HL7 BE Laboratory WG Implementation Guide
1.0.1 - STU Belgium flag

HL7 BE Laboratory WG Implementation Guide, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 1.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/lab/ and changes regularly. See the Directory of published versions

Resource Profile: BeLaboratoryReport - Detailed Descriptions

Draft as of 2020-09-07 Maturity Level: 1

Definitions for the be-laboratory-report resource profile.

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

0. DiagnosticReport
2. DiagnosticReport.text
4. DiagnosticReport.text.status
Pattern Valueempty
6. 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
  • 8. DiagnosticReport.extension:note
    Slice Namenote
    Control0..*
    TypeExtension(BeExtNote) (Extension Type: Annotation)
    Must Supporttrue
    10. DiagnosticReport.identifier
    Definition

    An identifier for this laboratory report.

    This identifier will be used to determine if a new resource is needed, or if this resource is an update of an existing one. When an identifier is given, a consumer SHALL NOT ignore it.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control1..?
    Must Supporttrue
    SlicingThis element introduces a set of slices on DiagnosticReport.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ system
    • 12. DiagnosticReport.identifier:DRID
      Slice NameDRID
      Definition

      The identifier SHALL at least contain 1 identifier of type BeLabReportDiagnosticReportId. The unicity of this identifier is guaranteed by using the NIHDI number of the lab and a unique number for that lab, separated by a dot.

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control1..1
      14. DiagnosticReport.identifier:DRID.system
      Control1..?
      Fixed Valuehttps://www.ehealth.fgov.be/lab-report/diagnostic-report-id
      16. DiagnosticReport.identifier:DRID.value
      Control1..?
      18. DiagnosticReport.basedOn
      Definition

      Details concerning the prescription this laboratory report fullfills. A reference to a ServiceRequest SHALL be given here that includes the time of prescription in its .authoredOn element. It is RECOMMENDED to also use the .identifier element of the ServiceRequest to identify the original order number. Note, within the Observation resource it is possible to define they were defined on a different serviceRequest (e.g. to clarify it was a sub ordering)

      ShortA reference to a ServiceRequest SHALL be given here that minimally includes the time of prescription.
      Control1..1
      TypeReference(ServiceRequest)
      Must Supporttrue
      20. DiagnosticReport.status
      Definition

      The status of the diagnostic report. Consult the HL7 list of allowed values here. Note when a report should actually replace a previous one, use the Replaces extension.

      ShortStatus of the report: consult the HL7 list of permitted values
      Must Supporttrue
      22. DiagnosticReport.category
      Definition

      The subject of this specialty, expressed in a LOINC code.

      The choice of what observations to categorize under what specialty are left ultimately to the discretion of the laboratory sending the results. Some non-restrictive guidelines: *18721-1 (THERAPEUTIC DRUG MONITORING STUDIES) will be used for a section carrying pharmacologyobservations on a patient. *Mycology and parasitology, as well as bacteriology, are part of the 18725-2 (MICROBIOLOGY STUDIES) specialty. *665 Virology MAY be included in 18725-2 (MICROBIOLOGY STUDIES) specialty or 18727-8 (SEROLOGY STUDIES)or split between both specialties, depending upon the Content Creator Actor’s choice

      ShortThe subject of this specialty, expressed in a LOINC code.
      Control1..?
      Must Supporttrue
      24. DiagnosticReport.category.coding
      Control1..?
      SlicingThis element introduces a set of slices on DiagnosticReport.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ code
      • 26. DiagnosticReport.category.coding.system
        Control1..?
        28. DiagnosticReport.category.coding.code
        Control1..?
        30. DiagnosticReport.category.coding.display
        Control1..?
        32. DiagnosticReport.category.coding:LABREPORT
        Slice NameLABREPORT
        Control1..1
        34. DiagnosticReport.category.coding:LABREPORT.system
        Fixed Valuehttp://terminology.hl7.org/CodeSystem/v2-0074
        36. DiagnosticReport.category.coding:LABREPORT.code
        Fixed ValueLAB
        38. DiagnosticReport.category.coding:LABREPORT.display
        Fixed ValueLaboratory
        40. DiagnosticReport.code
        Must Supporttrue
        42. DiagnosticReport.subject
        ShortIn the initial iteration of the Belgium lab project: when sending to eHealthBox, this is BePatient.
        Control1..?
        TypeReference(Patient core BE profile, Group, Device, Location)
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        44. DiagnosticReport.effective[x]
        Definition

