HL7 Europe Imaging Report R5
0.1.1-build - 150

HL7 Europe Imaging Report R5, published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 0.1.1-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/imaging-r5/ and changes regularly. See the Directory of published versions

Resource Profile: DocumentReference: Key Image

Official URL: http://hl7.eu/fhir/imaging-r5/StructureDefinition/DocumentReferenceKeyImageEuImaging Version: 0.1.1-build
Standards status: Draft Draft as of 2025-10-20 Maturity Level: 1 Computable Name: DocumentReferenceKeyImageEuImaging

Copyright/Legal: Copyright HL7 Europe. Licensed under Creative Commons public domain (CC0 1.0).

A document containing key images for a patient. It can refer to a DICOM or non-DICOM image. When referring to a DICOM image, the DocumentReference.content.attachment.url should be a WADO-URI. When referring to a non-DICOM image, the DocumentReference.content.attachment.url should be a direct URL to the image.

When the resource represents a DICOM instance it SHALL contain a the SOP Instance UID in the identifier element. When the resource represents a DICOM series it SHALL contain the Series Instance UID in the identifier element.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
.... identifier:seriesInstanceUid Σ 0..1 Identifier Business identifiers for the document
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... 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/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 00080018
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value ΣC 1..1 string The value that is unique
Example General: 123456
.... identifier:sopClassInstanceUid Σ 0..1 Identifier Business identifiers for the document
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... 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://dicom.nema.org/resources/ontology/DCM
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 112002
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value ΣC 1..1 string The value that is unique
Example General: 123456
... Slices for basedOn 0..* Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) Procedure that caused this media to be created
Slice: Unordered, Open by type:$this
.... basedOn:ServiceRequestOrderEuImagingaccession 0..1 Reference(ServiceRequest: Imaging Order) Procedure that caused this media to be created
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... identifier ΣC 1..1 AccessionNumberIdentifierEuImaging Logical reference, when literal reference is not known
... status ?!Σ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
... modality Σ 1..1 CodeableConcept Imaging modality used
Binding: Modality (extensible): Type of acquired data in the instance.
... Slices for category Σ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by profile:$this
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
.... category:imkeyimages Σ 1..1 CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
..... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:$this
...... coding:keyimagecode 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: 55113-5
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
... subject Σ 1..1 Reference(Patient (EU core)) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... Slices for author Σ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
Slice: Unordered, Open by profile:$this
.... author:performer Σ 0..* Reference(PractitionerRole (EU core)) Who and/or what authored the document
... Slices for content Σ 1..* BackboneElement Document referenced
Slice: Unordered, Open by value:extension.value
.... content:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
.... content:thumbnail Σ 0..1 BackboneElement Document referenced
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
....... value[x] 1..1 boolean Value of extension
Required Pattern: true
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
.... content:content Σ 1..1 BackboneElement Document referenced
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
....... value[x] 1..1 boolean Value of extension
Required Pattern: false
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
...... url Σ 1..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.identifier:seriesInstanceUid.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:seriesInstanceUid.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.identifier:sopClassInstanceUid.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:sopClassInstanceUid.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.modality Base extensible Modality 📦2025.2.20250411 DICOM v2025b
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.category:imkeyimages Base example Referenced Item Category Value Set 📍5.0.0 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().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 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()
docRef-1 warning DocumentReference facilityType SHALL only be present if context is not an encounter facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2 warning DocumentReference practiceSetting SHALL only be present if context is not present practiceSetting.empty() or context.where(resolve() is Encounter).empty()
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()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... Slices for identifier 0..* Identifier Business identifiers for the document
Slice: Unordered, Open by value:$this
.... identifier:seriesInstanceUid 0..1 Identifier Business identifiers for the document
..... type 1..1 CodeableConcept Description of identifier
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.eu/fhir/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 00080018
..... system 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value 1..1 string The value that is unique
.... identifier:sopClassInstanceUid 0..1 Identifier Business identifiers for the document
..... type 1..1 CodeableConcept Description of identifier
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://dicom.nema.org/resources/ontology/DCM
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 112002
..... system 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value 1..1 string The value that is unique
... Slices for basedOn 0..* Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) Procedure that caused this media to be created
Slice: Unordered, Open by type:$this
.... basedOn:ServiceRequestOrderEuImagingaccession 0..1 Reference(ServiceRequest: Imaging Order) Procedure that caused this media to be created
..... identifier 1..1 AccessionNumberIdentifierEuImaging Logical reference, when literal reference is not known
... modality 1..1 CodeableConcept Imaging modality used
.... category:imkeyimages 1..1 CodeableConcept Categorization of document
..... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:$this
...... coding:keyimagecode 1..1 Coding Code defined by a terminology system
Required Pattern: At least the following
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 55113-5
... subject 1..1 Reference(Patient (EU core)) Who/what is the subject of the document
... Slices for author 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
Slice: Unordered, Open by profile:$this
.... author:performer 0..* Reference(PractitionerRole (EU core)) Who and/or what authored the document
... Slices for content 1..* BackboneElement Document referenced
Slice: Unordered, Open by value:extension.value
.... content:thumbnail 0..1 BackboneElement Document referenced
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... value[x] 1..1 boolean Value of extension
Required Pattern: true
.... content:content 1..1 BackboneElement Document referenced
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... value[x] 1..1 boolean Value of extension
Required Pattern: false
..... attachment
...... url 1..1 url Uri where the data can be found

