MyHealtheVet PHR FHIR API
0.3.9-current - ci-build United States of America flag

MyHealtheVet PHR FHIR API, published by VA Digital Services. This guide is not an authorized publication; it is the continuous build for version 0.3.9-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/department-of-veterans-affairs/mhv-fhir-phr-mapping/ and changes regularly. See the Directory of published versions

Resource Profile: MHVchReport - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 3

Definitions for the VA.MHV.PHR.chReport resource profile.

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

0. DiagnosticReport
2. DiagnosticReport.extension
SlicingThis element introduces a set of slices on DiagnosticReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. DiagnosticReport.extension:note
    Slice Namenote
    Control0..*
    TypeExtension(Notes) (Extension Type: string)
    Must Supporttrue
    6. DiagnosticReport.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control1..?
    SlicingThis element introduces a set of slices on DiagnosticReport.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ use
    • 8. DiagnosticReport.identifier:Rid
      Slice NameRid
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1
      10. DiagnosticReport.identifier:Rid.use
      Control1..?
      Pattern Valueusual
      12. DiagnosticReport.identifier:Rid.system
      ShortDNS universalIdType: `urn:fdc:` + {universalID} + `:` + {namespaceId}
      14. DiagnosticReport.identifier:Rid.value
      Short{labTestPromises.recordIdentifier.identity}
      16. DiagnosticReport.identifier:TOid
      Slice NameTOid
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1
      18. DiagnosticReport.identifier:TOid.use
      Control1..?
      Pattern Valuesecondary
      20. DiagnosticReport.identifier:TOid.system
      Shorturn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
      InvariantsTOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} (value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.'))
      22. DiagnosticReport.identifier:TOid.value
      Short`recordIdentifier.identifier` | `/` | {specimentTakenDate.literal}
      24. DiagnosticReport.basedOn
      Control1..?
      TypeReference(VA MHV PHR CH labTests.orderedTestCode)contained
      Must Supporttrue
      26. DiagnosticReport.status
      28. DiagnosticReport.category
      Control2..?
      30. DiagnosticReport.category:ChSlice
      Slice NameChSlice
      Control1..1
      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
          "code" : "CH"
        }]
      }
      32. DiagnosticReport.code
      34. DiagnosticReport.code.coding
      Control0..0
      36. DiagnosticReport.code.text
      Control1..?
      Must Supporttrue
      Pattern ValueCH
      38. DiagnosticReport.subject
      40. DiagnosticReport.encounter
      Control0..0
      42. DiagnosticReport.effective[x]
      Control1..?
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      SlicingThis element introduces a set of slices on DiagnosticReport.effective[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • type @ $this
      • 44. DiagnosticReport.effective[x]:effectiveDateTime
        Slice NameeffectiveDateTime
        Control1..1
        TypedateTime
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Must Support TypesdateTime
        46. DiagnosticReport.issued
        Control1..?
        48. DiagnosticReport.performer
        ShortrecordSource
        Control1..1
        TypeReference(VA MHV PHR Organization)contained
        50. DiagnosticReport.resultsInterpreter
        Control0..0
        52. DiagnosticReport.specimen
        Control1..1
        TypeReference(VA MHV PHR HDR CH Specimen)contained
        Must Supporttrue
        54. DiagnosticReport.result
        TypeReference(VA MHV PHR CH labTest.chemistryResults)contained
        56. DiagnosticReport.imagingStudy
        Control0..0
        58. DiagnosticReport.media
        Control0..0
        60. DiagnosticReport.conclusion
        Control0..0
        62. DiagnosticReport.conclusionCode
        Control0..0
        64. DiagnosticReport.presentedForm
        Control0..0

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

        0. DiagnosticReport
        Definition

        -


        The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.

        ShortA Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
        Comments

        -


        This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

        Control0..*
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Alternate NamesReport, Test, Result, Results, Labs, Laboratory, Lab Result, Lab Report
        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        us-core-8: effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' ((status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists())
        us-core-9: issued SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' ((status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies issued.exists())
        2. DiagnosticReport.implicitRules
        Definition

        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        ShortA set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control0..1
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        4. DiagnosticReport.extension
        Definition

        An Extension


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

        ShortExtensionAdditional content defined by implementations
        Comments

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

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on DiagnosticReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 6. DiagnosticReport.extension:note
          Slice Namenote
          Definition

          Notes

          ShortNotes
          Control0..*
          This element is affected by the following invariants: ele-1
          TypeExtension(Notes) (Extension Type: string)
          Is Modifierfalse
          Must Supporttrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          8. DiagnosticReport.modifierExtension
          Definition

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

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored
          Comments

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

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Summaryfalse
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          10. DiagnosticReport.identifier
          Definition

          Identifiers assigned to this report by the performer or other systems.