        The time or time-period the observed values are related to. This is the time specimen collection(s)

        ShortTime of the specimen collection - is overruled when collection time is given in .specimen element.
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Must Supporttrue
        46. DiagnosticReport.issued
        Control1..?
        Must Supporttrue
        48. DiagnosticReport.performer
        Definition

        The diagnostic service that is responsible for issuing the report. In the laboratory report, this is typically an organization (i.e. the laboratory) Note the Observation MAY have a different performer.

        ShortIn the initial iteration of the Belgium lab project: when sending to eHealthBox, this is BeOrganization.
        Control1..?
        TypeReference(Organisation core BE profile, Practitioner core BE profile, CareTeam, Practitioner role core BE profile)
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        50. DiagnosticReport.resultsInterpreter
        ShortIn the initial iteration of the Belgium lab project: when sending to eHealthBox, this is BePractitioner.
        Control1..?
        TypeReference(Practitioner core BE profile, Practitioner role core BE profile, Organisation core BE profile, CareTeam)
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        52. DiagnosticReport.specimen
        TypeReference(BeSpecimenLaboratory)
        Must Supporttrue
        54. DiagnosticReport.result
        TypeReference(BeObservationLaboratory)
        Must Supporttrue
        56. DiagnosticReport.media
        Must Supporttrue
        58. DiagnosticReport.conclusion
        Must Supporttrue
        60. DiagnosticReport.conclusionCode
        Must Supporttrue
        62. DiagnosticReport.presentedForm
        Must Supporttrue

        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
        Summaryfalse
        Alternate NamesReport, Test, Result, Results, Labs, Laboratory
        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())
        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

          BeExtNote

          ShortBeExtNote
          Control0..*
          This element is affected by the following invariants: ele-1
          TypeExtension(BeExtNote) (Extension Type: Annotation)
          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

          An identifier for this laboratory report.

          This identifier will be used to determine if a new resource is needed, or if this resource is an update of an existing one. When an identifier is given, a consumer SHALL NOT ignore it.


          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
          Must Supporttrue
          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:
          • value @ system
          • 12. DiagnosticReport.identifier:DRID
            Slice NameDRID
            Definition

            The identifier SHALL at least contain 1 identifier of type BeLabReportDiagnosticReportId. The unicity of this identifier is guaranteed by using the NIHDI number of the lab and a unique number for that lab, separated by a dot.


            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..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:DRID.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.

            Control0..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.

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

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

            ShortThe namespace for the identifier value
            Comments

            Identifier.system is always case sensitive.

            Control10..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.

            Fixed Valuehttps://www.ehealth.fgov.be/lab-report/diagnostic-report-id
            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:DRID.value
            Definition

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

            ShortThe 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.

            Control10..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.basedOn
            Definition

            Details concerning the prescription this laboratory report fullfills. A reference to a ServiceRequest SHALL be given here that includes the time of prescription in its .authoredOn element. It is RECOMMENDED to also use the .identifier element of the ServiceRequest to identify the original order number. Note, within the Observation resource it is possible to define they were defined on a different serviceRequest (e.g. to clarify it was a sub ordering)


            Details concerning a service requested.

            ShortA reference to a ServiceRequest SHALL be given here that minimally includes the time of prescription.What 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..1*
            TypeReference(ServiceRequest, CarePlan, ImmunizationRecommendation, MedicationRequest, NutritionOrder)
            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()))
            22. DiagnosticReport.status
            Definition

            The status of the diagnostic report. Consult the HL7 list of allowed values here. Note when a report should actually replace a previous one, use the Replaces extension.


