HL7 Europe Imaging Study Report
0.1.1-build - ci-build 150

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

Resource Profile: ImDiagnosticReport - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the ImDiagnosticReport resource profile.

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

0. DiagnosticReport
Definition

The findings and interpretation of diagnostic tests performed on patients, groups of patients, products, substances, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports. The report also includes non-clinical context such as batch analysis and stability reporting of products and substances.

ShortA Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
Comments

This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate NamesReport, Test, Result, Results, Labs, Laboratory
Invariantsdgr-1: When a Composition is referenced in `Diagnostic.composition`, all Observation resources referenced in `Composition.entry` must also be referenced in `Diagnostic.entry` or in the references Observations in `Observation.hasMember` (composition.exists() implies (composition.resolve().section.entry.reference.where(resolve() is Observation) in (result.reference|result.reference.resolve().hasMember.reference)))
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. DiagnosticReport.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. DiagnosticReport.contained
Definition

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

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

Control0..*
This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
TypeResource
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
6. DiagnosticReport.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on DiagnosticReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. DiagnosticReport.extension:artifactVersion
    Slice NameartifactVersion
    Definition

    The identifier that is used to identify this version of the artifact when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the artifact author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.

    ShortBusiness version of the artifact
    Control0..1
    TypeExtension(ArtifactVersion) (Extension Type: string)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. DiagnosticReport.extension:comparison
    Slice Namecomparison
    Definition

    Studies used for comparison in part of diagnostic reporting.

    ShortComparison studies
    Control0..*
    TypeExtension(HL7IDR DiagnosticReport Comparison Study) (Extension Type: Reference(ImagingStudy: General, ImagingSelection))
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. DiagnosticReport.extension:patientHistory
    Slice NamepatientHistory
    Definition

    May have originally been extracted from the medical record by imaging staff, automated tools, or by the radiologists themselves.

    ShortPatient history items selected by radiologist
    Control0..*
    TypeExtension(HL7IDR Patient History) (Extension Type: Reference)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    14. DiagnosticReport.extension:procedure
    Slice Nameprocedure
    Definition

    Imaging procedure used to acquire the study.

    ShortImaging procedure
    Control0..*
    TypeExtension(HL7IDR Imaging Procedure) (Extension Type: Reference(Procedure: Imaging Acquisition))
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    16. DiagnosticReport.extension:finding
    Slice Namefinding
    Definition

    Key images in the report

    ShortKey image findings
    Control0..*
    TypeExtension(HL7IDR Impression) (Extension Type: Reference(DocumentReference: Key Image, ImagingSelection: Key Image))
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    18. DiagnosticReport.extension:impression
    Slice Nameimpression
    Definition

    Impression in the imaging report.

    ShortImpression
    Control0..*
    TypeExtension(HL7IDR Impression) (Extension Type: Reference(Observation: Imaging Finding, Condition, DocumentReference: Key Image, ImagingSelection: Key Image))
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    20. DiagnosticReport.extension:recommendation
    Slice Namerecommendation
    Definition

    Recommendations a radiologist provides in the report for possible follow up actions.

    ShortRecommendations
    Control0..*
    TypeExtension(HL7IDR Recommendation) (Extension Type: Reference(CarePlan, ServiceRequest))
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    22. DiagnosticReport.extension:communication
    Slice Namecommunication
    Definition

    Communications captures what communications have been made with other care providers.

    ShortCommunications with other care providers
    Control0..*
    TypeExtension(HL7IDR Communication) (Extension Type: Reference)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    24. DiagnosticReport.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Must Supportfalse
    Summarytrue
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    26. DiagnosticReport.identifier
    Definition

    Identifiers assigned to this Imaging Report by the performer or other systems. It shall be common to several report versions


    Identifiers assigned to this report by the performer or other systems.

    ShortReport identifierBusiness identifier for report
    Comments

    Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists


    Usually assigned by the Information System of the diagnostic service provider (filler id).

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

    Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

    Alternate NamesReportID, Filler ID, Placer ID
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. DiagnosticReport.basedOn
    Definition

    Details concerning a service requested.

    ShortWhat was requested
    Comments

    Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

    Control0..*
    TypeReference(CarePlan, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Requirements

    This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

    Alternate NamesRequest
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on DiagnosticReport.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 30. DiagnosticReport.basedOn:imorderaccession
      Slice Nameimorderaccession
      Definition

      Details concerning a service requested.

      ShortWhat was requested
      Comments

      Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

      Control0..*
      TypeReference(ServiceRequest: Imaging Order, CarePlan, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Requirements

      This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

      Alternate NamesRequest
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. DiagnosticReport.basedOn:imorderaccession.reference
      Definition

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

      ShortLiteral reference, Relative, internal or absolute URL
      Comments

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

      Control0..1
      This element is affected by the following invariants: ref-2, ref-1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. DiagnosticReport.basedOn:imorderaccession.identifier
      Definition

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

      ShortLogical reference, when literal reference is not known
      Comments

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

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

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

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

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

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control10..1
      This element is affected by the following invariants: ref-2
      TypeIdentifier(Identifier: Accession Number)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. DiagnosticReport.status
      Definition

      The status of the diagnostic report.

