Mobile Access to DICOM Objects (MADO), published by IHE Radiology Technical Committee. This guide is not an authorized publication; it is the continuous build for version 0.1.0-SNAPSHOT built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/bvdh/bvdh-ihe-mado/ and changes regularly. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• XML
• JSON
• TTL

Resource Profile: MADO MHD DocumentReference Profile for FHIR Imaging Manifests

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

Usages:

• Refer to this Profile: MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	MinimalDocumentReference	A reference to a document
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: Anatomical Region (extensible)
extension:reference		0..1	Extension	Reference to a resource (by instance) Constraints: ext-1
url		1..1	uri	"reference"
extension:_datatype		0..1	(Complex)	Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier	Σ	1..1	UniqueIdIdentifier	Master Version Specific Identifier
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID	SΣ	0..*	EntryUUIDIdentifier	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: MHD DocumentReference status codes (required)
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(Patient)	Who/what is the subject of the document
date	SΣ	0..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
Slices for relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
relatesTo:fhirReference	SΣ	0..1	BackboneElement	Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Required Pattern: transforms
target	Σ	1..1	Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests)	Target of the relationship
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	(Complex)	Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile Constraints: ext-1
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:value[x]		1..1	Extension	Extension Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"value[x]"
Slices for value[x]		0..1		Code|uri|canonical Slice: Unordered, Open by type:$this Binding: R5_v3_HL7FormatCodes_for_R4 (0.0.1-snapshot-2) (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
value[x]:valueCanonical		0..1	canonical()	Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
contentType	Σ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	Σ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026"
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
context	Σ	1..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
period	SΣ	0..1	Period	Time of service that is being documented
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo	S	0..1	Reference(Patient)	Patient demographics from source
Slices for related		1..*	Reference(Resource)	Related identifiers or resources Slice: Unordered, Open by value:identifier
related:study-instance-uid		1..1	MadoReferencedStudyInstanceUidIdentifier(Resource)	The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number		0..1	MadoReferencedAccessionNumberIdentifier(Resource)	The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	Anatomical Region	📦0.1.0-SNAPSHOT	This IG
DocumentReference.status	Base	required	MHD DocumentReference status codes	📦4.2.4-current	Mobile access to Health Documents vnull
DocumentReference.type	Base	preferred	Document Type Value Set	📍4.0.1	FHIR Std.
DocumentReference.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.relatesTo:fhirReference.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.content.​extension:profile.extension:value[x].​value[x]	Base	preferred	Cross-version VS for R5.HL7FormatCodes for use in FHIR R4	📍0.0.1-snapshot-2	FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 v0.0
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	preferred	IHE ValueSet of Format Codes for use with Document Sharing	📦1.4.0	IHE FormatCode Vocabulary v1.4
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from MinimalDocumentReference

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

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	Anatomical Region	📦0.1.0-SNAPSHOT	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	MinimalDocumentReference	A reference to a document
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: Anatomical Region (extensible)
extension:reference		0..1	Extension	Reference to a resource (by instance) Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"reference"
value[x]		0..1	Reference()	Reference to a resource (by instance)
extension:_datatype		0..1	(Complex)	Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
id		0..1	id	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier	Σ	1..1	UniqueIdIdentifier	Master Version Specific Identifier
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID	SΣ	0..*	EntryUUIDIdentifier	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: MHD DocumentReference status codes (required)
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(Patient)	Who/what is the subject of the document
date	SΣ	0..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
authenticator		0..1	Reference(Practitioner | PractitionerRole | Organization)	Who/what authenticated the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
Slices for relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
relatesTo:fhirReference	SΣ	0..1	BackboneElement	Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Required Pattern: transforms
target	Σ	1..1	Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	(Complex)	Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:value[x]		1..1	Extension	Extension Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"value[x]"
Slices for value[x]		0..1		Code|uri|canonical Slice: Unordered, Open by type:$this Binding: R5_v3_HL7FormatCodes_for_R4 (0.0.1-snapshot-2) (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
value[x]:valueCanonical		0..1	canonical()	Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	Σ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	Σ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	Σ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026"
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
context	Σ	1..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter		0..*	Reference(Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time of service that is being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo	S	0..1	Reference(Patient)	Patient demographics from source
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Slices for related		1..*	Reference(Resource)	Related identifiers or resources Slice: Unordered, Open by value:identifier
related:study-instance-uid		1..1	MadoReferencedStudyInstanceUidIdentifier(Resource)	The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number		0..1	MadoReferencedAccessionNumberIdentifier(Resource)	The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
DocumentReference.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	Anatomical Region	📦0.1.0-SNAPSHOT	This IG
DocumentReference.status	Base	required	MHD DocumentReference status codes	📦4.2.4-current	Mobile access to Health Documents vnull
DocumentReference.type	Base	preferred	Document Type Value Set	📍4.0.1	FHIR Std.
DocumentReference.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.relatesTo:fhirReference.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.content.​extension:profile.extension:value[x].​value[x]	Base	preferred	Cross-version VS for R5.HL7FormatCodes for use in FHIR R4	📍0.0.1-snapshot-2	FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 v0.0
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	preferred	IHE ValueSet of Format Codes for use with Document Sharing	📦1.4.0	IHE FormatCode Vocabulary v1.4
DocumentReference.context.​event	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.0
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​sourcePatientInfo.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from MinimalDocumentReference

Summary

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

Structures

This structure refers to these other structures:

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

Extensions

This structure refers to these extensions:

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

Slices

This structure defines the following Slices:

