Manifest-based Access to DICOM Objects (MADO) Profile (FHIR-R5 elements)
0.2.0-ballot - ci-build 150

Manifest-based Access to DICOM Objects (MADO) Profile (FHIR-R5 elements), published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 0.2.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/imaging-manifest/ and changes regularly. See the Directory of published versions

Resource Profile: ImManifestDocumentReference - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the ImManifestDocumentReference resource profile.

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

0. DocumentReference
Definition

A reference to a document of any kind for any purpose. While the term “document” implies a more narrow focus, for this resource this "document" encompasses any serialized object with a mime-type, it includes formal patient-centric documents (CDA), clinical notes, scanned paper, non-patient specific documents like policy text, as well as a photo, video, or audio recording acquired or used in healthcare. The DocumentReference resource provides metadata about the document so that the document can be discovered and managed. The actual content may be inline base64 encoded data or provided by direct reference.

ShortA reference to a document
Comments

Usually, this is used for documents other than those defined by FHIR.

Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
InvariantsdocRef-1: facilityType SHALL only be present if context is not an encounter (facilityType.empty() or context.where(resolve() is Encounter).empty())
docRef-2: practiceSetting SHALL only be present if context is not present (practiceSetting.empty() or context.where(resolve() is Encounter).empty())
dom-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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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())
im-docref-1: At least a KOS or FHIR manifest needs to be present. (content.value.subsumes( $dcm#113030) or content.value.endsWith('ImManifestDocumentReference'))
2. DocumentReference.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. 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 its 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 its meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. DocumentReference.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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..*
This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
TypeResource
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
6. DocumentReference.modifierExtension
Definition

An Extension


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 managable, 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).

ShortExtensionExtensions 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..0*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Supportfalse
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
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())
8. DocumentReference.identifier
Definition

Other business identifiers associated with the document, including version independent identifiers.

ShortBusiness identifiers for the document
Comments

The structure and format of this identifier would be consistent with the specification corresponding to the format of the document. (e.g. for a DICOM standard document, a 64-character numeric UID; for an HL7 CDA format, the CDA Document Id root and extension).

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

Document identifiers usually assigned by the source of the document, or other business identifiers such as XDS DocumentEntry.uniqueId and DocumentEntry.entryUUID. These identifiers are specific to this instance of the document.

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 DocumentReference.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ system
  • 10. DocumentReference.identifier:entry-uuid
    Slice Nameentry-uuid
    Definition

    Other business identifiers associated with the document, including version independent identifiers.

    ShortBusiness identifiers for the document
    Comments

    The structure and format of this identifier would be consistent with the specification corresponding to the format of the document. (e.g. for a DICOM standard document, a 64-character numeric UID; for an HL7 CDA format, the CDA Document Id root and extension).

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..1*
    TypeIdentifier(Placeholder for IHE MHD Entry UUID Identifier in FHIR R5.)
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Document identifiers usually assigned by the source of the document, or other business identifiers such as XDS DocumentEntry.uniqueId and DocumentEntry.entryUUID. These identifiers are specific to this instance of the document.

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

    The status of this document reference.

    Shortcurrent | superseded | entered-in-error
    Comments

    This is the status of the DocumentReference object, which might be independent from the docStatus element.

    This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

    Control1..1
    BindingThe codes SHALL be taken from DocumentReferenceStatushttp://hl7.org/fhir/ValueSet/document-reference-status|5.0.0
    (required to http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0)

    The status of the document reference.

    Typecode
    Is Modifiertrue because This element is labelled 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 Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. DocumentReference.modality
    Definition

    Imaging modality used. This may include both acquisition and non-acquisition modalities.

    ShortImaging modality used
    Control10..*
    BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.htmlhttp://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
    (required to https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. DocumentReference.type
    Definition

    Specifies that it refers to a Imaging Manifest


    Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

    ShortType of Imaging ManifestKind of document (LOINC if possible)
    Comments

    Corresponds to the type of the Imaging Manifest resource.


    Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.

    Control10..1
    BindingThe codes SHOULD be taken from HL7 EU Imaging Manifest Typeshttp://hl7.org/fhir/ValueSet/doc-typecodes
    (preferred to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/ImImagingManifestTypesEuVS)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. DocumentReference.category
    Definition

    A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

    ShortCategorization of document
    Comments

    Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

    Control10..*
    BindingFor example codes, see ReferencedItemCategoryValueSethttp://hl7.org/fhir/ValueSet/referenced-item-category
    (example to http://hl7.org/fhir/ValueSet/referenced-item-category)

    High-level kind of document at a macro level.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Alternate Namesclass, classCode
    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 DocumentReference.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ $this
    • 20. DocumentReference.category:class-code
      Slice Nameclass-code
      Definition

      A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

      ShortCategorization of document
      Comments

      Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

      Control0..*
      BindingThe codes SHOULD be taken from For example codes, see XDS Class Codeshttp://hl7.org/fhir/ValueSet/referenced-item-category
      (preferred to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/im-xds-class-code-valueset)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Alternate Namesclass, classCode
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. DocumentReference.subject
      Definition

      Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

      ShortWho/what is the subject of the document
      Control10..1
      TypeReference(Resource)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. DocumentReference.context
      Definition

      Describes the clinical encounter or type of care that the document content is associated with.

      ShortContext of the document content
      Control0..*
      This element is affected by the following invariants: docRef-1, docRef-2
      TypeReference(Appointment, Encounter, EpisodeOfCare)
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. DocumentReference.bodySite
      Definition

      The anatomic structures included in the document.

      ShortThe concept field is required for all bodySites.Body part included
      Control0..*
      BindingFor example codes, see SNOMEDCTBodyStructureshttp://hl7.org/fhir/ValueSet/body-site
      (example to http://hl7.org/fhir/ValueSet/body-site)

      SNOMED CT Body site concepts

      TypeCodeableReference(CodeableReferenceWithRequiredCoding)(BodyStructure)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      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 DocumentReference.bodySite. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ concept
      • 28. DocumentReference.bodySite:anatomical-region
        Slice Nameanatomical-region
        Definition

        This field may be used to provide additional information about the anatomical region of interest for the imaging manifest.


        The anatomic structures included in the document.

        ShortThe anatomical region of the patient that is the focus of the imaging manifest, concept field is required.Body part included
        Comments

        This element corresponds to ImagingStudy.series.bodySite.

        Control0..*
        BindingThe codes SHALL be taken from For example codes, see Anatomical Regionhttp://hl7.org/fhir/ValueSet/body-site
        (required to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/im-anatomical-region-valueset)
        TypeCodeableReference(BodyStructure)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. DocumentReference.practiceSetting
        Definition

        This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.

        ShortAdditional details about where the content was created (e.g. clinical specialty)
        Comments

        This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.