            The status of the diagnostic report.

            ShortStatus of the report: consult the HL7 list of permitted valuesregistered | partial | preliminary | final +
            Control1..1
            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|4.0.1)

            The status of the diagnostic report.

            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()))
            24. DiagnosticReport.category
            Definition

            The subject of this specialty, expressed in a LOINC code.

            The choice of what observations to categorize under what specialty are left ultimately to the discretion of the laboratory sending the results. Some non-restrictive guidelines: *18721-1 (THERAPEUTIC DRUG MONITORING STUDIES) will be used for a section carrying pharmacologyobservations on a patient. *Mycology and parasitology, as well as bacteriology, are part of the 18725-2 (MICROBIOLOGY STUDIES) specialty. *665 Virology MAY be included in 18725-2 (MICROBIOLOGY STUDIES) specialty or 18727-8 (SEROLOGY STUDIES)or split between both specialties, depending upon the Content Creator Actor’s choice


            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.

            ShortThe subject of this specialty, expressed in a LOINC code.Service 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..*
            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()))
            26. DiagnosticReport.category.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.

            Control10..*
            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()))
            SlicingThis element introduces a set of slices on DiagnosticReport.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ code
            • 28. DiagnosticReport.category.coding.system
              Definition

              The identification of the code system that defines the meaning of the symbol in the code.

              ShortIdentity of the terminology system
              Comments

              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

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

              Need to be unambiguous about the source of the definition of the symbol.

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

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

              ShortSymbol in syntax defined by the system
              Control10..1
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to refer to a particular code in the system.

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

              A representation of the meaning of the code in the system, following the rules of the system.

              ShortRepresentation defined by the system
              Control10..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              34. DiagnosticReport.category.coding:LABREPORT
              Slice NameLABREPORT
              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.

              Control10..1*
              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()))
              36. DiagnosticReport.category.coding:LABREPORT.system
              Definition

              The identification of the code system that defines the meaning of the symbol in the code.

              ShortIdentity of the terminology system
              Comments

              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

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

              Need to be unambiguous about the source of the definition of the symbol.

              Fixed Valuehttp://terminology.hl7.org/CodeSystem/v2-0074
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              38. DiagnosticReport.category.coding:LABREPORT.code
              Definition

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

              ShortSymbol in syntax defined by the system
              Control0..1
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to refer to a particular code in the system.

              Fixed ValueLAB
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              40. DiagnosticReport.category.coding:LABREPORT.display
              Definition

              A representation of the meaning of the code in the system, following the rules of the system.

              ShortRepresentation defined by the system
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

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

              A code or name that describes this diagnostic report.

              ShortName/Code for this diagnostic report
              Control1..1
              BindingThe codes SHOULD be taken from LOINCDiagnosticReportCodeshttp://hl7.org/fhir/ValueSet/report-codes
              (preferred to http://hl7.org/fhir/ValueSet/report-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()))
              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.

              ShortIn the initial iteration of the Belgium lab project: when sending to eHealthBox, this is BePatient.The subject of the report - usually, but not always, the patient
              Control10..1
              TypeReference(Patient core BE profile, Group, Device, Location, Patient)
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              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.effective[x]
              Definition

              The time or time-period the observed values are related to. This is the time specimen collection(s)


              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.

              ShortTime of the specimen collection - is overruled when collection time is given in .specimen element.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.

              Control0..1
              TypeChoice of: dateTime, 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 TypesNo must-support rules about the choice of types/profiles
              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()))
              48. 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.

              ShortDateTime 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
              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()))
              50. DiagnosticReport.performer
              Definition

              The diagnostic service that is responsible for issuing the report. In the laboratory report, this is typically an organization (i.e. the laboratory) Note the Observation MAY have a different performer.


              The diagnostic service that is responsible for issuing the report.