      ShortStatus of the Reportregistered | partial | preliminary | modified | final | amended | corrected | appended | cancelled | entered-in-error | unknown
      Comments

      DiagnosticReport.status and Composition.status shall be aligned

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

      The status of the diagnostic report.

      Typecode
      Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

      Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

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

      A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

      ShortService category
      Comments

      Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

      Control10..*
      BindingFor example codes, see DiagnosticServiceSectionCodeshttp://hl7.org/fhir/ValueSet/diagnostic-service-sections|5.0.0
      (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections|5.0.0)

      HL7 V2 table 0074

      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Alternate NamesDepartment, Sub-department, Service, Discipline
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ $this
      • 40. DiagnosticReport.category:diagnostic-service
        Slice Namediagnostic-service
        Definition

        A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

        ShortService category
        Comments

        Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

        Control10..1*
        BindingThe codes SHALL be taken from For example codes, see DiagnosticServiceSectionCodeshttp://hl7.org/fhir/ValueSet/diagnostic-service-sections|5.0.0
        (required to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Alternate NamesDepartment, Sub-department, Service, Discipline
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. DiagnosticReport.code
        Definition

        Defines the document type, it is recommended to take this from the suggested LOINC set.


        A code or name that describes this diagnostic report.

        ShortType of Imaging Diagnostic ReportName/Code for this diagnostic report
        Control1..1
        BindingThe codes SHOULD be taken from Radiology Report Typeshttp://hl7.org/fhir/ValueSet/report-codes|5.0.0
        (preferred to http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Alternate NamesType
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. DiagnosticReport.subject
        Definition

        The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.

        ShortThe subject of the report - usually, but not always, the patient
        Control0..1
        TypeReference(Patient (EU core), Patient, Group, Device, Location, Organization, Practitioner, Medication, Substance, BiologicallyDerivedProduct)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        SHALL know the subject context.

        Alternate NamesPatient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. DiagnosticReport.performer
        Definition

        The diagnostic service that is responsible for issuing the report.

        ShortResponsible Diagnostic Service
        Comments

        This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

        Control0..*
        TypeReference(Practitioner, PractitionerRole, Organization, CareTeam)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

        Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on DiagnosticReport.performer. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • profile @ $this
        • 48. DiagnosticReport.performer:organization
          Slice Nameorganization
          Definition

          The organization responsible for producing this report. In case practitioners produce them in their private practices, they will be accounted as an organization for this purpose.


          The diagnostic service that is responsible for issuing the report.

          ShortThe organization producer of this reportResponsible Diagnostic Service
          Comments

          This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

          Control0..*
          TypeReference(Organization (EU core), Practitioner, PractitionerRole, Organization, CareTeam)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

          Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. DiagnosticReport.resultsInterpreter
          Definition

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

          ShortPrimary result interpreter
          Comments

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

          Control0..*
          TypeReference(Practitioner, PractitionerRole, Organization, CareTeam)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

          Alternate NamesAnalyzed by, Reported by
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on DiagnosticReport.resultsInterpreter. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • profile @ resolve()
          • 52. DiagnosticReport.resultsInterpreter:author
            Slice Nameauthor
            Definition

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

            ShortPrimary result interpreter
            Comments

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

            Control0..*
            TypeReference(PractitionerRole (EU core), Practitioner, PractitionerRole, Organization, CareTeam)
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Requirements

            Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

            Alternate NamesAnalyzed by, Reported by
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. DiagnosticReport.result
            Definition

            Detailed description of the findings on the imaging study. The findings should be described in a clear and concise manner, using standardized anatomic, pathologic, and radiologic terminology whenever possible.


            Observations that are part of this diagnostic report.

            ShortFindingsObservations
            Comments

            Observations can contain observations.

            Control0..*
            This element is affected by the following invariants: dgr-1
            TypeReference(Observation: Imaging Finding, Observation)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

            Alternate NamesData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. DiagnosticReport.study
            Definition

            Study subject to this report. Note: Any associated study (e.g. comparison studies) used during reporting should be tracked in the associatedStudy extension.


            One or more links to full details of any study performed during the diagnostic investigation. An ImagingStudy might comprise a set of radiologic images obtained via a procedure that are analyzed as a group. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images. A GenomicStudy might comprise one or more analyses, each serving a specific purpose. These analyses may vary in method (e.g., karyotyping, CNV, or SNV detection), performer, software, devices used, or regions targeted.