        Control0..1
        This element is affected by the following invariants: docRef-2
        BindingThe codes SHOULD be taken from For example codes, see Practice Settingshttp://hl7.org/fhir/ValueSet/c80-practice-codes
        (preferred to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/im-practice-settings)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

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

        Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

        ShortOrganization that manages the Imaging ManifestOrganization which maintains the document
        Comments

        Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

        Control0..1
        TypeReference(Organization)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. DocumentReference.custodian.reference
        Definition

        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

        ShortLiteral reference, Relative, internal or absolute URL
        Comments

        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

        Control0..1
        This element is affected by the following invariants: ref-2, ref-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()))
        36. DocumentReference.custodian.identifier
        Definition

        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

        ShortLogical reference, when literal reference is not known
        Comments

        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

        This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control10..1
        This element is affected by the following invariants: ref-2
        TypeIdentifier
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. DocumentReference.custodian.identifier.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|5.0.0
        (required to http://hl7.org/fhir/ValueSet/identifier-use|5.0.0)

        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()))
        40. DocumentReference.custodian.identifier.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 IdentifierTypeCodeshttp://hl7.org/fhir/ValueSet/identifier-type
        (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.

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.eu/fhir/imaging-manifest-r5/CodeSystem/codesystem-missing-dicom-terminology",
            "code" : "0040E031"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. DocumentReference.content
        Definition

        The document and format referenced. If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata.

        ShortDocument referenced
        Comments

        content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.

        Control1..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.

        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 DocumentReference.content. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ value
        • 44. DocumentReference.content.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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 managable, 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())
          46. DocumentReference.content.attachment
          Definition

          The document or URL of the document along with critical metadata to prove content has integrity.

          ShortWhere to access the document
          Control1..1
          TypeAttachment
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. DocumentReference.content:kos
          Slice Namekos
          Definition

          The document and format referenced. If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata.

          ShortDocument referenced
          Comments

          content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.

          Control01..1*
          TypeBackboneElement
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. DocumentReference.content:kos.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 managable, 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())
          52. DocumentReference.content:kos.attachment
          Definition

          The document or URL of the document along with critical metadata to prove content has integrity.

          ShortWhere to access the document
          Control1..1
          TypeAttachment
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. DocumentReference.content:kos.attachment.contentType
          Definition

          Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

          ShortMime type of the content, with charset etc.
          Control0..1
          This element is affected by the following invariants: att-1
          BindingThe codes SHALL be taken from MimeTypeshttp://hl7.org/fhir/ValueSet/mimetypes|5.0.0
          (required to http://hl7.org/fhir/ValueSet/mimetypes|5.0.0)

          BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Processors of the data need to be able to know how to interpret the data.

          Pattern Valueapplication/dicom
          ExampleGeneral: text/plain; charset=UTF-8, image/png
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. DocumentReference.content:kos.attachment.url
          Definition

          A location where the data can be accessed.

          ShortUri where the data can be found
          Comments

          If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

          The data needs to be transmitted by reference.

          ExampleGeneral: http://www.acme.com/logo-small.png
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. DocumentReference.content:kos.profile
          Definition

          An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

          ShortContent profile rules for the document
          Comments

          Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

          For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.

          Control10..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Alternate Namesformat, formatCode
          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 DocumentReference.content.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ value
          • 60. DocumentReference.content:kos.profile.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 managable, 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. DocumentReference.content:kos.profile.value[x]
            Definition

            Code|uri|canonical.

            ShortCode|uri|canonical
            Control1..1
            BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharinghttp://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
            (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

            Document Format Codes.

            TypeChoice of: Coding, uri, canonical
            [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 Supportfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            64. DocumentReference.content:kos.profile:kos-manifest
            Slice Namekos-manifest
            Definition

            An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

            ShortContent profile rules for the document
            Comments

            Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

            For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Alternate Namesformat, formatCode
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. DocumentReference.content:kos.profile:kos-manifest.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 managable, 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())
            68. DocumentReference.content:kos.profile:kos-manifest.value[x]
            Definition

            Code|uri|canonical.

            ShortCode|uri|canonical
            Control1..1
            BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharinghttp://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
            (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

            Document Format Codes.

            TypeChoice of: Coding, uri, canonical
            [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 Supportfalse
            Summarytrue
            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 DocumentReference.content.profile.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • type @ $this
            • 70. DocumentReference.content:kos.profile:kos-manifest.value[x]:valueCoding
              Slice NamevalueCoding
              Definition

              Code|uri|canonical.

              ShortCode|uri|canonical
              Control01..1
              BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharinghttp://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
              (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

              Document Format Codes.

              TypeCoding, canonical, uri
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Pattern Value{
                "system" : "http://dicom.nema.org/resources/ontology/DCM",
                "code" : "113030"
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. DocumentReference.content:fhir
              Slice Namefhir
              Definition

              The document and format referenced. If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata.

              ShortDocument referenced
              Comments

              content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.

              Control01..1*
              TypeBackboneElement
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Requirements

              Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. DocumentReference.content:fhir.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 managable, 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())
              76. DocumentReference.content:fhir.attachment
              Definition

              The document or URL of the document along with critical metadata to prove content has integrity.

              ShortWhere to access the document
              Control1..1
              TypeAttachment
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              78. DocumentReference.content:fhir.attachment.contentType
              Definition

              Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

              ShortMime type of the content, with charset etc.
              Control0..1
              This element is affected by the following invariants: att-1
              BindingThe codes SHALL be taken from MimeTypeshttp://hl7.org/fhir/ValueSet/mimetypes|5.0.0
              (required to http://hl7.org/fhir/ValueSet/mimetypes|5.0.0)

              BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Processors of the data need to be able to know how to interpret the data.

              Pattern Valueapplication/fhir+json
              ExampleGeneral: text/plain; charset=UTF-8, image/png
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              80. DocumentReference.content:fhir.attachment.url
              Definition

              A location where the data can be accessed.

              ShortUri where the data can be found
              Comments

              If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

              The data needs to be transmitted by reference.

              ExampleGeneral: http://www.acme.com/logo-small.png
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              82. DocumentReference.content:fhir.profile
              Definition

              An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

              ShortContent profile rules for the document
              Comments

              Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

              For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.

              Control10..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Alternate Namesformat, formatCode
              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 DocumentReference.content.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ value
              • 84. DocumentReference.content:fhir.profile.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 managable, 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())
                86. DocumentReference.content:fhir.profile.value[x]
                Definition

                Code|uri|canonical.

                ShortCode|uri|canonical
                Control1..1
                BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharinghttp://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
                (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

                Document Format Codes.

                TypeChoice of: Coding, uri, canonical
                [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 Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                88. DocumentReference.content:fhir.profile:fhir-manifest
                Slice Namefhir-manifest
                Definition

                An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                ShortContent profile rules for the document
                Comments

                Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

                For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.

                Control10..1*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Alternate Namesformat, formatCode
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                90. DocumentReference.content:fhir.profile:fhir-manifest.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 managable, 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())
                92. DocumentReference.content:fhir.profile:fhir-manifest.value[x]
                Definition

                Code|uri|canonical.

