrief |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 23-4-2024 | Verwijsbrief |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 10-11-2024 | Verwijsbrief |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 18-12-2024 | Verwijsbrief |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 18-12-2024 | Radiologie |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 4-6-2025 | Blanco brief WZA |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 4-8-2025 | Blanco brief WZA |  | 394802001 | application/pdf | 51852-2
+ | Chipsoft-Bundle | 4-6-2025 | Blanco brief |  | 394802001 | application/pdf | 68609-7
+ | Chipsoft-Bundle | 19-8-2025 | Ourmind .docx |  | 394802001 | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 51852-2
+ | Chipsoft-Bundle | 19-8-2025 | Ourmind |  | 394802001 | application/pdf | 51852-2
+ | Chipsoft-Bundle | 19-8-2025 | Ourmind |  | 394802001 | application/pdf | 51852-2
+ | Chipsoft-Bundle | 19-8-2025 | Ourmind |  | 394802001 | application/pdf | 51852-2
+ | Chipsoft-Bundle | 19-8-2025 | Ourmind |  | 394802001 | application/pdf | 51852-2
+ | Chipsoft | 11-5-2022 | test |  | 394802001 | application/pdf | 51852-2
+ | Epic-PZP | 23-7-2025 | Artsenbrief, Proactieve zorgplanning | RPHM. Muskens, Oogarts |  | application/pdf | Artsenbrief
+ | Epic | 15-12-2021 | Patiëntenbrief, Brief (uit) | G Boer | KGA - Genetica | application/pdf | Patiëntenbrief

### Kolom Definities

Kolom label | FHIR Path Expression | FHIR Type | Zib element | Toelichting of regels
Bron | `meta.extension('http://hl7.org/fhir/4.0/StructureDefinition/extension-Meta.source').valueUri` | `string` | nvt | Lookup adhv uri (AGB-Z of OID) `<adressering-base>/Organization?identifier=<.meta.tag.code>` en gebruik dan `Organization.name`
Datum | `iif(exists(context.period.start), context.period.start, indexed)` | `dateTime` | nvt | N.B. tijd is GMT, dus omzetten naar CET. Ter info: indien datum uit `indexed` komt, deze markeren met een icoontje ⓘ
Beschrijving | `iif(exists(description), description, content.attachment.title.replace('.pdf',''))+iif(exists(context.encounter.display),', '+context.encounter.display,'')` | `string` | nvt | Tijdelijk voor Zorgplatform: gebruik `content.attachment.title` voor de beschrijving van documenten inclusief het strippen van de `.pdf` extensie
Auteur | `author.display` | `string` | nvt | Tijdelijk voor Zorgplatform: indien `author.display` is gevuld met een OID, dan wordt het veld gevuld met `Auteur niet bekend`
Specialisme | `iif(context.practiceSetting.text.startsWith('2.16.840.1.113883.'), context.practiceSetting.coding.code, context.practiceSetting.text)` | `string` | nvt | Tijdelijk voor Zorgplatform: indien `context.practiceSetting.text` is gevuld met een OID (startsWith('2.16.840.1.113883.)), dan wordt het veld gevuld met `context.practiceSetting.coding.code` (een SNOMED CT code)
MARKERING
(MimeType) | `content.attachment.contentType` | `code` | nvt | Alleen `application/pdf` tonen
(Type) | `iif(type.text.startsWith('2.16.840.1.113883.'), type.coding[0].code, type.text)` | `string` | nvt |

### Document soorten herkennen

class (higher level grouping) | type (http://loinc.org) | type descriptions
correspondence Correspondentie | Healthcare communication Document (56444-3) | Correspondentie, Patiëntenbrief, Verwijsbrief, Poliklinische brief, Artsenbrief
CS: Brief (51852-2) CS: Hospital Letter (68609-7) | CS: Brief (51852-2) CS: Hospital Letter (68609-7) | {OID?}
imaging-result Imaging result | Procedure note (28570-0) | Radiologie verslag
clinical-note Notitie | Epic clinical-note(s) types from DocumentReference.Search (Clinical Notes) (STU3) Discharge Documentation (18842-5) Consultation (11488-4) History & Physical (34117-2) Progress Note (11506-3) Procedure Note (28570-0) Emergency Department Note (34111-5) Nurse Note (34746-8) Discharge Instructions (74213-0) Risk assessment and screening note (75492-9) OR Note (11504-8) Miscellaneous Notes (34109-9) |

