HL7 Europe Imaging Report R4, published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 1.0.0-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-r4/ and changes regularly. See the Directory of published versions

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

Resource Profile: EEHRxF MHD DocumentReference Profile for Imaging Reports

Profile for DocumentReference resources used in the EEHRxF context, based on the IHE MHD Minimal DocumentReference profile. This profile is used for the DocumentReference resources that represent imaging reports in the EEHRxF context. It includes additional constraints and extensions specific to imaging reports, such as the type of report, the clinical specialty, the anatomical region of interest and the profile of the imaging report.

Usages:

• Examples for this Profile: DocumentReference/DocumentReferenceSemiStructured, DocumentReference/DocumentReferenceStructuredReport and DocumentReference/RenderableFormatWithBasicMetadata

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	EehrxfMhdDocumentReference	A reference to a document
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:version		0..1	string	Version of the document referenced by this DocumentReference. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.version Constraints: ext-1
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: ValueSet: Anatomical Region (extensible)
extension:reference		0..1	Extension	Reference to a resource (by instance) Constraints: ext-1
url		1..1	uri	"reference"
extension:_datatype		0..1	(Complex)	Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier	Σ	1..1	UniqueIdIdentifier(4.2.3)	Master Version Specific Identifier
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID	SΣ	0..*	EntryUUIDIdentifier(4.2.3)	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStats (4.2.3) (required)
type	SΣ	1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: EEHRxF Document Type ValueSet (preferred)
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:imaging-report	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 85430-7
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
category	SΣ	1..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:priority-area	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/eu-health-data-api/CodeSystem/eehrxf-document-priority-category-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Medical-Imaging
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
subject	SΣ	1..1	Reference(Patient (EU core)(2.0.0-recon))	Who/what is the subject of the document
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
custodian		1..1	Reference(Organization (EU base)(2.0.0-recon))	Organization that manages the Imaging Report
relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	canonical()	Contains the profile of the referred report URL: http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-documentreference-content-profile
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
contentType	Σ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	Σ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: IHE_FormatCode_vs (1.4.0) (preferred)
context	Σ	0..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
period	SΣ	0..1	Period	Time of service that is being documented
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Clinical specialty (e.g., radiology, laboratory) - SHOULD be used for lab vs imaging differentiation Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo	S	0..1	Reference(Patient)	Patient demographics from source
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	ValueSet: Anatomical Region	📦1.0.0-ballot	This IG
DocumentReference.status	Base	required	MHD DocumentReference status codes	📍4.2.3	Mobile access to Health Documents v4.2
DocumentReference.type	Base	preferred	EEHRxF Document Type ValueSet	📦0.1.0	EU Health Data API vnull
DocumentReference.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	preferred	IHE ValueSet of Format Codes for use with Document Sharing	📍1.4.0	IHE FormatCode Vocabulary v1.4
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.0.1	FHIR Std.