                ShortCode|uri|canonical
                Control1..1
                BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharinghttp://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
                (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

                Document Format Codes.

                TypeChoice of: Coding, uri, canonical
                [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 Supportfalse
                Summarytrue
                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 DocumentReference.content.profile.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • type @ $this
                • 94. DocumentReference.content:fhir.profile:fhir-manifest.value[x]:valueCanonical
                  Slice NamevalueCanonical
                  Definition

                  Code|uri|canonical.

                  ShortCode|uri|canonical
                  Control01..1
                  Typecanonical, Coding, uri
                  [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 Supportfalse
                  Summarytrue
                  Pattern Valuehttp://hl7.eu/fhir/imaging-manifest-r5/StructureDefinition/ImImagingStudyManifest
                  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 foundhere

                  0. DocumentReference
                  Invariantsim-docref-1: At least a KOS or FHIR manifest needs to be present. (content.value.subsumes( $dcm#113030) or content.value.endsWith('ImManifestDocumentReference'))
                  2. DocumentReference.modifierExtension
                  Control0..0
                  4. DocumentReference.identifier
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control1..?
                  SlicingThis element introduces a set of slices on DocumentReference.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ system
                  • 6. DocumentReference.identifier:entry-uuid
                    Slice Nameentry-uuid
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control1..1
                    TypeIdentifier(Placeholder for IHE MHD Entry UUID Identifier in FHIR R5.)
                    8. DocumentReference.modality
                    Control1..?
                    BindingThe codes SHALL be taken from https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html
                    (required to https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html)
                    10. DocumentReference.type
                    Definition

                    Specifies that it refers to a Imaging Manifest

                    ShortType of Imaging Manifest
                    Comments

                    Corresponds to the type of the Imaging Manifest resource.

                    Control1..?
                    BindingThe codes SHOULD be taken from HL7 EU Imaging Manifest Types
                    (preferred to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/ImImagingManifestTypesEuVS)
                    12. DocumentReference.category
                    Control1..?
                    SlicingThis element introduces a set of slices on DocumentReference.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ $this
                    • 14. DocumentReference.category:class-code
                      Slice Nameclass-code
                      Control0..*
                      BindingThe codes SHOULD be taken from XDS Class Codes
                      (preferred to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/im-xds-class-code-valueset)
                      16. DocumentReference.subject
                      Control1..?
                      18. DocumentReference.bodySite
                      ShortThe concept field is required for all bodySites.
                      TypeCodeableReference(CodeableReferenceWithRequiredCoding)(BodyStructure)
                      SlicingThis element introduces a set of slices on DocumentReference.bodySite. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ concept
                      • 20. DocumentReference.bodySite:anatomical-region
                        Slice Nameanatomical-region
                        Definition

                        This field may be used to provide additional information about the anatomical region of interest for the imaging manifest.

                        ShortThe anatomical region of the patient that is the focus of the imaging manifest, concept field is required.
                        Comments

                        This element corresponds to ImagingStudy.series.bodySite.

                        Control0..*
                        BindingThe codes SHALL be taken from Anatomical Region
                        (required to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/im-anatomical-region-valueset)
                        22. DocumentReference.practiceSetting
                        BindingThe codes SHOULD be taken from Practice Settings
                        (preferred to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/im-practice-settings)
                        24. DocumentReference.custodian
                        ShortOrganization that manages the Imaging Manifest
                        26. DocumentReference.custodian.identifier
                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        Control1..?
                        28. DocumentReference.custodian.identifier.type
                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.eu/fhir/imaging-manifest-r5/CodeSystem/codesystem-missing-dicom-terminology",
                            "code" : "0040E031"
                          }]
                        }
                        30. DocumentReference.content
                        SlicingThis element introduces a set of slices on DocumentReference.content. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ value
                        • 32. DocumentReference.content:kos
                          Slice Namekos
                          Control0..1
                          34. DocumentReference.content:kos.attachment
                          36. DocumentReference.content:kos.attachment.contentType
                          Pattern Valueapplication/dicom
                          38. DocumentReference.content:kos.attachment.url
                          Control1..?
                          40. DocumentReference.content:kos.profile
                          Control1..?
                          SlicingThis element introduces a set of slices on DocumentReference.content.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ value
                          • 42. DocumentReference.content:kos.profile:kos-manifest
                            Slice Namekos-manifest
                            Control1..1
                            44. DocumentReference.content:kos.profile:kos-manifest.value[x]
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            SlicingThis element introduces a set of slices on DocumentReference.content.profile.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • type @ $this
                            • 46. DocumentReference.content:kos.profile:kos-manifest.value[x]:valueCoding
                              Slice NamevalueCoding
                              Control0..1
                              TypeCoding
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Pattern Value{
                                "system" : "http://dicom.nema.org/resources/ontology/DCM",
                                "code" : "113030"
                              }
                              48. DocumentReference.content:fhir
                              Slice Namefhir
                              Control0..1
                              50. DocumentReference.content:fhir.attachment
                              52. DocumentReference.content:fhir.attachment.contentType
                              Pattern Valueapplication/fhir+json
                              54. DocumentReference.content:fhir.attachment.url
                              Control1..?
                              56. DocumentReference.content:fhir.profile
                              Control1..?
                              SlicingThis element introduces a set of slices on DocumentReference.content.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ value
                              • 58. DocumentReference.content:fhir.profile:fhir-manifest
                                Slice Namefhir-manifest
                                Control1..1
                                60. DocumentReference.content:fhir.profile:fhir-manifest.value[x]
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                SlicingThis element introduces a set of slices on DocumentReference.content.profile.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • type @ $this
                                • 62. DocumentReference.content:fhir.profile:fhir-manifest.value[x]:valueCanonical
                                  Slice NamevalueCanonical
                                  Control0..1
                                  Typecanonical
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Pattern Valuehttp://hl7.eu/fhir/imaging-manifest-r5/StructureDefinition/ImImagingStudyManifest

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

                                  0. DocumentReference
                                  Definition

                                  A reference to a document of any kind for any purpose. While the term “document” implies a more narrow focus, for this resource this "document" encompasses any serialized object with a mime-type, it includes formal patient-centric documents (CDA), clinical notes, scanned paper, non-patient specific documents like policy text, as well as a photo, video, or audio recording acquired or used in healthcare. The DocumentReference resource provides metadata about the document so that the document can be discovered and managed. The actual content may be inline base64 encoded data or provided by direct reference.

                                  ShortA reference to a document
                                  Comments

                                  Usually, this is used for documents other than those defined by FHIR.

