Represents a key image for a patient as image content in a DocumentReference. Use this profile to include or directly link the image (DICOM or non-DICOM); use ImagingSelectionKeyImageEuImaging when the key image is identified using DICOM selection data.

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 artifact it SHALL contain the applicable DICOM identifier in the identifier element: the SOP Instance UID for a DICOM instance, the Series Instance UID for a DICOM series, and/or the Study Instance UID for a DICOM study. Such a resource MAY also reference an ImagingSelectionKeyImageEuImaging to indicate the DICOM source.

A key image is an image, or a specific frame within an image, that the imaging clinician has selected as particularly relevant to the report — for example an image that best demonstrates a finding, supports the impression, or is useful for comparison and follow-up. In radiology a study can contain hundreds or thousands of instances, so flagging key images helps the referring physician and other readers quickly locate the most significant images. In DICOM, key images are typically captured using a Key Object Selection (KOS) document, described by Key Object Selection, TID 2010 in DICOM PS3.16.

Representation of Key Images

Key images can be represented either as image content or as a reference to DICOM selection data:

• DocumentReference (DocumentReferenceKeyImageEuImaging) — the key image as image content.
• ImagingSelection (ImagingSelectionKeyImageEuImaging) — the key image identified using DICOM selection data.

ImagingSelection is more DICOM oriented and relates to DICOM identifiers. DocumentReference represents the image content and contains information such as its size, format and duration. The eHN Imaging Studies and Reports guidelines requires information on the size, format and duration; these data elements are provided by the Attachment in DocumentReference.content.attachment.

This IG uses DocumentReference in R5 for image content, and ImagingSelection when the key image is identified using DICOM selection data (for example, to state that an image can come from a Procedure Phase).

The ImagingSelection resource points to DICOM data. The DICOM instance data also holds the data required by the eHN Imaging Studies and Reports, so the client can retrieve the information from the DICOM source data. Access to the imaging data can be direct or through a web based image viewer; a scenario supported by ImagingSelection requires access to the DICOM identifiers and a WADO endpoint.

DocumentReference resources refer to the image data directly, either by including it in the Attachment or by linking to it. The report may also refer to key images such as charts or PDFs that are not stored in a DICOM PACS; DocumentReference supports this case.

Key images can be represented by ImagingSelection or DocumentReference resources. When using DocumentReference to represent a DICOM artifact, it carries an identifier corresponding to the SOP instance, series or study it represents. In the case of ImagingSelection these values are represented as fields in the resource.

One or more DICOM identifier codes used by this profile come from the temporary MissingDicomTerminology CodeSystem and must be replaced with the equivalents defined by the DICOM terminology IG once it is published.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: docRef-1, docRef-2
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.Slices for identifier	Σ This element is included in summaries.	0..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for identifier.identifier:seriesInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:studyInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:studyInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 110180
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:studyInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.Slices for identifier.identifier:studyInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
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:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession		0..1	Reference(ServiceRequest: Imaging Order)	Procedure that caused this media to be created
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.identifier	Σ This element is included in summaries. C	0..1	AccessionNumberIdentifierEuImaging	Logical reference, when literal reference is not known
DocumentReference.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
DocumentReference.modality	Σ This element is included in summaries.	1..1	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
DocumentReference.type	Σ This element is included in summaries.	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Image Reference Type (preferred)
DocumentReference.Slices for category	Σ This element is included in summaries.	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages	Σ This element is included in summaries.	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
DocumentReference.Slices for category.category:imkeyimages.Slices for coding	Σ This element is included in summaries.	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages.Slices for coding				Content/Rules for all slices
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.display		0..1	string	Representation defined by the system
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.subject	Σ This element is included in summaries.	1..1	Reference(Patient (EU core))	Who/what is the subject of the document
DocumentReference.context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
DocumentReference.Slices for author	Σ This element is included in summaries.	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:performer	Σ This element is included in summaries.	0..*	Reference(PractitionerRole (EU core))	Who and/or what authored the document
DocumentReference.Slices for content	Σ This element is included in summaries.	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.value Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:All Slices				Content/Rules for all slices
DocumentReference.Slices for content.content:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:All Slices.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:thumbnail	Σ This element is included in summaries.	0..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:thumbnail.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:thumbnail.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.extension		0..0		Extension Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: true
DocumentReference.Slices for content.content:thumbnail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:thumbnail.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:content	Σ This element is included in summaries.	1..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:content.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:content.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.extension		0..0		Extension Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: false
DocumentReference.Slices for content.content:content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:content.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:content.attachment.url	Σ This element is included in summaries.	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
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.identifier:studyInstanceUid.​use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
DocumentReference.identifier:studyInstanceUid.​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	📦2025.3.20250714	DICOM v2025c
DocumentReference.type	Base	preferred	Image Reference Type	📦1.0.0	THO v7.1
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()