            ShortStudy subject to this reportReference to full details of an analysis associated with the diagnostic report
            Comments

            For laboratory-type studies like GenomeStudy, type resources will be used for tracking additional metadata and workflow aspects of complex studies. ImagingStudy and the media element are somewhat overlapping - typically, the list of image references in the media element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.

            Control0..*
            TypeReference(ImagingStudy: General, GenomicStudy, ImagingStudy)
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. DiagnosticReport.media
            Definition

            A list of key images or data associated with this report. The images or data are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).

            ShortKey images or data associated with this report
            Control0..0*
            TypeBackboneElement
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Requirements

            Many diagnostic services include images or data in the report as part of their service.

            Alternate NamesDICOM, Slides, Scans
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. DiagnosticReport.composition
            Definition

            Reference to a Composition resource instance that provides structure for organizing the contents of the DiagnosticReport.

            ShortImaging Diagnostic ReportReference to a Composition resource for the DiagnosticReport structure
            Comments

            The Composition provides structure to the content of the DiagnosticReport (and only contains contents referenced in the DiagnosticReport) - e.g., to order the sections of an anatomic pathology structured report.

            Control10..1
            This element is affected by the following invariants: dgr-1
            TypeReference(Composition: Imaging Report, Composition)
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

            0. DiagnosticReport
            2. DiagnosticReport.extension
            SlicingThis element introduces a set of slices on DiagnosticReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 4. DiagnosticReport.extension:artifactVersion
              Slice NameartifactVersion
              Control0..1
              TypeExtension(ArtifactVersion) (Extension Type: string)
              6. DiagnosticReport.extension:comparison
              Slice Namecomparison
              Definition

              Studies used for comparison in part of diagnostic reporting.

              ShortComparison studies
              Control0..*
              TypeExtension(HL7IDR DiagnosticReport Comparison Study) (Extension Type: Reference(ImagingStudy: General, ImagingSelection))
              Must Supporttrue
              8. DiagnosticReport.extension:patientHistory
              Slice NamepatientHistory
              Definition

              May have originally been extracted from the medical record by imaging staff, automated tools, or by the radiologists themselves.

              ShortPatient history items selected by radiologist
              Control0..*
              TypeExtension(HL7IDR Patient History) (Extension Type: Reference)
              Must Supporttrue
              10. DiagnosticReport.extension:procedure
              Slice Nameprocedure
              Definition

              Imaging procedure used to acquire the study.

              ShortImaging procedure
              Control0..*
              TypeExtension(HL7IDR Imaging Procedure) (Extension Type: Reference(Procedure: Imaging Acquisition))
              Must Supporttrue
              12. DiagnosticReport.extension:finding
              Slice Namefinding
              Definition

              Key images in the report

              ShortKey image findings
              Control0..*
              TypeExtension(HL7IDR Impression) (Extension Type: Reference(DocumentReference: Key Image, ImagingSelection: Key Image))
              Must Supporttrue
              14. DiagnosticReport.extension:impression
              Slice Nameimpression
              Definition

              Impression in the imaging report.

              ShortImpression
              Control0..*
              TypeExtension(HL7IDR Impression) (Extension Type: Reference(Observation: Imaging Finding, Condition, DocumentReference: Key Image, ImagingSelection: Key Image))
              Must Supporttrue
              16. DiagnosticReport.extension:recommendation
              Slice Namerecommendation
              Definition

              Recommendations a radiologist provides in the report for possible follow up actions.

              ShortRecommendations
              Control0..*
              TypeExtension(HL7IDR Recommendation) (Extension Type: Reference(CarePlan, ServiceRequest))
              Must Supporttrue
              18. DiagnosticReport.extension:communication
              Slice Namecommunication
              Definition

              Communications captures what communications have been made with other care providers.

              ShortCommunications with other care providers
              Control0..*
              TypeExtension(HL7IDR Communication) (Extension Type: Reference)
              Must Supporttrue
              20. DiagnosticReport.identifier
              Definition

              Identifiers assigned to this Imaging Report by the performer or other systems. It shall be common to several report versions

              ShortReport identifier
              Comments

              Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists

              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control1..?
              22. DiagnosticReport.basedOn
              SlicingThis element introduces a set of slices on DiagnosticReport.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • type @ $this
              • 24. DiagnosticReport.basedOn:imorderaccession
                Slice Nameimorderaccession
                Control0..*
                TypeReference(ServiceRequest: Imaging Order)
                26. DiagnosticReport.basedOn:imorderaccession.identifier
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control1..?
                TypeIdentifier(Identifier: Accession Number)
                28. DiagnosticReport.status
                ShortStatus of the Report
                Comments

                DiagnosticReport.status and Composition.status shall be aligned

                30. DiagnosticReport.category
                Control1..?
                SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ $this
                • 32. DiagnosticReport.category:diagnostic-service
                  Slice Namediagnostic-service
                  Control1..1
                  BindingThe codes SHALL be taken from DiagnosticServiceSectionCodes
                  (required to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)
                  34. DiagnosticReport.code
                  Definition

                  Defines the document type, it is recommended to take this from the suggested LOINC set.