                                  Control0..*
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  InvariantsdocRef-1: facilityType SHALL only be present if context is not an encounter (facilityType.empty() or context.where(resolve() is Encounter).empty())
                                  docRef-2: practiceSetting SHALL only be present if context is not present (practiceSetting.empty() or context.where(resolve() is Encounter).empty())
                                  dom-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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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())
                                  im-docref-1: At least a KOS or FHIR manifest needs to be present. (content.value.subsumes( $dcm#113030) or content.value.endsWith('ImManifestDocumentReference'))
                                  2. DocumentReference.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

                                  Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

                                  Control0..1
                                  Typeid
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summarytrue
                                  4. DocumentReference.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
                                  Must Supportfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  6. DocumentReference.implicitRules
                                  Definition

                                  A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. 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 its 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 its meaning or interpretation
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supportfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  8. DocumentReference.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 SHALL be taken from AllLanguages
                                  (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0)

                                  IETF language tag for a human language

                                  Typecode
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supportfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  10. DocumentReference.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 a 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
                                  This element is affected by the following invariants: dom-6
                                  TypeNarrative
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Alternate Namesnarrative, html, xhtml, display
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  12. DocumentReference.contained
                                  Definition

                                  These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

                                  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..*
                                  This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
                                  TypeResource
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Alternate Namesinline resources, anonymous resources, contained resources
                                  14. DocumentReference.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, 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
                                  Must Supportfalse
                                  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())
                                  16. DocumentReference.modifierExtension
                                  Definition

                                  An Extension

                                  ShortExtension
                                  Control0..0
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                  Must Supportfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  18. DocumentReference.identifier
                                  Definition

                                  Other business identifiers associated with the document, including version independent identifiers.

                                  ShortBusiness identifiers for the document
                                  Comments

                                  The structure and format of this identifier would be consistent with the specification corresponding to the format of the document. (e.g. for a DICOM standard document, a 64-character numeric UID; for an HL7 CDA format, the CDA Document Id root and extension).

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

                                  Document identifiers usually assigned by the source of the document, or other business identifiers such as XDS DocumentEntry.uniqueId and DocumentEntry.entryUUID. These identifiers are specific to this instance of the document.

                                  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 DocumentReference.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ system
                                  • 20. DocumentReference.identifier:entry-uuid
                                    Slice Nameentry-uuid
                                    Definition

                                    Other business identifiers associated with the document, including version independent identifiers.

                                    ShortBusiness identifiers for the document
                                    Comments

                                    The structure and format of this identifier would be consistent with the specification corresponding to the format of the document. (e.g. for a DICOM standard document, a 64-character numeric UID; for an HL7 CDA format, the CDA Document Id root and extension).

                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                    Control1..1
                                    TypeIdentifier(Placeholder for IHE MHD Entry UUID Identifier in FHIR R5.)
                                    Is Modifierfalse
                                    Must Supportfalse
                                    Summarytrue
                                    Requirements

                                    Document identifiers usually assigned by the source of the document, or other business identifiers such as XDS DocumentEntry.uniqueId and DocumentEntry.entryUUID. These identifiers are specific to this instance of the document.

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

                                    An explicitly assigned identifer of a variation of the content in the DocumentReference.

                                    ShortAn explicitly assigned identifer of a variation of the content in the DocumentReference
                                    Comments

                                    While each resource, including the DocumentReference itself, has its own version identifier, this is a formal identifier for the logical version of the DocumentReference as a whole. It would remain constant if the resources were moved to a new server, and all got new individual resource versions, for example.

                                    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
                                    Must Supportfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    24. DocumentReference.basedOn
                                    Definition

                                    A procedure that is fulfilled in whole or in part by the creation of this media.

                                    ShortProcedure that caused this media to be created
                                    Control0..*
                                    TypeReference(Appointment, AppointmentResponse, CarePlan, Claim, CommunicationRequest, Contract, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, RequestOrchestration, ServiceRequest, SupplyRequest, VisionPrescription)
                                    Is Modifierfalse
                                    Must Supportfalse
                                    Summaryfalse
                                    Requirements

                                    Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

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

                                    The status of this document reference.

                                    Shortcurrent | superseded | entered-in-error
                                    Comments

                                    This is the status of the DocumentReference object, which might be independent from the docStatus element.

                                    This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

                                    Control1..1
                                    BindingThe codes SHALL be taken from DocumentReferenceStatus
                                    (required to http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0)

                                    The status of the document reference.

                                    Typecode
                                    Is Modifiertrue because This element is labelled 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 Supportfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    28. DocumentReference.docStatus
                                    Definition

                                    The status of the underlying document.

                                    Shortregistered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown
                                    Comments

                                    The document that is pointed to might be in various lifecycle states.

                                    Control0..1
                                    BindingThe codes SHALL be taken from CompositionStatus
                                    (required to http://hl7.org/fhir/ValueSet/composition-status|5.0.0)

                                    Status of the underlying document.

                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supportfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    30. DocumentReference.modality
                                    Definition

                                    Imaging modality used. This may include both acquisition and non-acquisition modalities.

                                    ShortImaging modality used
                                    Control1..*
                                    BindingThe codes SHALL be taken from https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html
                                    (required to https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supportfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    32. DocumentReference.type
                                    Definition

                                    Specifies that it refers to a Imaging Manifest

                                    ShortType of Imaging Manifest
                                    Comments

                                    Corresponds to the type of the Imaging Manifest resource.

                                    Control1..1
                                    BindingThe codes SHOULD be taken from HL7 EU Imaging Manifest Types
                                    (preferred to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/ImImagingManifestTypesEuVS)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supportfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    34. DocumentReference.category
                                    Definition

                                    A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

                                    ShortCategorization of document
                                    Comments

                                    Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

                                    Control1..*
                                    BindingFor example codes, see ReferencedItemCategoryValueSet
                                    (example to http://hl7.org/fhir/ValueSet/referenced-item-category)

                                    High-level kind of document at a macro level.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supportfalse
                                    Summarytrue
                                    Alternate Namesclass, classCode
                                    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 DocumentReference.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ $this
                                    • 36. DocumentReference.category:class-code
                                      Slice Nameclass-code
                                      Definition

                                      A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

                                      ShortCategorization of document
                                      Comments

                                      Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

                                      Control0..*
                                      BindingThe codes SHOULD be taken from XDS Class Codes
                                      (preferred to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/im-xds-class-code-valueset)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summarytrue
                                      Alternate Namesclass, classCode
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      38. DocumentReference.subject
                                      Definition

                                      Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

                                      ShortWho/what is the subject of the document
                                      Control1..1
                                      TypeReference(Resource)
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      40. DocumentReference.context
                                      Definition

                                      Describes the clinical encounter or type of care that the document content is associated with.

                                      ShortContext of the document content
                                      Control0..*
                                      This element is affected by the following invariants: docRef-1, docRef-2
                                      TypeReference(Appointment, Encounter, EpisodeOfCare)
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      42. DocumentReference.event
                                      Definition

                                      This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.

                                      ShortMain clinical acts documented
                                      Comments

                                      An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation.