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... 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: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business identifiers for the document
Slice: Unordered, Open by value:$this
.... identifier:seriesInstanceUid Σ 0..1 Identifier Business identifiers for the document
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... 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/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 00080018
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value ΣC 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:sopClassInstanceUid Σ 0..1 Identifier Business identifiers for the document
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... 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://dicom.nema.org/resources/ontology/DCM
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 112002
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value ΣC 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... version Σ 0..1 string An explicitly assigned identifer of a variation of the content in the DocumentReference
... Slices for basedOn 0..* Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) Procedure that caused this media to be created
Slice: Unordered, Open by type:$this
.... basedOn:ServiceRequestOrderEuImagingaccession 0..1 Reference(ServiceRequest: Imaging Order) Procedure that caused this media to be created
..... id 0..1 id 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") - must be a resource in resources
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier ΣC 1..1 AccessionNumberIdentifierEuImaging Logical reference, when literal reference is not known
..... display ΣC 0..1 string Text alternative for the resource
... status ?!Σ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
... docStatus Σ 0..1 code registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown
Binding: CompositionStatus (required): Status of the underlying document.
... modality Σ 1..1 CodeableConcept Imaging modality used
Binding: Modality (extensible): Type of acquired data in the instance.
... type Σ 0..1 CodeableConcept Kind of document (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
... Slices for category Σ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by profile:$this
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
.... category:imkeyimages Σ 1..1 CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:$this
...... coding:keyimagecode 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: 55113-5
....... 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 Σ 1..1 Reference(Patient (EU core)) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... event 0..* CodeableReference() Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
... bodySite Σ 0..* CodeableReference(BodyStructure) Body part included
Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
... facilityType C 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
... practiceSetting C 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty)
Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
... period Σ 0..1 Period Time of service that is being documented
... date Σ 0..1 instant When this document reference was created
... Slices for author Σ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
Slice: Unordered, Open by profile:$this
.... author:performer Σ 0..* Reference(PractitionerRole (EU core)) Who and/or what authored the document
... attester 0..* BackboneElement Attests to accuracy of the 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
.... mode 1..1 CodeableConcept personal | professional | legal | official
Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
.... time 0..1 dateTime When the document was attested
.... party 0..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the document
... custodian 0..1 Reference(Organization) Organization which maintains the document
... relatesTo Σ 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 CodeableConcept The relationship type with another document
Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 markdown Human-readable description
... securityLabel Σ 0..* CodeableConcept Document security-tags
Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
... Slices for content Σ 1..* BackboneElement Document referenced
Slice: Unordered, Open by value:extension.value
.... content:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
..... profile Σ 0..* BackboneElement Content profile rules for the 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
...... value[x] Σ 1..1 Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
....... valueCoding Coding
....... valueUri uri
....... valueCanonical canonical(Any)
.... content:thumbnail Σ 0..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:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... id 0..1 id Unique id for inter-element referencing
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
....... value[x] 1..1 boolean Value of extension
Required Pattern: true
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
..... profile Σ 0..* BackboneElement Content profile rules for the 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
...... value[x] Σ 1..1 Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
....... valueCoding Coding
....... valueUri uri
....... valueCanonical canonical(Any)
.... content: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:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... id 0..1 id Unique id for inter-element referencing
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
....... value[x] 1..1 boolean Value of extension
Required Pattern: false
..... 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 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... contentType ΣC 0..1 code Mime type of the content, with charset etc.
Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Example General: text/plain; charset=UTF-8, image/png
...... language Σ 0..1 code Human language of the content (BCP-47)
Binding: AllLanguages (required): IETF language tag for a human language.
Additional BindingsPurpose
CommonLanguages Starter