          ShortBusiness identifier for report
          Comments

          Usually assigned by the Information System of the diagnostic service provider (filler id).

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control10..*
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          Requirements

          Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

          Alternate NamesReportID, Filler ID, Placer ID
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on DiagnosticReport.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • pattern @ use
          • 12. DiagnosticReport.identifier:Rid
            Slice NameRid
            Definition

            Identifiers assigned to this report by the performer or other systems.

            ShortBusiness identifier for report
            Comments

            Usually assigned by the Information System of the diagnostic service provider (filler id).

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1*
            TypeIdentifier
            Is Modifierfalse
            Summarytrue
            Requirements

            Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

            Alternate NamesReportID, Filler ID, Placer ID
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            14. DiagnosticReport.identifier:Rid.use
            Definition

            The purpose of this identifier.

            Shortusual | official | temp | secondary | old (If known)
            Comments

            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

            Control10..1
            BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

            Identifies the purpose for this identifier, if known .

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

            Pattern Valueusual
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            16. DiagnosticReport.identifier:Rid.system
            Definition

            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

            ShortDNS universalIdType: `urn:fdc:` + {universalID} + `:` + {namespaceId}The namespace for the identifier value
            Comments

            Identifier.system is always case sensitive.

            Control0..1
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

            Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            18. DiagnosticReport.identifier:Rid.value
            Definition

            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

            Short{labTestPromises.recordIdentifier.identity}The value that is unique
            Comments

            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Example<br/><b>General</b>:123456
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            20. DiagnosticReport.identifier:TOid
            Slice NameTOid
            Definition

            Identifiers assigned to this report by the performer or other systems.

            ShortBusiness identifier for report
            Comments

            Usually assigned by the Information System of the diagnostic service provider (filler id).

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1*
            TypeIdentifier
            Is Modifierfalse
            Summarytrue
            Requirements

            Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

            Alternate NamesReportID, Filler ID, Placer ID
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            22. DiagnosticReport.identifier:TOid.use
            Definition

            The purpose of this identifier.

            Shortusual | official | temp | secondary | old (If known)
            Comments

            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

            Control10..1
            BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

            Identifies the purpose for this identifier, if known .

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

            Pattern Valuesecondary
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. DiagnosticReport.identifier:TOid.system
            Definition

            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

            Shorturn:oid:2.16.840.1.113883.4.349.4.{stationNbr}The namespace for the identifier value
            Comments

            Identifier.system is always case sensitive.

            Control0..1
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

            Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} (value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.'))
            26. DiagnosticReport.identifier:TOid.value
            Definition

            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

            Short`recordIdentifier.identifier` | `/` | {specimentTakenDate.literal}The value that is unique
            Comments

            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Example<br/><b>General</b>:123456
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. DiagnosticReport.basedOn
            Definition

            Details concerning a service requested.

            ShortWhat was requested
            Comments

            Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

            Control10..*
            TypeReference(VA MHV PHR CH labTests.orderedTestCode, CarePlan, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)contained
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

            Alternate NamesRequest
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. DiagnosticReport.status
            Definition

            The status of the diagnostic report.

            Shortregistered | partial | preliminary | final +
            Control1..1
            This element is affected by the following invariants: us-core-8, us-core-9
            BindingThe codes SHALL be taken from DiagnosticReportStatushttp://hl7.org/fhir/ValueSet/diagnostic-report-status|4.0.1
            (required to http://hl7.org/fhir/ValueSet/diagnostic-report-status)
            Typecode
            Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. DiagnosticReport.category
            Definition

            A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

            ShortService category
            Comments

            Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

            Control20..*
            BindingFor example codes, see DiagnosticServiceSectionCodeshttp://hl7.org/fhir/ValueSet/diagnostic-service-sections
            (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)

            Codes for diagnostic service sections.