Zie het Excelbestand tab "classCode+decision tree" voor LOINC codes: Nationale XDS metadataset

### Request

1. Opvragen (search) alle documenten

   `GET <ontsluiten-bronsysteem-base>/DocumentReference?patient=<fhir_patient_id>&status=current`

### Bronsysteem herkennen

De Zorgviewer-backend of Ontsluiten bronsysteem MOET na bevragen van het bronsysteem aan elk resultaat resource een meta-tag toevoegen met de AGB, OID of URA identifier van de zorgaanbieder (zie Organization voor voorbeelden). Dit wordt vervolgens gebruikt in de "Bron" kolom in de Zorgviewer-frontend. N.B. We gebruiken hier een pre-adopt van de FHIR R4 Meta.source.

Toevoegen aan elke response, dus per resource (bij een read) of per Bundle (bij een search):

    "meta": {
        "extension": [ {
            "url": "http://hl7.org/fhir/4.0/StructureDefinition/extension-Meta.source",
            "valueUri": "urn:oid:2.16.840.1.113883.2.4.3.8"
        } ]
    }

Alternatief: Elke entry van een search response Bundle bevat een referentie naar de bijbehorende Patient (`<resource>.subject|patient`). Elke patient heeft een `Patient.managingOrganization` en in de gerefereerde `Organization.identifier` staat vervolgens o.a. de OID van het bronsysyeem. Of je gebruikt de identifiers om een volledige Organization op te zoeken in het adresboek en zie inhoud hier.

Usages:

- CapabilityStatements using this Profile: Ontsluiten Bronsysteem
- This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

Changes since version 1.20.0:

- No changes

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | Nictiz.IHE.MHD.Minimal.DocumentReference | A reference to a document Constraints: zv-dr-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | S Σ | 1..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Class & Type waardelijst (extensible)
class | S Σ | 0..1 | CodeableConcept | Categorization of document Binding: Document Class & Type waardelijst (extensible)
subject | S Σ | 0..1 | Reference(Patient) {r, b} | Who/what is the subject of the document
indexed | S Σ | 1..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner | Organization) {c} | Who and/or what authored the document
relatesTo | ?!S Σ | 0..* | BackboneElement | Relationships to other documents
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | S Σ | 0..1 | string | Human-readable description (title)
securityLabel | S Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..1 | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: zv-dr-2
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | S Σ | 0..1 | code | Human language of the content (BCP-47) Binding: Common Languages (extensible): A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Example General: en-AU
url | S Σ | 1..1 | uri | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
context | Σ | 0..1 | BackboneElement | Clinical context of document
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
period | S Σ | 0..1 | Period | Time of service that is being documented
start | S Σ C | 0..1 | dateTime | Starting time with inclusive boundary
facilityType | S Σ | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: Facility Type Code Value Set (example): XDS Facility Type.
practiceSetting | S Σ | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Code Value Set (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo | S Σ | 0..1 | Reference() {c} | Patient demographics from source
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📦3.0.2 | FHIR Std.
DocumentReference.type | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.class | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📦3.0.2 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | All Security Labels | 📦3.0.2 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | ​ null (missing link) | 📦 | unknown?
DocumentReference.content.​attachment.language | Base | extensible | Common Languages | 📦3.0.2 | FHIR Std.
DocumentReference.content.​format | Base | preferred | IHE ValueSet of Format Codes for use with Document Sharing | 📦20180126 | nictiz.fhir.nl.stu3.zib2017 v2.0
DocumentReference.context.​facilityType | Base | example | Facility Type Code Value Set | 📦20091109 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | example | Practice Setting Code Value Set | 📦20091109 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-1 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain any narrative | `contained.text.empty()`
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource | `contained.where(('#'+id in %resource.descendants().reference).not()).empty()`
dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() | (children().count() > id.count())`
zv-dr-1 | error | DocumentReference | Only documents with status 'current' (final documents) are expected. | `status='current'`
zv-dr-2 | warning | DocumentReference.content.attachment | Only pdf documents are expected through the url | `contentType='application/pdf'`