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.Slices for identifier		0..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for identifier.identifier:seriesInstanceUid		0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type		1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.system		1..1	uri	The namespace for the identifier value
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.value		1..1	string	The value that is unique
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid		0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type		1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.system		1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.value		1..1	string	The value that is unique
DocumentReference.Slices for identifier.identifier:studyInstanceUid		0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type		1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 110180
DocumentReference.Slices for identifier.identifier:studyInstanceUid.system		1..1	uri	The namespace for the identifier value
DocumentReference.Slices for identifier.identifier:studyInstanceUid.value		1..1	string	The value that is unique
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:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession		0..1	Reference(ServiceRequest: Imaging Order)	Procedure that caused this media to be created
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.identifier		0..1	AccessionNumberIdentifierEuImaging	Logical reference, when literal reference is not known
DocumentReference.modality		1..1	CodeableConcept	Imaging modality used
DocumentReference.type		0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Image Reference Type (preferred)
DocumentReference.Slices for category		1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages		1..1	CodeableConcept	Categorization of document
DocumentReference.Slices for category.category:imkeyimages.Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages.Slices for coding				Content/Rules for all slices
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode		1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
DocumentReference.subject		1..1	Reference(Patient (EU core))	Who/what is the subject of the document
DocumentReference.Slices for author		0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:performer		0..*	Reference(PractitionerRole (EU core))	Who and/or what authored the document
DocumentReference.Slices for content		1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.value Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:thumbnail		0..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:thumbnail.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:thumbnail.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: true
DocumentReference.Slices for content.content:content		1..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:content.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:content.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: false
DocumentReference.Slices for content.content:content.attachment
DocumentReference.Slices for content.content:content.attachment.url		1..1	url	Uri where the data can be found
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.type	Base	preferred	Image Reference Type	📦1.0.0	THO v7.1