              ShortIn the initial iteration of the Belgium lab project: when sending to eHealthBox, this is BeOrganization.Responsible 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..*
              TypeReference(Organisation core BE profile, Practitioner core BE profile, CareTeam, Practitioner role core BE profile, Practitioner, PractitionerRole, Organization)
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              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()))
              52. DiagnosticReport.resultsInterpreter
              Definition

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

              ShortIn the initial iteration of the Belgium lab project: when sending to eHealthBox, this is BePractitioner.Primary result interpreter
              Comments

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

              Control10..*
              TypeReference(Practitioner core BE profile, Practitioner role core BE profile, Organisation core BE profile, CareTeam, Practitioner, PractitionerRole, Organization)
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              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()))
              54. 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.

              Control0..*
              TypeReference(BeSpecimenLaboratory, Specimen)
              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()))
              56. DiagnosticReport.result
              Definition

              Observations that are part of this diagnostic report.

              ShortObservations
              Comments

              Observations can contain observations.

              Control0..*
              TypeReference(BeObservationLaboratory, Observation)
              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()))
              58. 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..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              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()))
              60. DiagnosticReport.media.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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 even if unrecognized
              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 element that contains them
              Summarytrue
              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, modifiers
              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())
              62. DiagnosticReport.media.link
              Definition

              Reference to the image source.

              ShortReference to the image source
              Control1..1
              TypeReference(Media)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. DiagnosticReport.conclusion
              Definition

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

              ShortClinical conclusion (interpretation) of test results
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              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()))
              66. 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..*
              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
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              68. 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..*
              TypeAttachment
              Is Modifierfalse
              Must Supporttrue
              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

              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
              Summaryfalse
              Alternate NamesReport, Test, Result, Results, Labs, Laboratory
              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())
              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.text.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
              14. DiagnosticReport.text.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.text.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 16. DiagnosticReport.text.status
                Definition

                The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

                Shortgenerated | extensions | additional | empty
                Control1..1
                BindingThe codes SHALL be taken from NarrativeStatus
                (required to http://hl7.org/fhir/ValueSet/narrative-status|4.0.1)

                The status of a resource narrative.

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

                The actual narrative content, a stripped down version of XHTML.

                ShortLimited xhtml content
                Comments

                The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

                Control1..1
                Typexhtml
                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()))
                txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
                txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())
                20. 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
                22. 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
                • 24. DiagnosticReport.extension:note
                  Slice Namenote
                  Definition

                  BeExtNote

                  ShortBeExtNote
                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeExtension(BeExtNote) (Extension Type: Annotation)
                  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())
                  26. 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())
                  28. DiagnosticReport.identifier
                  Definition

                  An identifier for this laboratory report.

                  This identifier will be used to determine if a new resource is needed, or if this resource is an update of an existing one. When an identifier is given, a consumer SHALL NOT ignore it.

                  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
                  Must Supporttrue
                  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:
                  • value @ system
                  • 30. DiagnosticReport.identifier:DRID
                    Slice NameDRID
                    Definition

                    The identifier SHALL at least contain 1 identifier of type BeLabReportDiagnosticReportId. The unicity of this identifier is guaranteed by using the NIHDI number of the lab and a unique number for that lab, separated by a dot.

                    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..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()))
                    32. DiagnosticReport.identifier:DRID.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
                    34. DiagnosticReport.identifier:DRID.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
                    • 36. DiagnosticReport.identifier:DRID.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.

                      Control0..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.

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

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

                      ShortThe namespace for the identifier value
                      Comments

                      Identifier.system is always case sensitive.

                      Control1..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.

                      Fixed Valuehttps://www.ehealth.fgov.be/lab-report/diagnostic-report-id
                      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()))
                      42. DiagnosticReport.identifier:DRID.value
                      Definition

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

                      ShortThe 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.