                                      Control0..*
                                      BindingFor example codes, see v3 Code System ActCode
                                      (example to http://terminology.hl7.org/ValueSet/v3-ActCode)

                                      This list of codes represents the main clinical acts being documented.

                                      TypeCodeableReference
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      44. DocumentReference.bodySite
                                      Definition

                                      The anatomic structures included in the document.

                                      ShortThe concept field is required for all bodySites.
                                      Control0..*
                                      BindingFor example codes, see SNOMEDCTBodyStructures
                                      (example to http://hl7.org/fhir/ValueSet/body-site)

                                      SNOMED CT Body site concepts

                                      TypeCodeableReference(CodeableReferenceWithRequiredCoding)(BodyStructure)
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summarytrue
                                      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 DocumentReference.bodySite. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ concept
                                      • 46. DocumentReference.bodySite:anatomical-region
                                        Slice Nameanatomical-region
                                        Definition

                                        This field may be used to provide additional information about the anatomical region of interest for the imaging manifest.

                                        ShortThe anatomical region of the patient that is the focus of the imaging manifest, concept field is required.
                                        Comments

                                        This element corresponds to ImagingStudy.series.bodySite.

                                        Control0..*
                                        BindingThe codes SHALL be taken from Anatomical Region
                                        (required to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/im-anatomical-region-valueset)
                                        TypeCodeableReference(BodyStructure)
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        48. DocumentReference.facilityType
                                        Definition

                                        The kind of facility where the patient was seen.

                                        ShortKind of facility where patient was seen
                                        Control0..1
                                        This element is affected by the following invariants: docRef-1
                                        BindingFor example codes, see FacilityTypeCodeValueSet
                                        (example to http://hl7.org/fhir/ValueSet/c80-facilitycodes)

                                        XDS Facility Type.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        50. DocumentReference.practiceSetting
                                        Definition

                                        This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.

                                        ShortAdditional details about where the content was created (e.g. clinical specialty)
                                        Comments

                                        This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.

                                        Control0..1
                                        This element is affected by the following invariants: docRef-2
                                        BindingThe codes SHOULD be taken from Practice Settings
                                        (preferred to http://hl7.eu/fhir/imaging-manifest-r5/ValueSet/im-practice-settings)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Requirements

                                        This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

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

                                        The time period over which the service that is described by the document was provided.

                                        ShortTime of service that is being documented
                                        Control0..1
                                        TypePeriod
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        54. DocumentReference.date
                                        Definition

                                        When the document reference was created.

                                        ShortWhen this document reference was created
                                        Comments

                                        Referencing/indexing time is used for tracking, organizing versions and searching.

                                        Control0..1
                                        Typeinstant
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supportfalse
                                        Summarytrue
                                        Alternate Namesindexed
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        56. DocumentReference.author
                                        Definition

                                        Identifies who is responsible for adding the information to the document.

                                        ShortWho and/or what authored the document
                                        Comments

                                        Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

                                        Control0..*
                                        TypeReference(Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson, CareTeam)
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        58. DocumentReference.attester
                                        Definition

                                        A participant who has authenticated the accuracy of the document.

                                        ShortAttests to accuracy of the document
                                        Comments

                                        Only list each attester once.

                                        Control0..*
                                        TypeBackboneElement
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Requirements

                                        Identifies responsibility for the accuracy of the document content.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        60. DocumentReference.attester.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
                                        This element is affected by the following invariants: ele-1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        62. DocumentReference.attester.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 managable, 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())
                                        64. DocumentReference.attester.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 managable, 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())
                                        66. DocumentReference.attester.mode
                                        Definition

                                        The type of attestation the authenticator offers.

                                        Shortpersonal | professional | legal | official
                                        Control1..1
                                        BindingThe codes SHOULD be taken from CompositionAttestationMode
                                        (preferred to http://hl7.org/fhir/ValueSet/composition-attestation-mode)

                                        The way in which a person authenticated a document.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Requirements

                                        Indicates the level of authority of the attestation.

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

                                        When the document was attested by the party.

                                        ShortWhen the document was attested
                                        Control0..1
                                        TypedateTime
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supportfalse
                                        Summaryfalse
                                        Requirements

                                        Identifies when the information in the document was deemed accurate. (Things may have changed since then.).

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

                                        Who attested the document in the specified way.

                                        ShortWho attested the document
                                        Control0..1
                                        TypeReference(Patient, RelatedPerson, Practitioner, PractitionerRole, Organization)
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Requirements

                                        Identifies who has taken on the responsibility for accuracy of the document content.

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

                                        Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

                                        ShortOrganization that manages the Imaging Manifest
                                        Comments

                                        Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

                                        Control0..1
                                        TypeReference(Organization)
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        74. DocumentReference.custodian.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
                                        This element is affected by the following invariants: ele-1
                                        Typeid
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        76. DocumentReference.custodian.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 managable, 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 DocumentReference.custodian.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 78. DocumentReference.custodian.reference
                                          Definition

                                          A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                          ShortLiteral reference, Relative, internal or absolute URL
                                          Comments

                                          Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                          Control0..1
                                          This element is affected by the following invariants: ref-2, ref-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()))
                                          80. DocumentReference.custodian.type
                                          Definition

                                          The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                          The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                          ShortType the reference refers to (e.g. "Patient") - must be a resource in resources
                                          Comments

                                          This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

                                          Control0..1
                                          BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                          (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                          Aa resource (or, for logical models, the URI of the logical model).

                                          Typeuri
                                          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()))
                                          82. DocumentReference.custodian.identifier
                                          Definition

                                          An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                          ShortLogical reference, when literal reference is not known
                                          Comments

                                          When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                          When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                          Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                          Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                          This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

                                          NoteThis is a business identifier, not a resource identifier (see discussion)
                                          Control1..1
                                          This element is affected by the following invariants: ref-2
                                          TypeIdentifier
                                          Is Modifierfalse
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          84. DocumentReference.custodian.identifier.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
                                          This element is affected by the following invariants: ele-1
                                          Typeid
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          86. DocumentReference.custodian.identifier.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 managable, 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 DocumentReference.custodian.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 88. DocumentReference.custodian.identifier.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|5.0.0)

                                            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()))
                                            90. DocumentReference.custodian.identifier.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 IdentifierTypeCodes
                                            (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.

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://hl7.eu/fhir/imaging-manifest-r5/CodeSystem/codesystem-missing-dicom-terminology",
                                                "code" : "0040E031"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            92. DocumentReference.custodian.identifier.system
                                            Definition

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

                                            ShortThe namespace for the identifier value
                                            Comments

                                            Identifier.system is always case sensitive.