This structure is derived from Nictiz.IHE.MHD.Minimal.DocumentReference

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | Nictiz.IHE.MHD.Minimal.DocumentReference | A reference to a document Constraints: zv-dr-1
status | S | 1..1 | code | current | superseded | entered-in-error
type | S | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Class & Type waardelijst (extensible)
class | S | 0..1 | CodeableConcept | Categorization of document Binding: Document Class & Type waardelijst (extensible)
author | S | 0..* | Reference(Practitioner | Organization) {c} | Who and/or what authored the document
description | S | 0..1 | string | Human-readable description (title)
content |  | 1..1 | BackboneElement | Document referenced
attachment | S C | 1..1 | Attachment | Where to access the document Constraints: zv-dr-2
contentType | S | 1..1 | code | Mime type of the content, with charset etc.
url | S | 1..1 | uri | Uri where the data can be found
context |  |  |  |
period |  |  |  |
start | S | 0..1 | dateTime | Starting time with inclusive boundary
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.type | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.class | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
zv-dr-1 | error | DocumentReference | Only documents with status 'current' (final documents) are expected. | `status='current'`
zv-dr-2 | warning | DocumentReference.content.attachment | Only pdf documents are expected through the url | `contentType='application/pdf'`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | Nictiz.IHE.MHD.Minimal.DocumentReference | A reference to a document Constraints: zv-dr-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: Common Languages (extensible): A human language.
Additional Bindings | Purpose
All Languages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | S Σ | 1..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Class & Type waardelijst (extensible)
class | S Σ | 0..1 | CodeableConcept | Categorization of document Binding: Document Class & Type waardelijst (extensible)
subject | S Σ | 0..1 | Reference(Patient) {r, b} | Who/what is the subject of the document
indexed | S Σ | 1..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner | Organization) {c} | Who and/or what authored the document
authenticator | Σ | 0..1 | Reference() {c} | Who/what authenticated the document
relatesTo | ?!S Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | S Σ | 0..1 | string | Human-readable description (title)
securityLabel | S Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..1 | BackboneElement | Document referenced
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: zv-dr-2
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | S Σ | 0..1 | code | Human language of the content (BCP-47) Binding: Common Languages (extensible): A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Example General: en-AU
url | S Σ | 1..1 | uri | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
context | Σ | 0..1 | BackboneElement | Clinical context of document
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
encounter | Σ | 0..1 | Reference(Encounter) | Context of the document content
event | Σ | 0..* | CodeableConcept | Main clinical acts documented Binding: ActCode (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url
start | S Σ C | 0..1 | dateTime | Starting time with inclusive boundary
end | Σ C | 0..1 | dateTime | End time with inclusive boundary, if not ongoing
facilityType | S Σ | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: Facility Type Code Value Set (example): XDS Facility Type.
practiceSetting | S Σ | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Code Value Set (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo | S Σ | 0..1 | Reference() {c} | Patient demographics from source
related | Σ | 0..* | BackboneElement | Related identifiers or resources
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..1 | Identifier | Identifier of related objects or events
ref | Σ | 0..1 | Reference(Resource) | Related Resource
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | extensible | Common Languages | 📦3.0.2 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📦3.0.2 | FHIR Std.
DocumentReference.type | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.class | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📦3.0.2 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | All Security Labels | 📦3.0.2 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | ​ null (missing link) | 📦 | unknown?
DocumentReference.content.​attachment.language | Base | extensible | Common Languages | 📦3.0.2 | FHIR Std.
DocumentReference.content.​format | Base | preferred | IHE ValueSet of Format Codes for use with Document Sharing | 📦20180126 | nictiz.fhir.nl.stu3.zib2017 v2.0
DocumentReference.context.​event | Base | example | v3 Code System ActCode | 📦2016-11-11 | FHIR Std.
DocumentReference.context.​facilityType | Base | example | Facility Type Code Value Set | 📦20091109 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | example | Practice Setting Code Value Set | 📦20091109 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-1 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain any narrative | `contained.text.empty()`
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource | `contained.where(('#'+id in %resource.descendants().reference).not()).empty()`
dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() | (children().count() > id.count())`
zv-dr-1 | error | DocumentReference | Only documents with status 'current' (final documents) are expected. | `status='current'`
zv-dr-2 | warning | DocumentReference.content.attachment | Only pdf documents are expected through the url | `contentType='application/pdf'`