Example General: en-AU
...... data C 0..1 base64Binary Data inline, base64ed
...... 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 integer64 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 Σ 0..1 dateTime Date attachment was first created
...... height 0..1 positiveInt Height of the image in pixels (photo/video)
...... width 0..1 positiveInt Width of the image in pixels (photo/video)
...... frames 0..1 positiveInt Number of frames if > 1 (photo)
...... duration 0..1 decimal Length in seconds (audio / video)
...... pages 0..1 positiveInt Number of printed pages
..... profile Σ 0..* BackboneElement Content profile rules for the 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
...... value[x] Σ 1..1 Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
....... valueCoding Coding
....... valueUri uri
....... valueCanonical canonical(Any)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.identifier:seriesInstanceUid.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:seriesInstanceUid.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.identifier:sopClassInstanceUid.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:sopClassInstanceUid.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.basedOn:ServiceRequestOrderEuImagingaccession.​type Base extensible Resource Types 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.docStatus Base required Composition Status 📍5.0.0 FHIR Std.
DocumentReference.modality Base extensible Modality 📦2025.2.20250411 DICOM v2025b
DocumentReference.type Base preferred FHIR Document Type Codes 📍5.0.0 FHIR Std.
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.category:imkeyimages Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.event Base example v3 Code System ActCode 📦3.0.0 THO v6.5
DocumentReference.bodySite Base example SNOMED CT Body Structures 📍5.0.0 FHIR Std.
DocumentReference.facilityType Base example Facility Type Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.practiceSetting Base example Practice Setting Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.attester.​mode Base preferred Composition Attestation Mode 📍5.0.0 FHIR Std.
DocumentReference.relatesTo.​code Base extensible Document Relationship Type 📍5.0.0 FHIR Std.
DocumentReference.securityLabel Base example Example set of Security Labels 📍5.0.0 FHIR Std.
DocumentReference.content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.content:thumbnail.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.content:content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.
DocumentReference.content:content.​attachment.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.content:content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

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().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 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()
docRef-1 warning DocumentReference facilityType SHALL only be present if context is not an encounter facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2 warning DocumentReference practiceSetting SHALL only be present if context is not present practiceSetting.empty() or context.where(resolve() is Encounter).empty()
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(9 nested mandatory elements)

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of DocumentReference.identifier
  • The element 1 is sliced based on the value of DocumentReference.basedOn
  • The element 1 is sliced based on the value of DocumentReference.category
  • The element 1 is sliced based on the value of DocumentReference.category.coding
  • The element 1 is sliced based on the value of DocumentReference.author
  • The element 1 is sliced based on the value of DocumentReference.content