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Alternate NamesDepartment, Sub-department, Service, Discipline
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ $this
            • 34. DiagnosticReport.category:LaboratorySlice
              Slice NameLaboratorySlice
              Definition

              A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

              ShortService category
              Comments

              Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

              Control10..1*
              BindingFor example codes, see DiagnosticServiceSectionCodeshttp://hl7.org/fhir/ValueSet/diagnostic-service-sections
              (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)

              Codes for diagnostic service sections.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Alternate NamesDepartment, Sub-department, Service, Discipline
              Pattern Value{
                "coding" : [{
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
                  "code" : "LAB"
                }]
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              36. DiagnosticReport.category:ChSlice
              Slice NameChSlice
              Definition

              A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

              ShortService category
              Comments

              Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

              Control10..1*
              BindingFor example codes, see DiagnosticServiceSectionCodeshttp://hl7.org/fhir/ValueSet/diagnostic-service-sections
              (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)

              Codes for diagnostic service sections.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Alternate NamesDepartment, Sub-department, Service, Discipline
              Pattern Value{
                "coding" : [{
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
                  "code" : "CH"
                }]
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              38. DiagnosticReport.code
              Definition

              The test, panel or battery that was ordered.


              A code or name that describes this diagnostic report.

              ShortUS Core Laboratory Report Order CodeName/Code for this diagnostic report
              Comments

              UsageNote= The typical patterns for codes are: 1) a LOINC code either as a translation from a "local" code or as a primary code, or 2) a local code only if no suitable LOINC exists, or 3) both the local and the LOINC translation. Systems SHALL be capable of sending the local code if one exists.

              Control1..1
              BindingUnless not suitable, these codes SHALL be taken from The codes SHOULD be taken from US Core Diagnostic Report Laboratory Codeshttp://hl7.org/fhir/ValueSet/report-codes
              (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-lab-codes)

              LOINC codes


              Codes that describe Diagnostic Reports.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Alternate NamesType
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              40. DiagnosticReport.code.coding
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

              Control0..0*
              TypeCoding
              Is Modifierfalse
              Summarytrue
              Requirements

              Allows for alternative encodings within a code system, and translations to other code systems.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              42. DiagnosticReport.code.text
              Definition

              A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

              ShortPlain text representation of the concept
              Comments

              Very often the text is the same as a displayName of one of the codings.

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

              The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

              Pattern ValueCH
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              44. DiagnosticReport.subject
              Definition

              The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.

              ShortThe subject of the report - usually, but not always, the patient
              Control10..1
              TypeReference(US Core Patient Profile, Patient, Group, Device, Location)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              SHALL know the subject context.

              Alternate NamesPatient
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              46. DiagnosticReport.encounter
              Definition

              The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.

              ShortHealth care event when test ordered
              Comments

              This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

              Control0..01
              TypeReference(Encounter)
              Is Modifierfalse
              Summarytrue
              Requirements

              Links the request to the Encounter context.

              Alternate NamesContext
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              48. DiagnosticReport.effective[x]
              Definition

              The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

              ShortDiagnostically relevant time (typically the time of specimen collection)Clinically relevant time/time-period for report
              Comments

              If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

              Control10..1
              This element is affected by the following invariants: us-core-8
              TypedateTime, Period
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Must Support TypesdateTime
              Summarytrue
              Requirements

              Need to know where in the patient history to file/present this report.

              Alternate NamesObservation time, Effective Time, Occurrence
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on DiagnosticReport.effective[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
              • type @ $this
              • 50. DiagnosticReport.effective[x]:effectiveDateTime
                Slice NameeffectiveDateTime
                Definition

                The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

                ShortDiagnostically relevant time (typically the time of specimen collection)Clinically relevant time/time-period for report
                Comments

                If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

                Control10..1
                This element is affected by the following invariants: us-core-8
                TypedateTime, Period
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Must Support TypesdateTime
                Summarytrue
                Requirements

                Need to know where in the patient history to file/present this report.

                Alternate NamesObservation time, Effective Time, Occurrence
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                52. DiagnosticReport.issued
                Definition

                The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.

                ShortWhen the report was releasedDateTime this version was made
                Comments

                May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.

                Control10..1
                This element is affected by the following invariants: us-core-9
                Typeinstant
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Requirements

                Clinicians need to be able to check the date that the report was released.

                Alternate NamesDate published, Date Issued, Date Verified
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                54. DiagnosticReport.performer
                Definition

                The diagnostic service that is responsible for issuing the report.