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

Maturity: 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	MinimalDocumentReference	A reference to a document
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: Anatomical Region (extensible)
extension:reference		0..1	Extension	Reference to a resource (by instance) Constraints: ext-1
url		1..1	uri	"reference"
extension:_datatype		0..1	(Complex)	Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier	Σ	1..1	UniqueIdIdentifier	Master Version Specific Identifier
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID	SΣ	0..*	EntryUUIDIdentifier	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: MHD DocumentReference status codes (required)
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(Patient)	Who/what is the subject of the document
date	SΣ	0..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
Slices for relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
relatesTo:fhirReference	SΣ	0..1	BackboneElement	Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Required Pattern: transforms
target	Σ	1..1	Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests)	Target of the relationship
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	(Complex)	Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile Constraints: ext-1
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:value[x]		1..1	Extension	Extension Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"value[x]"
Slices for value[x]		0..1		Code|uri|canonical Slice: Unordered, Open by type:$this Binding: R5_v3_HL7FormatCodes_for_R4 (0.0.1-snapshot-2) (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
value[x]:valueCanonical		0..1	canonical()	Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
contentType	Σ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	Σ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026"
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
context	Σ	1..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
period	SΣ	0..1	Period	Time of service that is being documented
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo	S	0..1	Reference(Patient)	Patient demographics from source
Slices for related		1..*	Reference(Resource)	Related identifiers or resources Slice: Unordered, Open by value:identifier
related:study-instance-uid		1..1	MadoReferencedStudyInstanceUidIdentifier(Resource)	The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number		0..1	MadoReferencedAccessionNumberIdentifier(Resource)	The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	Anatomical Region	📦0.1.0-SNAPSHOT	This IG
DocumentReference.status	Base	required	MHD DocumentReference status codes	📦4.2.4-current	Mobile access to Health Documents vnull
DocumentReference.type	Base	preferred	Document Type Value Set	📍4.0.1	FHIR Std.
DocumentReference.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.relatesTo:fhirReference.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.content.​extension:profile.extension:value[x].​value[x]	Base	preferred	Cross-version VS for R5.HL7FormatCodes for use in FHIR R4	📍0.0.1-snapshot-2	FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 v0.0
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	preferred	IHE ValueSet of Format Codes for use with Document Sharing	📦1.4.0	IHE FormatCode Vocabulary v1.4
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from MinimalDocumentReference

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

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	Anatomical Region	📦0.1.0-SNAPSHOT	This IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	MinimalDocumentReference	A reference to a document
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: Anatomical Region (extensible)
extension:reference		0..1	Extension	Reference to a resource (by instance) Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"reference"
value[x]		0..1	Reference()	Reference to a resource (by instance)
extension:_datatype		0..1	(Complex)	Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
id		0..1	id	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier	Σ	1..1	UniqueIdIdentifier	Master Version Specific Identifier
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID	SΣ	0..*	EntryUUIDIdentifier	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: MHD DocumentReference status codes (required)
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(Patient)	Who/what is the subject of the document
date	SΣ	0..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
authenticator		0..1	Reference(Practitioner | PractitionerRole | Organization)	Who/what authenticated the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
Slices for relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:code
relatesTo:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
relatesTo:fhirReference	SΣ	0..1	BackboneElement	Reference to the DocumentReference resource that contains the DICOM KOS manifest that corresponds to this imaging report in FHIR format
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Required Pattern: transforms
target	Σ	1..1	Reference(MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	(Complex)	Contains the profile of the referred report URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:value[x]		1..1	Extension	Extension Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"value[x]"
Slices for value[x]		0..1		Code|uri|canonical Slice: Unordered, Open by type:$this Binding: R5_v3_HL7FormatCodes_for_R4 (0.0.1-snapshot-2) (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
value[x]:valueCanonical		0..1	canonical()	Code|uri|canonical Required Pattern: https://profiles.ihe.net/RAD/MADO/StructureDefinition/MadoFhirBundle
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.content.profile"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	Σ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	Σ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	Σ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: IHE ValueSet of Format Codes for use with Document Sharing (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: urn:ihe:rad:MADO:fhir-manifest:2026"
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
context	Σ	1..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter		0..*	Reference(Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time of service that is being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo	S	0..1	Reference(Patient)	Patient demographics from source
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Slices for related		1..*	Reference(Resource)	Related identifiers or resources Slice: Unordered, Open by value:identifier
related:study-instance-uid		1..1	MadoReferencedStudyInstanceUidIdentifier(Resource)	The Study Instance UID of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Study Instance UID.
related:accession-number		0..1	MadoReferencedAccessionNumberIdentifier(Resource)	The Accession Number of the imaging study that is the focus of the imaging manifest, represented as an Identifier with a fixed system and a value that corresponds to the Accession Number.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
DocumentReference.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	Anatomical Region	📦0.1.0-SNAPSHOT	This IG
DocumentReference.status	Base	required	MHD DocumentReference status codes	📦4.2.4-current	Mobile access to Health Documents vnull
DocumentReference.type	Base	preferred	Document Type Value Set	📍4.0.1	FHIR Std.
DocumentReference.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.relatesTo:fhirReference.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.content.​extension:profile.extension:value[x].​value[x]	Base	preferred	Cross-version VS for R5.HL7FormatCodes for use in FHIR R4	📍0.0.1-snapshot-2	FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 v0.0
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	preferred	IHE ValueSet of Format Codes for use with Document Sharing	📦1.4.0	IHE FormatCode Vocabulary v1.4
DocumentReference.context.​event	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.0
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​sourcePatientInfo.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from MinimalDocumentReference

Summary

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

Structures

This structure refers to these other structures:

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

Extensions

This structure refers to these extensions:

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

Slices

This structure defines the following Slices:

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

Maturity: 1