                      Control1..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()))
                      44. DiagnosticReport.identifier:DRID.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()))
                      46. DiagnosticReport.identifier:DRID.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()))
                      48. DiagnosticReport.basedOn
                      Definition

                      Details concerning the prescription this laboratory report fullfills. A reference to a ServiceRequest SHALL be given here that includes the time of prescription in its .authoredOn element. It is RECOMMENDED to also use the .identifier element of the ServiceRequest to identify the original order number. Note, within the Observation resource it is possible to define they were defined on a different serviceRequest (e.g. to clarify it was a sub ordering)

                      ShortA reference to a ServiceRequest SHALL be given here that minimally includes the time of prescription.
                      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..1
                      TypeReference(ServiceRequest)
                      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()))
                      50. DiagnosticReport.status
                      Definition

                      The status of the diagnostic report. Consult the HL7 list of allowed values here. Note when a report should actually replace a previous one, use the Replaces extension.

                      ShortStatus of the report: consult the HL7 list of permitted values
                      Control1..1
                      BindingThe codes SHALL be taken from DiagnosticReportStatus
                      (required to http://hl7.org/fhir/ValueSet/diagnostic-report-status|4.0.1)

                      The status of the diagnostic report.

                      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()))
                      52. DiagnosticReport.category
                      Definition

                      The subject of this specialty, expressed in a LOINC code.

                      The choice of what observations to categorize under what specialty are left ultimately to the discretion of the laboratory sending the results. Some non-restrictive guidelines: *18721-1 (THERAPEUTIC DRUG MONITORING STUDIES) will be used for a section carrying pharmacologyobservations on a patient. *Mycology and parasitology, as well as bacteriology, are part of the 18725-2 (MICROBIOLOGY STUDIES) specialty. *665 Virology MAY be included in 18725-2 (MICROBIOLOGY STUDIES) specialty or 18727-8 (SEROLOGY STUDIES)or split between both specialties, depending upon the Content Creator Actor’s choice

                      ShortThe subject of this specialty, expressed in a LOINC code.
                      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..*
                      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()))
                      54. DiagnosticReport.category.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
                      56. DiagnosticReport.category.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.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 58. DiagnosticReport.category.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.

                        Control1..*
                        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()))
                        SlicingThis element introduces a set of slices on DiagnosticReport.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ code
                        • 60. DiagnosticReport.category.coding.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
                          62. DiagnosticReport.category.coding.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.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 64. DiagnosticReport.category.coding.system
                            Definition

                            The identification of the code system that defines the meaning of the symbol in the code.

                            ShortIdentity of the terminology system
                            Comments

                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

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

                            Need to be unambiguous about the source of the definition of the symbol.

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

                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                            ShortVersion of the system - if relevant
                            Comments

                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                            NoteThis is a business version Id, not a resource version Id (see discussion)
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            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()))
                            68. DiagnosticReport.category.coding.code
                            Definition

                            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                            ShortSymbol in syntax defined by the system
                            Control1..1
                            Typecode
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to refer to a particular code in the system.

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

                            A representation of the meaning of the code in the system, following the rules of the system.

                            ShortRepresentation defined by the system
                            Control1..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

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

                            Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                            ShortIf this coding was chosen directly by the user
                            Comments

                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            74. DiagnosticReport.category.coding:LABREPORT
                            Slice NameLABREPORT
                            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.

                            Control1..1
                            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.category.coding:LABREPORT.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
                            78. DiagnosticReport.category.coding:LABREPORT.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.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 80. DiagnosticReport.category.coding:LABREPORT.system
                              Definition

                              The identification of the code system that defines the meaning of the symbol in the code.

                              ShortIdentity of the terminology system
                              Comments

                              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

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

                              Need to be unambiguous about the source of the definition of the symbol.

                              Fixed Valuehttp://terminology.hl7.org/CodeSystem/v2-0074
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              82. DiagnosticReport.category.coding:LABREPORT.version
                              Definition

                              The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                              ShortVersion of the system - if relevant
                              Comments

                              Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                              NoteThis is a business version Id, not a resource version Id (see discussion)
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              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()))
                              84. DiagnosticReport.category.coding:LABREPORT.code
                              Definition

                              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                              ShortSymbol in syntax defined by the system
                              Control0..1
                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Need to refer to a particular code in the system.