                ShortrecordSourceResponsible Diagnostic Service
                Comments

                This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

                Control10..1*
                TypeReference(VA MHV PHR Organization, Practitioner, PractitionerRole, Organization, CareTeam)contained
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                56. DiagnosticReport.resultsInterpreter
                Definition

                The practitioner or organization that is responsible for the report's conclusions and interpretations.

                ShortPrimary result interpreter
                Comments

                Might not be the same entity that takes responsibility for the clinical report.

                Control0..0*
                TypeReference(Practitioner, PractitionerRole, Organization, CareTeam)
                Is Modifierfalse
                Summarytrue
                Requirements

                Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                Alternate NamesAnalyzed by, Reported by
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                58. DiagnosticReport.specimen
                Definition

                Details about the specimens on which this diagnostic report is based.

                ShortSpecimens this report is based on
                Comments

                If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.

                Control10..1*
                TypeReference(VA MHV PHR HDR CH Specimen, Specimen)contained
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Need to be able to report information about the collected specimens on which the report is based.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                60. DiagnosticReport.result
                Definition

                Observations that are part of this diagnostic report.

                ShortObservations
                Comments

                Observations can contain observations.

                Control0..*
                TypeReference(VA MHV PHR CH labTest.chemistryResults, Observation)contained
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

                Alternate NamesData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                62. DiagnosticReport.imagingStudy
                Definition

                One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.

                ShortReference to full details of imaging associated with the diagnostic report
                Comments

                ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.

                Control0..0*
                TypeReference(ImagingStudy)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                64. DiagnosticReport.media
                Definition

                A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).

                ShortKey images associated with this report
                Control0..0*
                TypeBackboneElement
                Is Modifierfalse
                Summarytrue
                Requirements

                Many diagnostic services include images in the report as part of their service.

                Alternate NamesDICOM, Slides, Scans
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                68. DiagnosticReport.conclusion
                Definition

                Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.

                ShortClinical conclusion (interpretation) of test results
                Control0..01
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Requirements

                Need to be able to provide a conclusion that is not lost among the basic result data.

                Alternate NamesReport
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                70. DiagnosticReport.conclusionCode
                Definition

                One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.

                ShortCodes for the clinical conclusion of test results
                Control0..0*
                BindingFor example codes, see SNOMEDCTClinicalFindingshttp://hl7.org/fhir/ValueSet/clinical-findings
                (example to http://hl7.org/fhir/ValueSet/clinical-findings)

                Diagnosis codes provided as adjuncts to the report.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                72. DiagnosticReport.presentedForm
                Definition

                Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.

                ShortEntire report as issued
                Comments

                "application/pdf" is recommended as the most reliable and interoperable in this context.

                Control0..0*
                TypeAttachment
                Is Modifierfalse
                Summaryfalse
                Requirements

                Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

                0. DiagnosticReport
                Definition

                -

                ShortA Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
                Comments

                -

                Control0..*
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Alternate NamesReport, Test, Result, Results, Labs, Laboratory, Lab Result, Lab Report
                Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                dom-6: A resource should have narrative for robust management (text.`div`.exists())
                us-core-8: effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' ((status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists())
                us-core-9: issued SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' ((status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies issued.exists())
                2. DiagnosticReport.id
                Definition

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

                ShortLogical id of this artifact
                Comments

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

                Control0..1
                Typeid
                Is Modifierfalse
                Summarytrue
                4. DiagnosticReport.meta
                Definition

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

                ShortMetadata about the resource
                Control0..1
                TypeMeta
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                6. DiagnosticReport.implicitRules
                Definition

                A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                ShortA set of rules under which this content was created
                Comments

                Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                Control0..1
                Typeuri
                Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                8. DiagnosticReport.language
                Definition

                The base language in which the resource is written.

                ShortLanguage of the resource content
                Comments

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

                Control0..1
                BindingThe codes SHOULD be taken from CommonLanguages
                (preferred to http://hl7.org/fhir/ValueSet/languages)

                A human language.