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

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

                                            ExampleGeneral: http://www.acme.com/identifiers/patient
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            94. DocumentReference.custodian.identifier.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 http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                            Control0..1
                                            This element is affected by the following invariants: ident-1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            ExampleGeneral: 123456
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            96. DocumentReference.custodian.identifier.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()))
                                            98. DocumentReference.custodian.identifier.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()))
                                            100. DocumentReference.custodian.display
                                            Definition

                                            Plain text narrative that identifies the resource in addition to the resource reference.

                                            ShortText alternative for the resource
                                            Comments

                                            This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                            Control0..1
                                            This element is affected by the following invariants: ref-2
                                            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()))
                                            102. DocumentReference.relatesTo
                                            Definition

                                            Relationships that this document has with other document references that already exist.

                                            ShortRelationships to other documents
                                            Comments

                                            This element is labeled as a modifier because documents that append to other documents are incomplete on their own.

                                            Control0..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supportfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            104. DocumentReference.relatesTo.id
                                            Definition

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

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            This element is affected by the following invariants: ele-1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            106. DocumentReference.relatesTo.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 managable, 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())
                                            108. DocumentReference.relatesTo.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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 managable, 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())
                                            110. DocumentReference.relatesTo.code
                                            Definition

                                            The type of relationship that this document has with anther document.

                                            ShortThe relationship type with another document
                                            Comments

                                            If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

                                            Control1..1
                                            BindingUnless not suitable, these codes SHALL be taken from DocumentRelationshipType
                                            (extensible to http://hl7.org/fhir/ValueSet/document-relationship-type)

                                            The type of relationship between the documents.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supportfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            112. DocumentReference.relatesTo.target
                                            Definition

                                            The target document of this relationship.

                                            ShortTarget of the relationship
                                            Control1..1
                                            TypeReference(DocumentReference)
                                            Is Modifierfalse
                                            Must Supportfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            114. DocumentReference.description
                                            Definition

                                            Human-readable description of the source document.

                                            ShortHuman-readable description
                                            Comments

                                            What the document is about, a terse summary of the document.

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

                                            Helps humans to assess whether the document is of interest.

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

                                            A set of Security-Tag codes specifying the level of privacy/security of the Document found at DocumentReference.content.attachment.url. Note that DocumentReference.meta.security contains the security labels of the data elements in DocumentReference, while DocumentReference.securityLabel contains the security labels for the document the reference refers to. The distinction recognizes that the document may contain sensitive information, while the DocumentReference is metadata about the document and thus might not be as sensitive as the document. For example: a psychotherapy episode may contain highly sensitive information, while the metadata may simply indicate that some episode happened.

                                            ShortDocument security-tags
                                            Comments

                                            The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce.

                                            In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.

                                            Control0..*
                                            BindingFor example codes, see SecurityLabelExamples
                                            (example to http://hl7.org/fhir/ValueSet/security-label-examples)

                                            Example Security Labels from the Healthcare Privacy and Security Classification System.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supportfalse
                                            Summarytrue
                                            Requirements

                                            Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

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

                                            The document and format referenced. If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata.

                                            ShortDocument referenced
                                            Comments

                                            content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.

                                            Control1..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supportfalse
                                            Summarytrue
                                            Requirements

                                            Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.

                                            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 DocumentReference.content. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ value
                                            • 120. DocumentReference.content.id
                                              Definition

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

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              This element is affected by the following invariants: ele-1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              122. DocumentReference.content.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 managable, 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())
                                              124. DocumentReference.content.modifierExtension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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 managable, 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())
                                              126. DocumentReference.content.attachment
                                              Definition

                                              The document or URL of the document along with critical metadata to prove content has integrity.

                                              ShortWhere to access the document
                                              Control1..1
                                              TypeAttachment
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              128. DocumentReference.content.profile
                                              Definition

                                              An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                                              ShortContent profile rules for the document
                                              Comments

                                              Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

                                              For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.

                                              Control0..*
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Alternate Namesformat, formatCode
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              130. DocumentReference.content.profile.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
                                              This element is affected by the following invariants: ele-1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              132. DocumentReference.content.profile.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 managable, 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())
                                              134. DocumentReference.content.profile.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 managable, 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())
                                              136. DocumentReference.content.profile.value[x]
                                              Definition

                                              Code|uri|canonical.

                                              ShortCode|uri|canonical
                                              Control1..1
                                              BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharing
                                              (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

                                              Document Format Codes.

                                              TypeChoice of: Coding, uri, canonical
                                              [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 Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              138. DocumentReference.content:kos
                                              Slice Namekos
                                              Definition

                                              The document and format referenced. If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata.

                                              ShortDocument referenced
                                              Comments

                                              content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.

                                              Control0..1
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Requirements

                                              Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              140. DocumentReference.content:kos.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
                                              This element is affected by the following invariants: ele-1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              142. DocumentReference.content:kos.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 managable, 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())
                                              144. DocumentReference.content:kos.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 managable, 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())
                                              146. DocumentReference.content:kos.attachment
                                              Definition

                                              The document or URL of the document along with critical metadata to prove content has integrity.

                                              ShortWhere to access the document
                                              Control1..1
                                              TypeAttachment
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              148. DocumentReference.content:kos.attachment.id
                                              Definition

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

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              This element is affected by the following invariants: ele-1
                                              Typeid
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              150. DocumentReference.content:kos.attachment.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 managable, 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 DocumentReference.content.attachment.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 152. DocumentReference.content:kos.attachment.contentType
                                                Definition

                                                Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

                                                ShortMime type of the content, with charset etc.
                                                Control0..1
                                                This element is affected by the following invariants: att-1
                                                BindingThe codes SHALL be taken from MimeTypes
                                                (required to http://hl7.org/fhir/ValueSet/mimetypes|5.0.0)

                                                BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)

                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Processors of the data need to be able to know how to interpret the data.

                                                Pattern Valueapplication/dicom
                                                ExampleGeneral: text/plain; charset=UTF-8, image/png
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                154. DocumentReference.content:kos.attachment.language
                                                Definition

                                                The human language of the content. The value can be any valid value according to BCP 47.

                                                ShortHuman language of the content (BCP-47)
                                                Control0..1
                                                BindingThe codes SHALL be taken from AllLanguages
                                                (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0)

                                                IETF language tag for a human language.

                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Users need to be able to choose between the languages in a set of attachments.

                                                ExampleGeneral: en-AU
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                156. DocumentReference.content:kos.attachment.data
                                                Definition

                                                The actual data of the attachment - a sequence of bytes, base64 encoded.

                                                ShortData inline, base64ed
                                                Comments

                                                The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

                                                Control0..1
                                                This element is affected by the following invariants: att-1
                                                Typebase64Binary
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                The data needs to able to be transmitted inline.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                158. DocumentReference.content:kos.attachment.url
                                                Definition

                                                A location where the data can be accessed.

                                                ShortUri where the data can be found
                                                Comments

                                                If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

                                                The data needs to be transmitted by reference.