                              Fixed ValueLAB
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              86. DiagnosticReport.category.coding:LABREPORT.display
                              Definition

                              A representation of the meaning of the code in the system, following the rules of the system.

                              ShortRepresentation defined by the system
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                              Fixed ValueLaboratory
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              88. DiagnosticReport.category.coding:LABREPORT.userSelected
                              Definition

                              Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                              ShortIf this coding was chosen directly by the user
                              Comments

                              Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                              This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

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

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

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

                              A code or name that describes this diagnostic report.

                              ShortName/Code for this diagnostic report
                              Control1..1
                              BindingThe codes SHOULD be taken from LOINCDiagnosticReportCodes
                              (preferred to http://hl7.org/fhir/ValueSet/report-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()))
                              94. 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.

                              ShortIn the initial iteration of the Belgium lab project: when sending to eHealthBox, this is BePatient.
                              Control1..1
                              TypeReference(Patient core BE profile, Group, Device, Location)
                              Is Modifierfalse
                              Must Supporttrue
                              Must Support TypesNo must-support rules about the choice of types/profiles
                              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()))
                              96. 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..1
                              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()))
                              98. DiagnosticReport.effective[x]
                              Definition

                              The time or time-period the observed values are related to. This is the time specimen collection(s)

                              ShortTime of the specimen collection - is overruled when collection time is given in .specimen element.
                              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.

                              Control0..1
                              TypeChoice of: dateTime, 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 TypesNo must-support rules about the choice of types/profiles
                              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()))
                              100. 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.

                              ShortDateTime 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.

                              Control1..1
                              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()))
                              102. DiagnosticReport.performer
                              Definition

                              The diagnostic service that is responsible for issuing the report. In the laboratory report, this is typically an organization (i.e. the laboratory) Note the Observation MAY have a different performer.

                              ShortIn the initial iteration of the Belgium lab project: when sending to eHealthBox, this is BeOrganization.
                              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..*
                              TypeReference(Organisation core BE profile, Practitioner core BE profile, CareTeam, Practitioner role core BE profile)
                              Is Modifierfalse
                              Must Supporttrue
                              Must Support TypesNo must-support rules about the choice of types/profiles
                              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()))
                              104. DiagnosticReport.resultsInterpreter
                              Definition

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

                              ShortIn the initial iteration of the Belgium lab project: when sending to eHealthBox, this is BePractitioner.
                              Comments

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

                              Control1..*
                              TypeReference(Practitioner core BE profile, Practitioner role core BE profile, Organisation core BE profile, CareTeam)
                              Is Modifierfalse
                              Must Supporttrue
                              Must Support TypesNo must-support rules about the choice of types/profiles
                              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()))
                              106. 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.

                              Control0..*
                              TypeReference(BeSpecimenLaboratory)
                              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()))
                              108. DiagnosticReport.result
                              Definition

                              Observations that are part of this diagnostic report.

                              ShortObservations
                              Comments

                              Observations can contain observations.

                              Control0..*
                              TypeReference(BeObservationLaboratory)
                              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()))
                              110. 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..*
                              TypeReference(ImagingStudy)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              112. 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..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Must Supporttrue
                              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()))
                              114. DiagnosticReport.media.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
                              116. DiagnosticReport.media.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())
                              118. DiagnosticReport.media.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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 even if unrecognized
                              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 element that contains them
                              Summarytrue
                              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, modifiers
                              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())
                              120. DiagnosticReport.media.comment
                              Definition

                              A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.

                              ShortComment about the image (e.g. explanation)
                              Comments

                              The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.

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

                              The provider of the report should make a comment about each image included in the report.

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

                              Reference to the image source.

                              ShortReference to the image source
                              Control1..1
                              TypeReference(Media)
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              124. DiagnosticReport.conclusion
                              Definition

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

                              ShortClinical conclusion (interpretation) of test results
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              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()))
                              126. 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..*
                              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
                              Must Supporttrue
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              128. 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..*
                              TypeAttachment
                              Is Modifierfalse
                              Must Supporttrue
                              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()))