This structure is derived from Nictiz.IHE.MHD.Minimal.DocumentReference

Summary

Mandatory: 1 element
Must-Support: 9 elements

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | Nictiz.IHE.MHD.Minimal.DocumentReference | A reference to a document Constraints: zv-dr-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | S Σ | 1..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Class & Type waardelijst (extensible)
class | S Σ | 0..1 | CodeableConcept | Categorization of document Binding: Document Class & Type waardelijst (extensible)
subject | S Σ | 0..1 | Reference(Patient) {r, b} | Who/what is the subject of the document
indexed | S Σ | 1..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner | Organization) {c} | Who and/or what authored the document
relatesTo | ?!S Σ | 0..* | BackboneElement | Relationships to other documents
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | S Σ | 0..1 | string | Human-readable description (title)
securityLabel | S Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..1 | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: zv-dr-2
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | S Σ | 0..1 | code | Human language of the content (BCP-47) Binding: Common Languages (extensible): A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Example General: en-AU
url | S Σ | 1..1 | uri | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
context | Σ | 0..1 | BackboneElement | Clinical context of document
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
period | S Σ | 0..1 | Period | Time of service that is being documented
start | S Σ C | 0..1 | dateTime | Starting time with inclusive boundary
facilityType | S Σ | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: Facility Type Code Value Set (example): XDS Facility Type.
practiceSetting | S Σ | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Code Value Set (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo | S Σ | 0..1 | Reference() {c} | Patient demographics from source
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📦3.0.2 | FHIR Std.
DocumentReference.type | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.class | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📦3.0.2 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | All Security Labels | 📦3.0.2 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | ​ null (missing link) | 📦 | unknown?
DocumentReference.content.​attachment.language | Base | extensible | Common Languages | 📦3.0.2 | FHIR Std.
DocumentReference.content.​format | Base | preferred | IHE ValueSet of Format Codes for use with Document Sharing | 📦20180126 | nictiz.fhir.nl.stu3.zib2017 v2.0
DocumentReference.context.​facilityType | Base | example | Facility Type Code Value Set | 📦20091109 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | example | Practice Setting Code Value Set | 📦20091109 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-1 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain any narrative | `contained.text.empty()`
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource | `contained.where(('#'+id in %resource.descendants().reference).not()).empty()`
dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() | (children().count() > id.count())`
zv-dr-1 | error | DocumentReference | Only documents with status 'current' (final documents) are expected. | `status='current'`
zv-dr-2 | warning | DocumentReference.content.attachment | Only pdf documents are expected through the url | `contentType='application/pdf'`

Differential View

This structure is derived from Nictiz.IHE.MHD.Minimal.DocumentReference

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | Nictiz.IHE.MHD.Minimal.DocumentReference | A reference to a document Constraints: zv-dr-1
status | S | 1..1 | code | current | superseded | entered-in-error
type | S | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Class & Type waardelijst (extensible)
class | S | 0..1 | CodeableConcept | Categorization of document Binding: Document Class & Type waardelijst (extensible)
author | S | 0..* | Reference(Practitioner | Organization) {c} | Who and/or what authored the document
description | S | 0..1 | string | Human-readable description (title)
content |  | 1..1 | BackboneElement | Document referenced
attachment | S C | 1..1 | Attachment | Where to access the document Constraints: zv-dr-2
contentType | S | 1..1 | code | Mime type of the content, with charset etc.
url | S | 1..1 | uri | Uri where the data can be found
context |  |  |  |
period |  |  |  |
start | S | 0..1 | dateTime | Starting time with inclusive boundary
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.type | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.class | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
zv-dr-1 | error | DocumentReference | Only documents with status 'current' (final documents) are expected. | `status='current'`
zv-dr-2 | warning | DocumentReference.content.attachment | Only pdf documents are expected through the url | `contentType='application/pdf'`