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: docRef-1, docRef-2
DocumentReference.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
DocumentReference.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
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.Slices for identifier	Σ This element is included in summaries.	0..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for identifier.identifier:seriesInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
DocumentReference.Slices for identifier.identifier:studyInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:studyInstanceUid.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for identifier.identifier:studyInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 110180
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:studyInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.Slices for identifier.identifier:studyInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:studyInstanceUid.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
DocumentReference.Slices for identifier.identifier:studyInstanceUid.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
DocumentReference.version	Σ This element is included in summaries.	0..1	string	An explicitly assigned identifer of a variation of the content in the DocumentReference
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 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession		0..1	Reference(ServiceRequest: Imaging Order)	Procedure that caused this media to be created
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.type	Σ This element is included in summaries.	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).
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.identifier	Σ This element is included in summaries. C	0..1	AccessionNumberIdentifierEuImaging	Logical reference, when literal reference is not known
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.display	Σ This element is included in summaries. C	0..1	string	Text alternative for the resource
DocumentReference.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
DocumentReference.docStatus	Σ This element is included in summaries.	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
DocumentReference.modality	Σ This element is included in summaries.	1..1	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
DocumentReference.type	Σ This element is included in summaries.	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Image Reference Type (preferred)
DocumentReference.Slices for category	Σ This element is included in summaries.	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages	Σ This element is included in summaries.	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
DocumentReference.Slices for category.category:imkeyimages.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for category.category:imkeyimages.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for category.category:imkeyimages.Slices for coding	Σ This element is included in summaries.	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages.Slices for coding				Content/Rules for all slices
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.display		0..1	string	Representation defined by the system
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for category.category:imkeyimages.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
DocumentReference.subject	Σ This element is included in summaries.	1..1	Reference(Patient (EU core))	Who/what is the subject of the document
DocumentReference.context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
DocumentReference.event		0..*	CodeableReference()	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
DocumentReference.bodySite	Σ This element is included in summaries.	0..*	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
DocumentReference.facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
DocumentReference.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).
DocumentReference.period	Σ This element is included in summaries.	0..1	Period	Time of service that is being documented
DocumentReference.date	Σ This element is included in summaries.	0..1	instant	When this document reference was created
DocumentReference.Slices for author	Σ This element is included in summaries.	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:performer	Σ This element is included in summaries.	0..*	Reference(PractitionerRole (EU core))	Who and/or what authored the document
DocumentReference.attester		0..*	BackboneElement	Attests to accuracy of the document
DocumentReference.attester.id		0..1	string	Unique id for inter-element referencing
DocumentReference.attester.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.attester.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.attester.mode		1..1	CodeableConcept	personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
DocumentReference.attester.time		0..1	dateTime	When the document was attested
DocumentReference.attester.party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the document
DocumentReference.custodian		0..1	Reference(Organization)	Organization which maintains the document
DocumentReference.relatesTo	Σ This element is included in summaries.	0..*	BackboneElement	Relationships to other documents
DocumentReference.relatesTo.id		0..1	string	Unique id for inter-element referencing
DocumentReference.relatesTo.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.relatesTo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.relatesTo.code	Σ This element is included in summaries.	1..1	CodeableConcept	The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
DocumentReference.relatesTo.target	Σ This element is included in summaries.	1..1	Reference(DocumentReference)	Target of the relationship
DocumentReference.description	Σ This element is included in summaries.	0..1	markdown	Human-readable description
DocumentReference.securityLabel	Σ This element is included in summaries.	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
DocumentReference.Slices for content	Σ This element is included in summaries.	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.value Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:All Slices				Content/Rules for all slices
DocumentReference.Slices for content.content:All Slices.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:All Slices.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for content.content:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:All Slices.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:All Slices.profile	Σ This element is included in summaries.	0..*	BackboneElement	Content profile rules for the document
DocumentReference.Slices for content.content:All Slices.profile.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:All Slices.profile.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for content.content:All Slices.profile.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:All Slices.profile.value[x]	Σ This element is included in summaries.	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
DocumentReference.Slices for content.content:All Slices.profile.value[x].valueCoding			Coding
DocumentReference.Slices for content.content:All Slices.profile.value[x].valueUri			uri
DocumentReference.Slices for content.content:All Slices.profile.value[x].valueCanonical			canonical(Any)
DocumentReference.Slices for content.content:thumbnail	Σ This element is included in summaries.	0..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:thumbnail.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:thumbnail.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:thumbnail.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.extension		0..0		Extension Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: true
DocumentReference.Slices for content.content:thumbnail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:thumbnail.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:thumbnail.profile	Σ This element is included in summaries.	0..*	BackboneElement	Content profile rules for the document
DocumentReference.Slices for content.content:thumbnail.profile.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:thumbnail.profile.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for content.content:thumbnail.profile.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:thumbnail.profile.value[x]	Σ This element is included in summaries.	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
DocumentReference.Slices for content.content:thumbnail.profile.value[x].valueCoding			Coding
DocumentReference.Slices for content.content:thumbnail.profile.value[x].valueUri			uri
DocumentReference.Slices for content.content:thumbnail.profile.value[x].valueCanonical			canonical(Any)
DocumentReference.Slices for content.content:content	Σ This element is included in summaries.	1..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:content.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:content.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:content.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.extension		0..0		Extension Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: false
DocumentReference.Slices for content.content:content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:content.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:content.attachment.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for content.content:content.attachment.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:content.attachment.contentType	Σ This element is included in summaries. C	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
DocumentReference.Slices for content.content:content.attachment.language	Σ This element is included in summaries.	0..1	code	Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language. Additional Bindings Purpose CommonLanguages Starter Example General: en-AU
DocumentReference.Slices for content.content:content.attachment.data	C	0..1	base64Binary	Data inline, base64ed
DocumentReference.Slices for content.content:content.attachment.url	Σ This element is included in summaries.	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
DocumentReference.Slices for content.content:content.attachment.size	Σ This element is included in summaries.	0..1	integer64	Number of bytes of content (if url provided)
DocumentReference.Slices for content.content:content.attachment.hash	Σ This element is included in summaries.	0..1	base64Binary	Hash of the data (sha-1, base64ed)
DocumentReference.Slices for content.content:content.attachment.title	Σ This element is included in summaries.	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
DocumentReference.Slices for content.content:content.attachment.creation	Σ This element is included in summaries.	0..1	dateTime	Date attachment was first created
DocumentReference.Slices for content.content:content.attachment.height		0..1	positiveInt	Height of the image in pixels (photo/video)
DocumentReference.Slices for content.content:content.attachment.width		0..1	positiveInt	Width of the image in pixels (photo/video)
DocumentReference.Slices for content.content:content.attachment.frames		0..1	positiveInt	Number of frames if > 1 (photo)
DocumentReference.Slices for content.content:content.attachment.duration		0..1	decimal	Length in seconds (audio / video)
DocumentReference.Slices for content.content:content.attachment.pages		0..1	positiveInt	Number of printed pages
DocumentReference.Slices for content.content:content.profile	Σ This element is included in summaries.	0..*	BackboneElement	Content profile rules for the document
DocumentReference.Slices for content.content:content.profile.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:content.profile.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for content.content:content.profile.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:content.profile.value[x]	Σ This element is included in summaries.	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
DocumentReference.Slices for content.content:content.profile.value[x].valueCoding			Coding
DocumentReference.Slices for content.content:content.profile.value[x].valueUri			uri
DocumentReference.Slices for content.content:content.profile.value[x].valueCanonical			canonical(Any)
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.identifier:studyInstanceUid.​use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
DocumentReference.identifier:studyInstanceUid.​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	📦2025.3.20250714	DICOM v2025c
DocumentReference.type	Base	preferred	Image Reference Type	📦1.0.0	THO v7.1
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 v7.1
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 v7.1
DocumentReference.content:thumbnail.​profile.value[x]	Base	preferred	HL7 ValueSet of Format Codes for use with Document Sharing	📦2.1.0	THO v7.1
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 v7.1