Maturity: 1

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
.... identifier:seriesInstanceUid Σ 0..1 Identifier Business identifiers for the document
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... 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/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 00080018
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value ΣC 1..1 string The value that is unique
Example General: 123456
.... identifier:sopClassInstanceUid Σ 0..1 Identifier Business identifiers for the document
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... 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://dicom.nema.org/resources/ontology/DCM
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 112002
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value ΣC 1..1 string The value that is unique
Example General: 123456
... Slices for basedOn 0..* Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) Procedure that caused this media to be created
Slice: Unordered, Open by type:$this
.... basedOn:ServiceRequestOrderEuImagingaccession 0..1 Reference(ServiceRequest: Imaging Order) Procedure that caused this media to be created
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... identifier ΣC 1..1 AccessionNumberIdentifierEuImaging Logical reference, when literal reference is not known
... status ?!Σ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
... modality Σ 1..1 CodeableConcept Imaging modality used
Binding: Modality (extensible): Type of acquired data in the instance.
... Slices for category Σ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by profile:$this
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
.... category:imkeyimages Σ 1..1 CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
..... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:$this
...... coding:keyimagecode 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: 55113-5
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
... subject Σ 1..1 Reference(Patient (EU core)) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... Slices for author Σ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
Slice: Unordered, Open by profile:$this
.... author:performer Σ 0..* Reference(PractitionerRole (EU core)) Who and/or what authored the document
... Slices for content Σ 1..* BackboneElement Document referenced
Slice: Unordered, Open by value:extension.value
.... content:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
.... content:thumbnail Σ 0..1 BackboneElement Document referenced
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
....... value[x] 1..1 boolean Value of extension
Required Pattern: true
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
.... content:content Σ 1..1 BackboneElement Document referenced
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
....... value[x] 1..1 boolean Value of extension
Required Pattern: false
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
...... url Σ 1..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.identifier:seriesInstanceUid.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:seriesInstanceUid.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.identifier:sopClassInstanceUid.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:sopClassInstanceUid.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.modality Base extensible Modality 📦2025.2.20250411 DICOM v2025b
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.category:imkeyimages Base example Referenced Item Category Value Set 📍5.0.0 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().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 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()
docRef-1 warning DocumentReference facilityType SHALL only be present if context is not an encounter facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2 warning DocumentReference practiceSetting SHALL only be present if context is not present practiceSetting.empty() or context.where(resolve() is Encounter).empty()
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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... Slices for identifier 0..* Identifier Business identifiers for the document
Slice: Unordered, Open by value:$this
.... identifier:seriesInstanceUid 0..1 Identifier Business identifiers for the document
..... type 1..1 CodeableConcept Description of identifier
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.eu/fhir/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 00080018
..... system 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value 1..1 string The value that is unique
.... identifier:sopClassInstanceUid 0..1 Identifier Business identifiers for the document
..... type 1..1 CodeableConcept Description of identifier
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://dicom.nema.org/resources/ontology/DCM
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 112002
..... system 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value 1..1 string The value that is unique
... Slices for basedOn 0..* Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) Procedure that caused this media to be created
Slice: Unordered, Open by type:$this
.... basedOn:ServiceRequestOrderEuImagingaccession 0..1 Reference(ServiceRequest: Imaging Order) Procedure that caused this media to be created
..... identifier 1..1 AccessionNumberIdentifierEuImaging Logical reference, when literal reference is not known
... modality 1..1 CodeableConcept Imaging modality used
.... category:imkeyimages 1..1 CodeableConcept Categorization of document
..... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:$this
...... coding:keyimagecode 1..1 Coding Code defined by a terminology system
Required Pattern: At least the following
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 55113-5
... subject 1..1 Reference(Patient (EU core)) Who/what is the subject of the document
... Slices for author 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
Slice: Unordered, Open by profile:$this
.... author:performer 0..* Reference(PractitionerRole (EU core)) Who and/or what authored the document
... Slices for content 1..* BackboneElement Document referenced
Slice: Unordered, Open by value:extension.value
.... content:thumbnail 0..1 BackboneElement Document referenced
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... value[x] 1..1 boolean Value of extension
Required Pattern: true
.... content:content 1..1 BackboneElement Document referenced
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... value[x] 1..1 boolean Value of extension
Required Pattern: false
..... attachment
...... url 1..1 url Uri where the data can be found

doco Documentation for this format

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... 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: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business identifiers for the document
Slice: Unordered, Open by value:$this
.... identifier:seriesInstanceUid Σ 0..1 Identifier Business identifiers for the document
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... 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/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 00080018
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value ΣC 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:sopClassInstanceUid Σ 0..1 Identifier Business identifiers for the document
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... 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://dicom.nema.org/resources/ontology/DCM
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 112002
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:ietf:rfc:3986
..... value ΣC 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... version Σ 0..1 string An explicitly assigned identifer of a variation of the content in the DocumentReference
... Slices for basedOn 0..* Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) Procedure that caused this media to be created
Slice: Unordered, Open by type:$this
.... basedOn:ServiceRequestOrderEuImagingaccession 0..1 Reference(ServiceRequest: Imaging Order) Procedure that caused this media to be created
..... id 0..1 id 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") - must be a resource in resources
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier ΣC 1..1 AccessionNumberIdentifierEuImaging Logical reference, when literal reference is not known
..... display ΣC 0..1 string Text alternative for the resource
... status ?!Σ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
... docStatus Σ 0..1 code registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown
Binding: CompositionStatus (required): Status of the underlying document.
... modality Σ 1..1 CodeableConcept Imaging modality used
Binding: Modality (extensible): Type of acquired data in the instance.
... type Σ 0..1 CodeableConcept Kind of document (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
... Slices for category Σ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by profile:$this
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
.... category:imkeyimages Σ 1..1 CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:$this
...... coding:keyimagecode 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: 55113-5
....... 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 Σ 1..1 Reference(Patient (EU core)) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... event 0..* CodeableReference() Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
... bodySite Σ 0..* CodeableReference(BodyStructure) Body part included
Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
... facilityType C 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
... practiceSetting C 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty)
Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
... period Σ 0..1 Period Time of service that is being documented
... date Σ 0..1 instant When this document reference was created
... Slices for author Σ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) Who and/or what authored the document
Slice: Unordered, Open by profile:$this
.... author:performer Σ 0..* Reference(PractitionerRole (EU core)) Who and/or what authored the document
... attester 0..* BackboneElement Attests to accuracy of the 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
.... mode 1..1 CodeableConcept personal | professional | legal | official
Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
.... time 0..1 dateTime When the document was attested
.... party 0..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the document
... custodian 0..1 Reference(Organization) Organization which maintains the document
... relatesTo Σ 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 CodeableConcept The relationship type with another document
Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 markdown Human-readable description
... securityLabel Σ 0..* CodeableConcept Document security-tags
Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
... Slices for content Σ 1..* BackboneElement Document referenced
Slice: Unordered, Open by value:extension.value
.... content:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
..... profile Σ 0..* BackboneElement Content profile rules for the 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
...... value[x] Σ 1..1 Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
....... valueCoding Coding
....... valueUri uri
....... valueCanonical canonical(Any)
.... content:thumbnail Σ 0..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:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... id 0..1 id Unique id for inter-element referencing
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
....... value[x] 1..1 boolean Value of extension
Required Pattern: true
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... attachment Σ 1..1 Attachment Where to access the document
..... profile Σ 0..* BackboneElement Content profile rules for the 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
...... value[x] Σ 1..1 Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
....... valueCoding Coding
....... valueUri uri
....... valueCanonical canonical(Any)
.... content: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:thumbnail 1..1 (Complex) Thumbnail state
URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
....... id 0..1 id Unique id for inter-element referencing
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
....... value[x] 1..1 boolean Value of extension
Required Pattern: false
..... 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 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... contentType ΣC 0..1 code Mime type of the content, with charset etc.
Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Example General: text/plain; charset=UTF-8, image/png
...... language Σ 0..1 code Human language of the content (BCP-47)
Binding: AllLanguages (required): IETF language tag for a human language.
Additional BindingsPurpose
CommonLanguages Starter