                Additional BindingsPurpose
                AllLanguagesMax Binding
                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                10. DiagnosticReport.text
                Definition

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

                ShortText summary of the resource, for human interpretation
                Comments

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

                Control0..1
                TypeNarrative
                Is Modifierfalse
                Summaryfalse
                Alternate Namesnarrative, html, xhtml, display
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                12. DiagnosticReport.contained
                Definition

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

                ShortContained, inline Resources
                Comments

                This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                Control0..*
                TypeResource
                Is Modifierfalse
                Summaryfalse
                Alternate Namesinline resources, anonymous resources, contained resources
                14. DiagnosticReport.extension
                Definition

                An Extension

                ShortExtension
                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on DiagnosticReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 16. DiagnosticReport.extension:note
                  Slice Namenote
                  Definition

                  Notes

                  ShortNotes
                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeExtension(Notes) (Extension Type: string)
                  Is Modifierfalse
                  Must Supporttrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  18. DiagnosticReport.modifierExtension
                  Definition

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

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored
                  Comments

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

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                  Summaryfalse
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  20. DiagnosticReport.identifier
                  Definition

                  Identifiers assigned to this report by the performer or other systems.

                  ShortBusiness identifier for report
                  Comments

                  Usually assigned by the Information System of the diagnostic service provider (filler id).

                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control1..*
                  TypeIdentifier
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

                  Alternate NamesReportID, Filler ID, Placer ID
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on DiagnosticReport.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • pattern @ use
                  • 22. DiagnosticReport.identifier:Rid
                    Slice NameRid
                    Definition

                    Identifiers assigned to this report by the performer or other systems.

                    ShortBusiness identifier for report
                    Comments

                    Usually assigned by the Information System of the diagnostic service provider (filler id).

                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..1
                    TypeIdentifier
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

                    Alternate NamesReportID, Filler ID, Placer ID
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    24. DiagnosticReport.identifier:Rid.id
                    Definition

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

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    26. DiagnosticReport.identifier:Rid.extension
                    Definition

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

                    ShortAdditional content defined by implementations
                    Comments

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

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    SlicingThis element introduces a set of slices on DiagnosticReport.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 28. DiagnosticReport.identifier:Rid.use
                      Definition

                      The purpose of this identifier.

                      Shortusual | official | temp | secondary | old (If known)
                      Comments

                      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                      Control1..1
                      BindingThe codes SHALL be taken from IdentifierUse
                      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                      Identifies the purpose for this identifier, if known .

                      Typecode
                      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                      Pattern Valueusual
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      30. DiagnosticReport.identifier:Rid.type
                      Definition

                      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                      ShortDescription of identifier
                      Comments

                      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                      Control0..1
                      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                      (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Allows users to make use of identifiers when the identifier system is not known.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      32. DiagnosticReport.identifier:Rid.system
                      Definition

                      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                      ShortDNS universalIdType: `urn:fdc:` + {universalID} + `:` + {namespaceId}
                      Comments

                      Identifier.system is always case sensitive.

                      Control0..1
                      Typeuri
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                      Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      34. DiagnosticReport.identifier:Rid.value
                      Definition

                      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                      Short{labTestPromises.recordIdentifier.identity}
                      Comments

                      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Example<br/><b>General</b>:123456
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      36. DiagnosticReport.identifier:Rid.period
                      Definition

                      Time period during which identifier is/was valid for use.

                      ShortTime period when id is/was valid for use
                      Control0..1
                      TypePeriod
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      38. DiagnosticReport.identifier:Rid.assigner
                      Definition

                      Organization that issued/manages the identifier.

                      ShortOrganization that issued id (may be just text)
                      Comments

                      The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                      Control0..1
                      TypeReference(Organization)
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      40. DiagnosticReport.identifier:TOid
                      Slice NameTOid
                      Definition

                      Identifiers assigned to this report by the performer or other systems.

                      ShortBusiness identifier for report
                      Comments

                      Usually assigned by the Information System of the diagnostic service provider (filler id).

                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      Control0..1
                      TypeIdentifier
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

                      Alternate NamesReportID, Filler ID, Placer ID
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      42. DiagnosticReport.identifier:TOid.id
                      Definition

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

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      44. DiagnosticReport.identifier:TOid.extension
                      Definition

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

                      ShortAdditional content defined by implementations
                      Comments

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

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on DiagnosticReport.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 46. DiagnosticReport.identifier:TOid.use
                        Definition

                        The purpose of this identifier.

                        Shortusual | official | temp | secondary | old (If known)
                        Comments

                        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                        Control1..1
                        BindingThe codes SHALL be taken from IdentifierUse
                        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                        Identifies the purpose for this identifier, if known .

                        Typecode
                        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                        Pattern Valuesecondary
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        48. DiagnosticReport.identifier:TOid.type
                        Definition

                        A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                        ShortDescription of identifier
                        Comments

                        This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                        (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                        A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Allows users to make use of identifiers when the identifier system is not known.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        50. DiagnosticReport.identifier:TOid.system
                        Definition

                        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                        Shorturn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
                        Comments

                        Identifier.system is always case sensitive.