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()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: docRef-1, docRef-2
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.Slices for identifier	Σ This element is included in summaries.	0..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for identifier.identifier:seriesInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:studyInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:studyInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 110180
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:studyInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.Slices for identifier.identifier:studyInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
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:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession		0..1	Reference(ServiceRequest: Imaging Order)	Procedure that caused this media to be created
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.identifier	Σ This element is included in summaries. C	0..1	AccessionNumberIdentifierEuImaging	Logical reference, when literal reference is not known
DocumentReference.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
DocumentReference.modality	Σ This element is included in summaries.	1..1	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
DocumentReference.type	Σ This element is included in summaries.	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Image Reference Type (preferred)
DocumentReference.Slices for category	Σ This element is included in summaries.	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages	Σ This element is included in summaries.	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
DocumentReference.Slices for category.category:imkeyimages.Slices for coding	Σ This element is included in summaries.	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages.Slices for coding				Content/Rules for all slices
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.display		0..1	string	Representation defined by the system
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.subject	Σ This element is included in summaries.	1..1	Reference(Patient (EU core))	Who/what is the subject of the document
DocumentReference.context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
DocumentReference.Slices for author	Σ This element is included in summaries.	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:performer	Σ This element is included in summaries.	0..*	Reference(PractitionerRole (EU core))	Who and/or what authored the document
DocumentReference.Slices for content	Σ This element is included in summaries.	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.value Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:All Slices				Content/Rules for all slices
DocumentReference.Slices for content.content:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:All Slices.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:thumbnail	Σ This element is included in summaries.	0..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:thumbnail.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:thumbnail.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.extension		0..0		Extension Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: true
DocumentReference.Slices for content.content:thumbnail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:thumbnail.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:content	Σ This element is included in summaries.	1..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:content.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:content.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.extension		0..0		Extension Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: false
DocumentReference.Slices for content.content:content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:content.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:content.attachment.url	Σ This element is included in summaries.	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
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.identifier:studyInstanceUid.​use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
DocumentReference.identifier:studyInstanceUid.​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	📦2025.3.20250714	DICOM v2025c
DocumentReference.type	Base	preferred	Image Reference Type	📦1.0.0	THO v7.1
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