Example General: en-AU
...... data C 0..1 base64Binary Data inline, base64ed
...... 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 integer64 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 Σ 0..1 dateTime Date attachment was first created
...... height 0..1 positiveInt Height of the image in pixels (photo/video)
...... width 0..1 positiveInt Width of the image in pixels (photo/video)
...... frames 0..1 positiveInt Number of frames if > 1 (photo)
...... duration 0..1 decimal Length in seconds (audio / video)
...... pages 0..1 positiveInt Number of printed pages
..... profile Σ 0..* BackboneElement Content profile rules for the 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
...... value[x] Σ 1..1 Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
....... valueCoding Coding
....... valueUri uri
....... valueCanonical canonical(Any)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.identifier:seriesInstanceUid.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:seriesInstanceUid.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.identifier:sopClassInstanceUid.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
DocumentReference.identifier:sopClassInstanceUid.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
DocumentReference.basedOn:ServiceRequestOrderEuImagingaccession.​type Base extensible Resource Types 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.docStatus Base required Composition Status 📍5.0.0 FHIR Std.
DocumentReference.modality Base extensible Modality 📦2025.2.20250411 DICOM v2025b
DocumentReference.type Base preferred FHIR Document Type Codes 📍5.0.0 FHIR Std.
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.category:imkeyimages Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.event Base example v3 Code System ActCode 📦3.0.0 THO v6.5
DocumentReference.bodySite Base example SNOMED CT Body Structures 📍5.0.0 FHIR Std.
DocumentReference.facilityType Base example Facility Type Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.practiceSetting Base example Practice Setting Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.attester.​mode Base preferred Composition Attestation Mode 📍5.0.0 FHIR Std.
DocumentReference.relatesTo.​code Base extensible Document Relationship Type 📍5.0.0 FHIR Std.
DocumentReference.securityLabel Base example Example set of Security Labels 📍5.0.0 FHIR Std.
DocumentReference.content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.content:thumbnail.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.content:content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.
DocumentReference.content:content.​attachment.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.content:content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

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().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 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()
docRef-1 warning DocumentReference facilityType SHALL only be present if context is not an encounter facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2 warning DocumentReference practiceSetting SHALL only be present if context is not present practiceSetting.empty() or context.where(resolve() is Encounter).empty()
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(9 nested mandatory elements)

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of DocumentReference.identifier
  • The element 1 is sliced based on the value of DocumentReference.basedOn
  • The element 1 is sliced based on the value of DocumentReference.category
  • The element 1 is sliced based on the value of DocumentReference.category.coding
  • The element 1 is sliced based on the value of DocumentReference.author
  • The element 1 is sliced based on the value of DocumentReference.content

Maturity: 1

 

Other representations of profile: CSV, Excel, Schematron