                        Control0..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                        Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr} (value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.'))
                        52. DiagnosticReport.identifier:TOid.value
                        Definition

                        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                        Short`recordIdentifier.identifier` | `/` | {specimentTakenDate.literal}
                        Comments

                        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Example<br/><b>General</b>:123456
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        54. DiagnosticReport.identifier:TOid.period
                        Definition

                        Time period during which identifier is/was valid for use.

                        ShortTime period when id is/was valid for use
                        Control0..1
                        TypePeriod
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        56. DiagnosticReport.identifier:TOid.assigner
                        Definition

                        Organization that issued/manages the identifier.

                        ShortOrganization that issued id (may be just text)
                        Comments

                        The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                        Control0..1
                        TypeReference(Organization)
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        58. DiagnosticReport.basedOn
                        Definition

                        Details concerning a service requested.

                        ShortWhat was requested
                        Comments

                        Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

                        Control1..*
                        TypeReference(VA MHV PHR CH labTests.orderedTestCode)contained
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

                        Alternate NamesRequest
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        60. DiagnosticReport.status
                        Definition

                        The status of the diagnostic report.

                        Shortregistered | partial | preliminary | final +
                        Control1..1
                        This element is affected by the following invariants: us-core-8, us-core-9
                        BindingThe codes SHALL be taken from DiagnosticReportStatus
                        (required to http://hl7.org/fhir/ValueSet/diagnostic-report-status)
                        Typecode
                        Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        62. DiagnosticReport.category
                        Definition

                        A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

                        ShortService category
                        Comments

                        Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

                        Control2..*
                        BindingFor example codes, see DiagnosticServiceSectionCodes
                        (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)

                        Codes for diagnostic service sections.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Alternate NamesDepartment, Sub-department, Service, Discipline
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • pattern @ $this
                        • 64. DiagnosticReport.category:LaboratorySlice
                          Slice NameLaboratorySlice
                          Definition

                          A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

                          ShortService category
                          Comments

                          Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

                          Control1..1
                          BindingFor example codes, see DiagnosticServiceSectionCodes
                          (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)

                          Codes for diagnostic service sections.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Alternate NamesDepartment, Sub-department, Service, Discipline
                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
                              "code" : "LAB"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          66. DiagnosticReport.category:ChSlice
                          Slice NameChSlice
                          Definition

                          A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

                          ShortService category
                          Comments

                          Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

                          Control1..1
                          BindingFor example codes, see DiagnosticServiceSectionCodes
                          (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)

                          Codes for diagnostic service sections.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Alternate NamesDepartment, Sub-department, Service, Discipline
                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
                              "code" : "CH"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          68. DiagnosticReport.code
                          Definition

                          The test, panel or battery that was ordered.

                          ShortUS Core Laboratory Report Order Code
                          Comments

                          UsageNote= The typical patterns for codes are: 1) a LOINC code either as a translation from a "local" code or as a primary code, or 2) a local code only if no suitable LOINC exists, or 3) both the local and the LOINC translation. Systems SHALL be capable of sending the local code if one exists.

                          Control1..1
                          BindingUnless not suitable, these codes SHALL be taken from US Core Diagnostic Report Laboratory Codes
                          (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-lab-codes)

                          LOINC codes

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Alternate NamesType
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          70. DiagnosticReport.code.id
                          Definition

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

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          72. DiagnosticReport.code.extension
                          Definition

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

                          ShortAdditional content defined by implementations
                          Comments

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

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on DiagnosticReport.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 74. DiagnosticReport.code.coding
                            Definition

                            A reference to a code defined by a terminology system.

                            ShortCode defined by a terminology system
                            Comments

                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                            Control0..0
                            TypeCoding
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            Allows for alternative encodings within a code system, and translations to other code systems.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            76. DiagnosticReport.code.text
                            Definition

                            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                            ShortPlain text representation of the concept
                            Comments

                            Very often the text is the same as a displayName of one of the codings.

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

                            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                            Pattern ValueCH
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            78. DiagnosticReport.subject
                            Definition

                            The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.

                            ShortThe subject of the report - usually, but not always, the patient
                            Control1..1
                            TypeReference(US Core Patient Profile)
                            Is Modifierfalse
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            SHALL know the subject context.