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.Slices for identifier		0..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for identifier.identifier:seriesInstanceUid		0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type		1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.system		1..1	uri	The namespace for the identifier value
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.value		1..1	string	The value that is unique
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid		0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type		1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.system		1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.value		1..1	string	The value that is unique
DocumentReference.Slices for identifier.identifier:studyInstanceUid		0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type		1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 110180
DocumentReference.Slices for identifier.identifier:studyInstanceUid.system		1..1	uri	The namespace for the identifier value
DocumentReference.Slices for identifier.identifier:studyInstanceUid.value		1..1	string	The value that is unique
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:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession		0..1	Reference(ServiceRequest: Imaging Order)	Procedure that caused this media to be created
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.identifier		0..1	AccessionNumberIdentifierEuImaging	Logical reference, when literal reference is not known
DocumentReference.modality		1..1	CodeableConcept	Imaging modality used
DocumentReference.type		0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Image Reference Type (preferred)
DocumentReference.Slices for category		1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages		1..1	CodeableConcept	Categorization of document
DocumentReference.Slices for category.category:imkeyimages.Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages.Slices for coding				Content/Rules for all slices
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode		1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
DocumentReference.subject		1..1	Reference(Patient (EU core))	Who/what is the subject of the document
DocumentReference.Slices for author		0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:performer		0..*	Reference(PractitionerRole (EU core))	Who and/or what authored the document
DocumentReference.Slices for content		1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.value Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:thumbnail		0..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:thumbnail.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:thumbnail.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: true
DocumentReference.Slices for content.content:content		1..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:content.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:content.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: false
DocumentReference.Slices for content.content:content.attachment
DocumentReference.Slices for content.content:content.attachment.url		1..1	url	Uri where the data can be found
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.type	Base	preferred	Image Reference Type	📦1.0.0	THO v7.1