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | Nictiz.IHE.MHD.Minimal.DocumentReference | A reference to a document Constraints: zv-dr-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: Common Languages (extensible): A human language.
Additional Bindings | Purpose
All Languages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | S Σ | 1..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type | S Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Class & Type waardelijst (extensible)
class | S Σ | 0..1 | CodeableConcept | Categorization of document Binding: Document Class & Type waardelijst (extensible)
subject | S Σ | 0..1 | Reference(Patient) {r, b} | Who/what is the subject of the document
indexed | S Σ | 1..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(Practitioner | Organization) {c} | Who and/or what authored the document
authenticator | Σ | 0..1 | Reference() {c} | Who/what authenticated the document
relatesTo | ?!S Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | S Σ | 0..1 | string | Human-readable description (title)
securityLabel | S Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..1 | BackboneElement | Document referenced
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
attachment | S Σ C | 1..1 | Attachment | Where to access the document Constraints: zv-dr-2
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | S Σ | 0..1 | code | Human language of the content (BCP-47) Binding: Common Languages (extensible): A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Example General: en-AU
url | S Σ | 1..1 | uri | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
context | Σ | 0..1 | BackboneElement | Clinical context of document
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
encounter | Σ | 0..1 | Reference(Encounter) | Context of the document content
event | Σ | 0..* | CodeableConcept | Main clinical acts documented Binding: ActCode (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url
start | S Σ C | 0..1 | dateTime | Starting time with inclusive boundary
end | Σ C | 0..1 | dateTime | End time with inclusive boundary, if not ongoing
facilityType | S Σ | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: Facility Type Code Value Set (example): XDS Facility Type.
practiceSetting | S Σ | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Code Value Set (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo | S Σ | 0..1 | Reference() {c} | Patient demographics from source
related | Σ | 0..* | BackboneElement | Related identifiers or resources
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..1 | Identifier | Identifier of related objects or events
ref | Σ | 0..1 | Reference(Resource) | Related Resource
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | extensible | Common Languages | 📦3.0.2 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📦3.0.2 | FHIR Std.
DocumentReference.type | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.class | Base | extensible | Document Class & Type waardelijst | 📦1.21.0 | This IG
DocumentReference.relatesTo.​code | Base | required | DocumentRelationshipType | 📦3.0.2 | FHIR Std.
DocumentReference.securityLabel | Base | extensible | All Security Labels | 📦3.0.2 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | ​ null (missing link) | 📦 | unknown?
DocumentReference.content.​attachment.language | Base | extensible | Common Languages | 📦3.0.2 | FHIR Std.
DocumentReference.content.​format | Base | preferred | IHE ValueSet of Format Codes for use with Document Sharing | 📦20180126 | nictiz.fhir.nl.stu3.zib2017 v2.0
DocumentReference.context.​event | Base | example | v3 Code System ActCode | 📦2016-11-11 | FHIR Std.
DocumentReference.context.​facilityType | Base | example | Facility Type Code Value Set | 📦20091109 | FHIR Std.
DocumentReference.context.​practiceSetting | Base | example | Practice Setting Code Value Set | 📦20091109 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-1 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain any narrative | `contained.text.empty()`
dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource | `contained.where(('#'+id in %resource.descendants().reference).not()).empty()`
dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() | (children().count() > id.count())`
zv-dr-1 | error | DocumentReference | Only documents with status 'current' (final documents) are expected. | `status='current'`
zv-dr-2 | warning | DocumentReference.content.attachment | Only pdf documents are expected through the url | `contentType='application/pdf'`

This structure is derived from Nictiz.IHE.MHD.Minimal.DocumentReference

Summary

Mandatory: 1 element
Must-Support: 9 elements

Other representations of profile: CSV, Excel, Schematron