Constraints

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	EehrxfMhdDocumentReference	A reference to a document
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:version		0..1	string	Version of the document referenced by this DocumentReference. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.version
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required.
extension		0..0		Extension
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: ValueSet: Anatomical Region (extensible)
value[x]		0..0		Value of extension
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance.
type		1..1	CodeableConcept	Type of Imaging Diagnostic Report
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:imaging-report		1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 85430-7
category		1..1	CodeableConcept	Categorization of document
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:priority-area		1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/eu-health-data-api/CodeSystem/eehrxf-document-priority-category-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Medical-Imaging
custodian		1..1	Reference(Organization (EU base)(2.0.0-recon))	Organization that manages the Imaging Report
content
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	canonical()	Contains the profile of the referred report URL: http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-documentreference-content-profile
context
practiceSetting		0..1	CodeableConcept	Clinical specialty (e.g., radiology, laboratory) - SHOULD be used for lab vs imaging differentiation
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	ValueSet: Anatomical Region	📦1.0.0-ballot	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	EehrxfMhdDocumentReference	A reference to a document
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:version		0..1	string	Version of the document referenced by this DocumentReference. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.version Constraints: ext-1
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: ValueSet: Anatomical Region (extensible)
extension:reference		0..1	Extension	Reference to a resource (by instance) Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"reference"
value[x]		0..1	Reference()	Reference to a resource (by instance)
extension:_datatype		0..1	(Complex)	Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
id		0..1	id	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier	Σ	1..1	UniqueIdIdentifier(4.2.3)	Master Version Specific Identifier
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID	SΣ	0..*	EntryUUIDIdentifier(4.2.3)	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStats (4.2.3) (required)
type	SΣ	1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: EEHRxF Document Type ValueSet (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:imaging-report	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 85430-7
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
category	SΣ	1..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:priority-area	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/eu-health-data-api/CodeSystem/eehrxf-document-priority-category-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Medical-Imaging
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient (EU core)(2.0.0-recon))	Who/what is the subject of the document
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
authenticator		0..1	Reference(Practitioner | PractitionerRole | Organization)	Who/what authenticated the document
custodian		1..1	Reference(Organization (EU base)(2.0.0-recon))	Organization that manages the Imaging Report
relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	canonical()	Contains the profile of the referred report URL: http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-documentreference-content-profile
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	Σ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	Σ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	Σ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: IHE_FormatCode_vs (1.4.0) (preferred)
context	Σ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter		0..*	Reference(Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time of service that is being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Clinical specialty (e.g., radiology, laboratory) - SHOULD be used for lab vs imaging differentiation Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo	S	0..1	Reference(Patient)	Patient demographics from source
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
DocumentReference.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	ValueSet: Anatomical Region	📦1.0.0-ballot	This IG
DocumentReference.status	Base	required	MHD DocumentReference status codes	📍4.2.3	Mobile access to Health Documents v4.2
DocumentReference.type	Base	preferred	EEHRxF Document Type ValueSet	📦0.1.0	EU Health Data API vnull
DocumentReference.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	preferred	IHE ValueSet of Format Codes for use with Document Sharing	📍1.4.0	IHE FormatCode Vocabulary v1.4
DocumentReference.context.​event	Base	example	v3 Code System ActCode	📍3.0.0	THO v7.1
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​sourcePatientInfo.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.

Constraints

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

Summary

Mandatory: 10 elements(2 nested mandatory elements)
Prohibited: 2 elements

Structures

This structure refers to these other structures:

• Organization (EU base) (http://hl7.eu/fhir/base/StructureDefinition/organization-eu)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.version
• http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite
• http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality
• http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-documentreference-content-profile

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.type.coding
• The element 1 is sliced based on the value of DocumentReference.category.coding

Maturity: 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	EehrxfMhdDocumentReference	A reference to a document
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:version		0..1	string	Version of the document referenced by this DocumentReference. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.version Constraints: ext-1
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: ValueSet: Anatomical Region (extensible)
extension:reference		0..1	Extension	Reference to a resource (by instance) Constraints: ext-1
url		1..1	uri	"reference"
extension:_datatype		0..1	(Complex)	Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier	Σ	1..1	UniqueIdIdentifier(4.2.3)	Master Version Specific Identifier
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID	SΣ	0..*	EntryUUIDIdentifier(4.2.3)	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStats (4.2.3) (required)
type	SΣ	1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: EEHRxF Document Type ValueSet (preferred)
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:imaging-report	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 85430-7
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
category	SΣ	1..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:priority-area	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/eu-health-data-api/CodeSystem/eehrxf-document-priority-category-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Medical-Imaging
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
subject	SΣ	1..1	Reference(Patient (EU core)(2.0.0-recon))	Who/what is the subject of the document
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
custodian		1..1	Reference(Organization (EU base)(2.0.0-recon))	Organization that manages the Imaging Report
relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	canonical()	Contains the profile of the referred report URL: http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-documentreference-content-profile
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
contentType	Σ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	Σ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: IHE_FormatCode_vs (1.4.0) (preferred)
context	Σ	0..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
period	SΣ	0..1	Period	Time of service that is being documented
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Clinical specialty (e.g., radiology, laboratory) - SHOULD be used for lab vs imaging differentiation Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo	S	0..1	Reference(Patient)	Patient demographics from source
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	ValueSet: Anatomical Region	📦1.0.0-ballot	This IG
DocumentReference.status	Base	required	MHD DocumentReference status codes	📍4.2.3	Mobile access to Health Documents v4.2
DocumentReference.type	Base	preferred	EEHRxF Document Type ValueSet	📦0.1.0	EU Health Data API vnull
DocumentReference.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	preferred	IHE ValueSet of Format Codes for use with Document Sharing	📍1.4.0	IHE FormatCode Vocabulary v1.4
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.0.1	FHIR Std.