Snapshot ViewView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: docRef-1, docRef-2
DocumentReference.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
DocumentReference.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
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.Slices for identifier	Σ This element is included in summaries.	0..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for identifier.identifier:seriesInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
DocumentReference.Slices for identifier.identifier:seriesInstanceUid.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging-r5/CodeSystem/codesystem-missing-dicom-terminology
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
DocumentReference.Slices for identifier.identifier:sopClassInstanceUid.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
DocumentReference.Slices for identifier.identifier:studyInstanceUid	Σ This element is included in summaries.	0..1	Identifier	Business identifiers for the document
DocumentReference.Slices for identifier.identifier:studyInstanceUid.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for identifier.identifier:studyInstanceUid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type	Σ This element is included in summaries.	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
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 110180
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for identifier.identifier:studyInstanceUid.type.text		0..1	string	Plain text representation of the concept
DocumentReference.Slices for identifier.identifier:studyInstanceUid.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.Slices for identifier.identifier:studyInstanceUid.value	Σ This element is included in summaries. C	1..1	string	The value that is unique Example General: 123456
DocumentReference.Slices for identifier.identifier:studyInstanceUid.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
DocumentReference.Slices for identifier.identifier:studyInstanceUid.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
DocumentReference.version	Σ This element is included in summaries.	0..1	string	An explicitly assigned identifer of a variation of the content in the DocumentReference
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 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession		0..1	Reference(ServiceRequest: Imaging Order)	Procedure that caused this media to be created
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.type	Σ This element is included in summaries.	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).
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.identifier	Σ This element is included in summaries. C	0..1	AccessionNumberIdentifierEuImaging	Logical reference, when literal reference is not known
DocumentReference.Slices for basedOn.basedOn:ServiceRequestOrderEuImagingaccession.display	Σ This element is included in summaries. C	0..1	string	Text alternative for the resource
DocumentReference.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
DocumentReference.docStatus	Σ This element is included in summaries.	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
DocumentReference.modality	Σ This element is included in summaries.	1..1	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
DocumentReference.type	Σ This element is included in summaries.	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Image Reference Type (preferred)
DocumentReference.Slices for category	Σ This element is included in summaries.	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages	Σ This element is included in summaries.	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
DocumentReference.Slices for category.category:imkeyimages.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for category.category:imkeyimages.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for category.category:imkeyimages.Slices for coding	Σ This element is included in summaries.	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:imkeyimages.Slices for coding				Content/Rules for all slices
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.display		0..1	string	Representation defined by the system
DocumentReference.Slices for category.category:imkeyimages.Slices for coding.coding:keyimagecode.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for category.category:imkeyimages.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
DocumentReference.subject	Σ This element is included in summaries.	1..1	Reference(Patient (EU core))	Who/what is the subject of the document
DocumentReference.context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
DocumentReference.event		0..*	CodeableReference()	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
DocumentReference.bodySite	Σ This element is included in summaries.	0..*	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
DocumentReference.facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
DocumentReference.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).
DocumentReference.period	Σ This element is included in summaries.	0..1	Period	Time of service that is being documented
DocumentReference.date	Σ This element is included in summaries.	0..1	instant	When this document reference was created
DocumentReference.Slices for author	Σ This element is included in summaries.	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:performer	Σ This element is included in summaries.	0..*	Reference(PractitionerRole (EU core))	Who and/or what authored the document
DocumentReference.attester		0..*	BackboneElement	Attests to accuracy of the document
DocumentReference.attester.id		0..1	string	Unique id for inter-element referencing
DocumentReference.attester.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.attester.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.attester.mode		1..1	CodeableConcept	personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
DocumentReference.attester.time		0..1	dateTime	When the document was attested
DocumentReference.attester.party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the document
DocumentReference.custodian		0..1	Reference(Organization)	Organization which maintains the document
DocumentReference.relatesTo	Σ This element is included in summaries.	0..*	BackboneElement	Relationships to other documents
DocumentReference.relatesTo.id		0..1	string	Unique id for inter-element referencing
DocumentReference.relatesTo.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.relatesTo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.relatesTo.code	Σ This element is included in summaries.	1..1	CodeableConcept	The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
DocumentReference.relatesTo.target	Σ This element is included in summaries.	1..1	Reference(DocumentReference)	Target of the relationship
DocumentReference.description	Σ This element is included in summaries.	0..1	markdown	Human-readable description
DocumentReference.securityLabel	Σ This element is included in summaries.	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
DocumentReference.Slices for content	Σ This element is included in summaries.	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.value Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:All Slices				Content/Rules for all slices
DocumentReference.Slices for content.content:All Slices.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:All Slices.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for content.content:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:All Slices.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:All Slices.profile	Σ This element is included in summaries.	0..*	BackboneElement	Content profile rules for the document