                            Alternate NamesPatient
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            80. DiagnosticReport.encounter
                            Definition

                            The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.

                            ShortHealth care event when test ordered
                            Comments

                            This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

                            Control0..0
                            TypeReference(Encounter)
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            Links the request to the Encounter context.

                            Alternate NamesContext
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            82. DiagnosticReport.effective[x]
                            Definition

                            The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

                            ShortDiagnostically relevant time (typically the time of specimen collection)
                            Comments

                            If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

                            Control1..1
                            This element is affected by the following invariants: us-core-8
                            TypedateTime
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Must Support TypesdateTime
                            Summarytrue
                            Requirements

                            Need to know where in the patient history to file/present this report.

                            Alternate NamesObservation time, Effective Time, Occurrence
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            SlicingThis element introduces a set of slices on DiagnosticReport.effective[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                            • type @ $this
                            • 84. DiagnosticReport.effective[x]:effectiveDateTime
                              Slice NameeffectiveDateTime
                              Definition

                              The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

                              ShortDiagnostically relevant time (typically the time of specimen collection)
                              Comments

                              If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

                              Control1..1
                              This element is affected by the following invariants: us-core-8
                              TypedateTime
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Must Support TypesdateTime
                              Summarytrue
                              Requirements

                              Need to know where in the patient history to file/present this report.

                              Alternate NamesObservation time, Effective Time, Occurrence
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              86. DiagnosticReport.issued
                              Definition

                              The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.

                              ShortWhen the report was released
                              Comments

                              May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.

                              Control1..1
                              This element is affected by the following invariants: us-core-9
                              Typeinstant
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              Clinicians need to be able to check the date that the report was released.

                              Alternate NamesDate published, Date Issued, Date Verified
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              88. DiagnosticReport.performer
                              Definition

                              The diagnostic service that is responsible for issuing the report.

                              ShortrecordSource
                              Comments

                              This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

                              Control1..1
                              TypeReference(VA MHV PHR Organization)contained
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                              Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              90. DiagnosticReport.resultsInterpreter
                              Definition

                              The practitioner or organization that is responsible for the report's conclusions and interpretations.

                              ShortPrimary result interpreter
                              Comments

                              Might not be the same entity that takes responsibility for the clinical report.

                              Control0..0
                              TypeReference(Practitioner, PractitionerRole, Organization, CareTeam)
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                              Alternate NamesAnalyzed by, Reported by
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              92. DiagnosticReport.specimen
                              Definition

                              Details about the specimens on which this diagnostic report is based.

                              ShortSpecimens this report is based on
                              Comments

                              If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.

                              Control1..1
                              TypeReference(VA MHV PHR HDR CH Specimen)contained
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              Need to be able to report information about the collected specimens on which the report is based.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              94. DiagnosticReport.result
                              Definition

                              Observations that are part of this diagnostic report.

                              ShortObservations
                              Comments

                              Observations can contain observations.

                              Control0..*
                              TypeReference(VA MHV PHR CH labTest.chemistryResults)contained
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

                              Alternate NamesData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              96. DiagnosticReport.imagingStudy
                              Definition

                              One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.

                              ShortReference to full details of imaging associated with the diagnostic report
                              Comments

                              ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.

                              Control0..0
                              TypeReference(ImagingStudy)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              98. DiagnosticReport.media
                              Definition

                              A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).

                              ShortKey images associated with this report
                              Control0..0
                              TypeBackboneElement
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Many diagnostic services include images in the report as part of their service.

                              Alternate NamesDICOM, Slides, Scans
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              105. DiagnosticReport.conclusion
                              Definition

                              Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.

                              ShortClinical conclusion (interpretation) of test results
                              Control0..0
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Requirements

                              Need to be able to provide a conclusion that is not lost among the basic result data.

                              Alternate NamesReport
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              107. DiagnosticReport.conclusionCode
                              Definition

                              One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.

                              ShortCodes for the clinical conclusion of test results
                              Control0..0
                              BindingFor example codes, see SNOMEDCTClinicalFindings
                              (example to http://hl7.org/fhir/ValueSet/clinical-findings)

                              Diagnosis codes provided as adjuncts to the report.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              109. DiagnosticReport.presentedForm
                              Definition

                              Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.

                              ShortEntire report as issued
                              Comments

                              "application/pdf" is recommended as the most reliable and interoperable in this context.

                              Control0..0
                              TypeAttachment
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))