                                                ExampleGeneral: http://www.acme.com/logo-small.png
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                160. DocumentReference.content:kos.attachment.size
                                                Definition

                                                The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

                                                ShortNumber of bytes of content (if url provided)
                                                Comments

                                                The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.

                                                Control0..1
                                                Typeinteger64
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                162. DocumentReference.content:kos.attachment.hash
                                                Definition

                                                The calculated hash of the data using SHA-1. Represented using base64.

                                                ShortHash of the data (sha-1, base64ed)
                                                Comments

                                                The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.

                                                Control0..1
                                                Typebase64Binary
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                164. DocumentReference.content:kos.attachment.title
                                                Definition

                                                A label or set of text to display in place of the data.

                                                ShortLabel to display in place of the data
                                                Comments

                                                May sometimes be derived from the source filename.

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

                                                Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

                                                ExampleGeneral: Official Corporate Logo
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                166. DocumentReference.content:kos.attachment.creation
                                                Definition

                                                The date that the attachment was first created.

                                                ShortDate attachment was first created
                                                Control0..1
                                                TypedateTime
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                This is often tracked as an integrity issue for use of the attachment.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                168. DocumentReference.content:kos.attachment.height
                                                Definition

                                                Height of the image in pixels (photo/video).

                                                ShortHeight of the image in pixels (photo/video)
                                                Control0..1
                                                TypepositiveInt
                                                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()))
                                                170. DocumentReference.content:kos.attachment.width
                                                Definition

                                                Width of the image in pixels (photo/video).

                                                ShortWidth of the image in pixels (photo/video)
                                                Control0..1
                                                TypepositiveInt
                                                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()))
                                                172. DocumentReference.content:kos.attachment.frames
                                                Definition

                                                The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gif. If there is more than one frame, this SHALL have a value in order to alert interface software that a multi-frame capable rendering widget is required.

                                                ShortNumber of frames if > 1 (photo)
                                                Comments

                                                if the number of frames is not supplied, the value may be unknown. Applications should not assume that there is only one frame unless it is explicitly stated.

                                                Control0..1
                                                TypepositiveInt
                                                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()))
                                                174. DocumentReference.content:kos.attachment.duration
                                                Definition

                                                The duration of the recording in seconds - for audio and video.

                                                ShortLength in seconds (audio / video)
                                                Comments

                                                The duration might differ from occurrencePeriod if recording was paused.

                                                Control0..1
                                                Typedecimal
                                                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()))
                                                176. DocumentReference.content:kos.attachment.pages
                                                Definition

                                                The number of pages when printed.

                                                ShortNumber of printed pages
                                                Control0..1
                                                TypepositiveInt
                                                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()))
                                                178. DocumentReference.content:kos.profile
                                                Definition

                                                An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                                                ShortContent profile rules for the document
                                                Comments

                                                Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

                                                For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.

                                                Control1..*
                                                TypeBackboneElement
                                                Is Modifierfalse
                                                Must Supportfalse
                                                Summarytrue
                                                Alternate Namesformat, formatCode
                                                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 DocumentReference.content.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ value
                                                • 180. DocumentReference.content:kos.profile.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
                                                  This element is affected by the following invariants: ele-1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  182. DocumentReference.content:kos.profile.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 managable, 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())
                                                  184. DocumentReference.content:kos.profile.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 managable, 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())
                                                  186. DocumentReference.content:kos.profile.value[x]
                                                  Definition

                                                  Code|uri|canonical.

                                                  ShortCode|uri|canonical
                                                  Control1..1
                                                  BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharing
                                                  (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

                                                  Document Format Codes.

                                                  TypeChoice of: Coding, uri, canonical
                                                  [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 Supportfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  188. DocumentReference.content:kos.profile:kos-manifest
                                                  Slice Namekos-manifest
                                                  Definition

                                                  An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                                                  ShortContent profile rules for the document
                                                  Comments

                                                  Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

                                                  For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.

                                                  Control1..1
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summarytrue
                                                  Alternate Namesformat, formatCode
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  190. DocumentReference.content:kos.profile:kos-manifest.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
                                                  This element is affected by the following invariants: ele-1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  192. DocumentReference.content:kos.profile:kos-manifest.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 managable, 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())
                                                  194. DocumentReference.content:kos.profile:kos-manifest.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 managable, 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())
                                                  196. DocumentReference.content:kos.profile:kos-manifest.value[x]
                                                  Definition

                                                  Code|uri|canonical.

                                                  ShortCode|uri|canonical
                                                  Control1..1
                                                  BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharing
                                                  (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

                                                  Document Format Codes.

                                                  TypeChoice of: Coding, uri, canonical
                                                  [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 Supportfalse
                                                  Summarytrue
                                                  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 DocumentReference.content.profile.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • type @ $this
                                                  • 198. DocumentReference.content:kos.profile:kos-manifest.value[x]:valueCoding
                                                    Slice NamevalueCoding
                                                    Definition

                                                    Code|uri|canonical.

                                                    ShortCode|uri|canonical
                                                    Control0..1
                                                    BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharing
                                                    (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

                                                    Document Format Codes.

                                                    TypeCoding
                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                    Is Modifierfalse
                                                    Must Supportfalse
                                                    Summarytrue
                                                    Pattern Value{
                                                      "system" : "http://dicom.nema.org/resources/ontology/DCM",
                                                      "code" : "113030"
                                                    }
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    200. DocumentReference.content:fhir
                                                    Slice Namefhir
                                                    Definition

                                                    The document and format referenced. If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata.

                                                    ShortDocument referenced
                                                    Comments

                                                    content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.

                                                    Control0..1
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Must Supportfalse
                                                    Summarytrue
                                                    Requirements

                                                    Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    202. DocumentReference.content:fhir.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
                                                    This element is affected by the following invariants: ele-1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    204. DocumentReference.content:fhir.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 managable, 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())
                                                    206. DocumentReference.content:fhir.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 managable, 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())
                                                    208. DocumentReference.content:fhir.attachment
                                                    Definition

                                                    The document or URL of the document along with critical metadata to prove content has integrity.

                                                    ShortWhere to access the document
                                                    Control1..1
                                                    TypeAttachment
                                                    Is Modifierfalse
                                                    Must Supportfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    210. DocumentReference.content:fhir.attachment.id
                                                    Definition

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

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    This element is affected by the following invariants: ele-1
                                                    Typeid
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    212. DocumentReference.content:fhir.attachment.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 managable, 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 DocumentReference.content.attachment.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 214. DocumentReference.content:fhir.attachment.contentType
                                                      Definition

                                                      Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

                                                      ShortMime type of the content, with charset etc.
                                                      Control0..1
                                                      This element is affected by the following invariants: att-1
                                                      BindingThe codes SHALL be taken from MimeTypes
                                                      (required to http://hl7.org/fhir/ValueSet/mimetypes|5.0.0)

                                                      BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)

                                                      Typecode
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      Processors of the data need to be able to know how to interpret the data.