DocumentReference.Slices for content.content:All Slices.profile.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:All Slices.profile.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for content.content:All Slices.profile.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:All Slices.profile.value[x]	Σ This element is included in summaries.	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
DocumentReference.Slices for content.content:All Slices.profile.value[x].valueCoding			Coding
DocumentReference.Slices for content.content:All Slices.profile.value[x].valueUri			uri
DocumentReference.Slices for content.content:All Slices.profile.value[x].valueCanonical			canonical(Any)
DocumentReference.Slices for content.content:thumbnail	Σ This element is included in summaries.	0..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:thumbnail.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:thumbnail.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:thumbnail.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.extension		0..0		Extension Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
DocumentReference.Slices for content.content:thumbnail.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: true
DocumentReference.Slices for content.content:thumbnail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:thumbnail.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:thumbnail.profile	Σ This element is included in summaries.	0..*	BackboneElement	Content profile rules for the document
DocumentReference.Slices for content.content:thumbnail.profile.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:thumbnail.profile.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for content.content:thumbnail.profile.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:thumbnail.profile.value[x]	Σ This element is included in summaries.	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
DocumentReference.Slices for content.content:thumbnail.profile.value[x].valueCoding			Coding
DocumentReference.Slices for content.content:thumbnail.profile.value[x].valueUri			uri
DocumentReference.Slices for content.content:thumbnail.profile.value[x].valueCanonical			canonical(Any)
DocumentReference.Slices for content.content:content	Σ This element is included in summaries.	1..1	BackboneElement	Document referenced
DocumentReference.Slices for content.content:content.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:content.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for content.content:content.Slices for extension				Content/Rules for all slices
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail		1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.extension		0..0		Extension Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
DocumentReference.Slices for content.content:content.Slices for extension.extension:thumbnail.value[x]		1..1	boolean	Value of extension Required Pattern: false
DocumentReference.Slices for content.content:content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:content.attachment	Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.Slices for content.content:content.attachment.id		0..1	id	Unique id for inter-element referencing
DocumentReference.Slices for content.content:content.attachment.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.Slices for content.content:content.attachment.contentType	Σ This element is included in summaries. C	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
DocumentReference.Slices for content.content:content.attachment.language	Σ This element is included in summaries.	0..1	code	Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language. Additional Bindings Purpose CommonLanguages Starter Example General: en-AU
DocumentReference.Slices for content.content:content.attachment.data	C	0..1	base64Binary	Data inline, base64ed
DocumentReference.Slices for content.content:content.attachment.url	Σ This element is included in summaries.	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
DocumentReference.Slices for content.content:content.attachment.size	Σ This element is included in summaries.	0..1	integer64	Number of bytes of content (if url provided)
DocumentReference.Slices for content.content:content.attachment.hash	Σ This element is included in summaries.	0..1	base64Binary	Hash of the data (sha-1, base64ed)
DocumentReference.Slices for content.content:content.attachment.title	Σ This element is included in summaries.	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
DocumentReference.Slices for content.content:content.attachment.creation	Σ This element is included in summaries.	0..1	dateTime	Date attachment was first created
DocumentReference.Slices for content.content:content.attachment.height		0..1	positiveInt	Height of the image in pixels (photo/video)
DocumentReference.Slices for content.content:content.attachment.width		0..1	positiveInt	Width of the image in pixels (photo/video)
DocumentReference.Slices for content.content:content.attachment.frames		0..1	positiveInt	Number of frames if > 1 (photo)
DocumentReference.Slices for content.content:content.attachment.duration		0..1	decimal	Length in seconds (audio / video)
DocumentReference.Slices for content.content:content.attachment.pages		0..1	positiveInt	Number of printed pages
DocumentReference.Slices for content.content:content.profile	Σ This element is included in summaries.	0..*	BackboneElement	Content profile rules for the document
DocumentReference.Slices for content.content:content.profile.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for content.content:content.profile.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for content.content:content.profile.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.Slices for content.content:content.profile.value[x]	Σ This element is included in summaries.	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
DocumentReference.Slices for content.content:content.profile.value[x].valueCoding			Coding
DocumentReference.Slices for content.content:content.profile.value[x].valueUri			uri
DocumentReference.Slices for content.content:content.profile.value[x].valueCanonical			canonical(Any)
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.identifier:studyInstanceUid.​use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
DocumentReference.identifier:studyInstanceUid.​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	📦2025.3.20250714	DICOM v2025c
DocumentReference.type	Base	preferred	Image Reference Type	📦1.0.0	THO v7.1
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 v7.1
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 v7.1
DocumentReference.content:thumbnail.​profile.value[x]	Base	preferred	HL7 ValueSet of Format Codes for use with Document Sharing	📦2.1.0	THO v7.1
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 v7.1

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()

This structure is derived from DocumentReference

Summary

Mandatory: 10 elements(11 nested mandatory elements)

Structures

This structure refers to these other structures:

• ServiceRequest: Imaging Order (http://hl7.eu/fhir/imaging-r5/StructureDefinition/ServiceRequestOrderEuImaging)
• Identifier: Accession Number (http://hl7.eu/fhir/imaging-r5/StructureDefinition/AccessionNumberIdentifierEuImaging)
• Patient (EU core) (http://hl7.eu/fhir/base-r5/StructureDefinition/patient-eu-core)
• PractitionerRole (EU core) (http://hl7.eu/fhir/base-r5/StructureDefinition/practitionerRole-eu-core)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail

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