Constraints

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

Differential View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	EehrxfMhdDocumentReference	A reference to a document
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:version		0..1	string	Version of the document referenced by this DocumentReference. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.version
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required.
extension		0..0		Extension
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: ValueSet: Anatomical Region (extensible)
value[x]		0..0		Value of extension
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance.
type		1..1	CodeableConcept	Type of Imaging Diagnostic Report
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:imaging-report		1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 85430-7
category		1..1	CodeableConcept	Categorization of document
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:priority-area		1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/eu-health-data-api/CodeSystem/eehrxf-document-priority-category-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Medical-Imaging
custodian		1..1	Reference(Organization (EU base)(2.0.0-recon))	Organization that manages the Imaging Report
content
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	canonical()	Contains the profile of the referred report URL: http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-documentreference-content-profile
context
practiceSetting		0..1	CodeableConcept	Clinical specialty (e.g., radiology, laboratory) - SHOULD be used for lab vs imaging differentiation
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	ValueSet: Anatomical Region	📦1.0.0-ballot	This IG

Snapshot ViewView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	EehrxfMhdDocumentReference	A reference to a document
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:version		0..1	string	Version of the document referenced by this DocumentReference. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.version Constraints: ext-1
extension:bodysite		0..1	(Complex)	Body part included URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Closed by value:url Constraints: ext-1
extension:concept		1..1	Extension	The anatomical region of the patient that is the focus of the imaging manifest, concept field is required. Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: ValueSet: Anatomical Region (extensible)
extension:reference		0..1	Extension	Reference to a resource (by instance) Constraints: ext-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"reference"
value[x]		0..1	Reference()	Reference to a resource (by instance)
extension:_datatype		0..1	(Complex)	Data type name for DocumentReference.bodySite from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype Constraints: ext-1
id		0..1	id	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite"
extension:modality		1..1	CodeableConcept	Imaging modality used URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality Binding: R5_dicom_cid_33_Modality_for_R4 (0.0.1-snapshot-2) (extensible): Type of acquired data in the instance. Constraints: ext-1
masterIdentifier	Σ	1..1	UniqueIdIdentifier(4.2.3)	Master Version Specific Identifier
Slices for identifier	SΣ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:use
identifier:entryUUID	SΣ	0..*	EntryUUIDIdentifier(4.2.3)	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStats (4.2.3) (required)
type	SΣ	1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: EEHRxF Document Type ValueSet (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:imaging-report	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 85430-7
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
category	SΣ	1..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:priority-area	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/eu-health-data-api/CodeSystem/eehrxf-document-priority-category-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Medical-Imaging
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient (EU core)(2.0.0-recon))	Who/what is the subject of the document
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
authenticator		0..1	Reference(Practitioner | PractitionerRole | Organization)	Who/what authenticated the document
custodian		1..1	Reference(Organization (EU base)(2.0.0-recon))	Organization that manages the Imaging Report
relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	SΣ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:profile		1..*	canonical()	Contains the profile of the referred report URL: http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-documentreference-content-profile
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	Σ	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	Σ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	Σ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: IHE_FormatCode_vs (1.4.0) (preferred)
context	Σ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter		0..*	Reference(Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time of service that is being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Clinical specialty (e.g., radiology, laboratory) - SHOULD be used for lab vs imaging differentiation Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo	S	0..1	Reference(Patient)	Patient demographics from source
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
DocumentReference.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.extension:bodysite.​extension:concept.value[x]	Base	extensible	ValueSet: Anatomical Region	📦1.0.0-ballot	This IG
DocumentReference.status	Base	required	MHD DocumentReference status codes	📍4.2.3	Mobile access to Health Documents v4.2
DocumentReference.type	Base	preferred	EEHRxF Document Type ValueSet	📦0.1.0	EU Health Data API vnull
DocumentReference.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	preferred	IHE ValueSet of Format Codes for use with Document Sharing	📍1.4.0	IHE FormatCode Vocabulary v1.4
DocumentReference.context.​event	Base	example	v3 Code System ActCode	📍3.0.0	THO v7.1
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.0.1	FHIR Std.
DocumentReference.context.​sourcePatientInfo.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.

Constraints

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

Summary

Mandatory: 10 elements(2 nested mandatory elements)
Prohibited: 2 elements

Structures

This structure refers to these other structures:

• Organization (EU base) (http://hl7.eu/fhir/base/StructureDefinition/organization-eu)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.version
• http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.bodySite
• http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.modality
• http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-documentreference-content-profile

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.type.coding
• The element 1 is sliced based on the value of DocumentReference.category.coding

Maturity: 1