                                                      Pattern Valueapplication/fhir+json
                                                      ExampleGeneral: text/plain; charset=UTF-8, image/png
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      216. DocumentReference.content:fhir.attachment.language
                                                      Definition

                                                      The human language of the content. The value can be any valid value according to BCP 47.

                                                      ShortHuman language of the content (BCP-47)
                                                      Control0..1
                                                      BindingThe codes SHALL be taken from AllLanguages
                                                      (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0)

                                                      IETF language tag for a human language.

                                                      Typecode
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      Users need to be able to choose between the languages in a set of attachments.

                                                      ExampleGeneral: en-AU
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      218. DocumentReference.content:fhir.attachment.data
                                                      Definition

                                                      The actual data of the attachment - a sequence of bytes, base64 encoded.

                                                      ShortData inline, base64ed
                                                      Comments

                                                      The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

                                                      Control0..1
                                                      This element is affected by the following invariants: att-1
                                                      Typebase64Binary
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      The data needs to able to be transmitted inline.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      220. DocumentReference.content:fhir.attachment.url
                                                      Definition

                                                      A location where the data can be accessed.

                                                      ShortUri where the data can be found
                                                      Comments

                                                      If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

                                                      The data needs to be transmitted by reference.

                                                      ExampleGeneral: http://www.acme.com/logo-small.png
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      222. DocumentReference.content:fhir.attachment.size
                                                      Definition

                                                      The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

                                                      ShortNumber of bytes of content (if url provided)
                                                      Comments

                                                      The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.

                                                      Control0..1
                                                      Typeinteger64
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      224. DocumentReference.content:fhir.attachment.hash
                                                      Definition

                                                      The calculated hash of the data using SHA-1. Represented using base64.

                                                      ShortHash of the data (sha-1, base64ed)
                                                      Comments

                                                      The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.

                                                      Control0..1
                                                      Typebase64Binary
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      226. DocumentReference.content:fhir.attachment.title
                                                      Definition

                                                      A label or set of text to display in place of the data.

                                                      ShortLabel to display in place of the data
                                                      Comments

                                                      May sometimes be derived from the source filename.

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

                                                      Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

                                                      ExampleGeneral: Official Corporate Logo
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      228. DocumentReference.content:fhir.attachment.creation
                                                      Definition

                                                      The date that the attachment was first created.

                                                      ShortDate attachment was first created
                                                      Control0..1
                                                      TypedateTime
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      This is often tracked as an integrity issue for use of the attachment.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      230. DocumentReference.content:fhir.attachment.height
                                                      Definition

                                                      Height of the image in pixels (photo/video).

                                                      ShortHeight of the image in pixels (photo/video)
                                                      Control0..1
                                                      TypepositiveInt
                                                      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()))
                                                      232. DocumentReference.content:fhir.attachment.width
                                                      Definition

                                                      Width of the image in pixels (photo/video).

                                                      ShortWidth of the image in pixels (photo/video)
                                                      Control0..1
                                                      TypepositiveInt
                                                      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()))
                                                      234. DocumentReference.content:fhir.attachment.frames
                                                      Definition

                                                      The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gif. If there is more than one frame, this SHALL have a value in order to alert interface software that a multi-frame capable rendering widget is required.

                                                      ShortNumber of frames if > 1 (photo)
                                                      Comments

                                                      if the number of frames is not supplied, the value may be unknown. Applications should not assume that there is only one frame unless it is explicitly stated.

                                                      Control0..1
                                                      TypepositiveInt
                                                      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()))
                                                      236. DocumentReference.content:fhir.attachment.duration
                                                      Definition

                                                      The duration of the recording in seconds - for audio and video.

                                                      ShortLength in seconds (audio / video)
                                                      Comments

                                                      The duration might differ from occurrencePeriod if recording was paused.

                                                      Control0..1
                                                      Typedecimal
                                                      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()))
                                                      238. DocumentReference.content:fhir.attachment.pages
                                                      Definition

                                                      The number of pages when printed.

                                                      ShortNumber of printed pages
                                                      Control0..1
                                                      TypepositiveInt
                                                      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()))
                                                      240. DocumentReference.content:fhir.profile
                                                      Definition

                                                      An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                                                      ShortContent profile rules for the document
                                                      Comments

                                                      Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

                                                      For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.

                                                      Control1..*
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Must Supportfalse
                                                      Summarytrue
                                                      Alternate Namesformat, formatCode
                                                      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 DocumentReference.content.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ value
                                                      • 242. DocumentReference.content:fhir.profile.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
                                                        This element is affected by the following invariants: ele-1
                                                        Typestring
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        244. DocumentReference.content:fhir.profile.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 managable, 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())
                                                        246. DocumentReference.content:fhir.profile.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 managable, 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())
                                                        248. DocumentReference.content:fhir.profile.value[x]
                                                        Definition

                                                        Code|uri|canonical.

                                                        ShortCode|uri|canonical
                                                        Control1..1
                                                        BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharing
                                                        (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

                                                        Document Format Codes.

                                                        TypeChoice of: Coding, uri, canonical
                                                        [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 Supportfalse
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        250. DocumentReference.content:fhir.profile:fhir-manifest
                                                        Slice Namefhir-manifest
                                                        Definition

                                                        An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                                                        ShortContent profile rules for the document
                                                        Comments

                                                        Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI.

                                                        For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.

                                                        Control1..1
                                                        TypeBackboneElement
                                                        Is Modifierfalse
                                                        Must Supportfalse
                                                        Summarytrue
                                                        Alternate Namesformat, formatCode
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        252. DocumentReference.content:fhir.profile:fhir-manifest.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
                                                        This element is affected by the following invariants: ele-1
                                                        Typestring
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        254. DocumentReference.content:fhir.profile:fhir-manifest.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 managable, 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())
                                                        256. DocumentReference.content:fhir.profile:fhir-manifest.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 managable, 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())
                                                        258. DocumentReference.content:fhir.profile:fhir-manifest.value[x]
                                                        Definition

                                                        Code|uri|canonical.

                                                        ShortCode|uri|canonical
                                                        Control1..1
                                                        BindingThe codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharing
                                                        (preferred to http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes)

                                                        Document Format Codes.

                                                        TypeChoice of: Coding, uri, canonical
                                                        [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 Supportfalse
                                                        Summarytrue
                                                        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 DocumentReference.content.profile.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • type @ $this
                                                        • 260. DocumentReference.content:fhir.profile:fhir-manifest.value[x]:valueCanonical
                                                          Slice NamevalueCanonical
                                                          Definition

                                                          Code|uri|canonical.

                                                          ShortCode|uri|canonical
                                                          Control0..1
                                                          Typecanonical
                                                          [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 Supportfalse
                                                          Summarytrue
                                                          Pattern Valuehttp://hl7.eu/fhir/imaging-manifest-r5/StructureDefinition/ImImagingStudyManifest
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))