                  ShortType of Imaging Diagnostic Report
                  BindingThe codes SHOULD be taken from Radiology Report Types
                  (preferred to http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS)
                  36. DiagnosticReport.subject
                  TypeReference(Patient (EU core))
                  38. DiagnosticReport.performer
                  SlicingThis element introduces a set of slices on DiagnosticReport.performer. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • profile @ $this
                  • 40. DiagnosticReport.performer:organization
                    Slice Nameorganization
                    Definition

                    The organization responsible for producing this report. In case practitioners produce them in their private practices, they will be accounted as an organization for this purpose.

                    ShortThe organization producer of this report
                    Control0..*
                    TypeReference(Organization (EU core))
                    42. DiagnosticReport.resultsInterpreter
                    SlicingThis element introduces a set of slices on DiagnosticReport.resultsInterpreter. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • profile @ resolve()
                    • 44. DiagnosticReport.resultsInterpreter:author
                      Slice Nameauthor
                      Control0..*
                      TypeReference(PractitionerRole (EU core))
                      46. DiagnosticReport.result
                      Definition

                      Detailed description of the findings on the imaging study. The findings should be described in a clear and concise manner, using standardized anatomic, pathologic, and radiologic terminology whenever possible.

                      ShortFindings
                      TypeReference(Observation: Imaging Finding)
                      Must Supporttrue
                      48. DiagnosticReport.note
                      50. DiagnosticReport.note.extension:annotation-type
                      Slice Nameannotation-type
                      Control0..*
                      TypeExtension(Annotation type) (Extension Type: CodeableConcept)
                      52. DiagnosticReport.note.extension:annotation-type.value[x]
                      BindingThe codes SHOULD be taken from Section codes used to label annotations.
                      (preferred to http://hl7.eu/fhir/imaging-r5/ValueSet/valueset-diagnosticreport-notes)
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      54. DiagnosticReport.study
                      Definition

                      Study subject to this report. Note: Any associated study (e.g. comparison studies) used during reporting should be tracked in the associatedStudy extension.

                      ShortStudy subject to this report
                      TypeReference(ImagingStudy: General)
                      56. DiagnosticReport.media
                      Control0..0
                      58. DiagnosticReport.composition
                      ShortImaging Diagnostic Report
                      Control1..?
                      TypeReference(Composition: Imaging Report)

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

                      0. DiagnosticReport
                      Definition

                      The findings and interpretation of diagnostic tests performed on patients, groups of patients, products, substances, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports. The report also includes non-clinical context such as batch analysis and stability reporting of products and substances.

                      ShortA Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
                      Comments

                      This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

                      Control0..*
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Alternate NamesReport, Test, Result, Results, Labs, Laboratory
                      Invariantsdgr-1: When a Composition is referenced in `Diagnostic.composition`, all Observation resources referenced in `Composition.entry` must also be referenced in `Diagnostic.entry` or in the references Observations in `Observation.hasMember` (composition.exists() implies (composition.resolve().section.entry.reference.where(resolve() is Observation) in (result.reference|result.reference.resolve().hasMember.reference)))
                      dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                      dom-6: A resource should have narrative for robust management (text.`div`.exists())
                      2. DiagnosticReport.id
                      Definition

                      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                      ShortLogical id of this artifact
                      Comments

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

                      Control0..1
                      Typeid
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      4. DiagnosticReport.meta
                      Definition

                      The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                      ShortMetadata about the resource
                      Control0..1
                      TypeMeta
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      6. DiagnosticReport.implicitRules
                      Definition

                      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                      ShortA set of rules under which this content was created
                      Comments

                      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

                      Control0..1
                      Typeuri
                      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supportfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      8. DiagnosticReport.language
                      Definition

                      The base language in which the resource is written.

                      ShortLanguage of the resource content
                      Comments

                      Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                      Control0..1
                      BindingThe codes SHALL be taken from AllLanguages
                      (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0)

                      IETF language tag for a human language

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

                      A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                      ShortText summary of the resource, for human interpretation
                      Comments

                      Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                      Control0..1
                      This element is affected by the following invariants: dom-6
                      TypeNarrative
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Alternate Namesnarrative, html, xhtml, display
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      12. DiagnosticReport.contained
                      Definition

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

                      ShortContained, inline Resources
                      Comments

                      This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

                      Control0..*
                      This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
                      TypeResource
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Alternate Namesinline resources, anonymous resources, contained resources
                      14. DiagnosticReport.extension
                      Definition

                      An Extension

                      ShortExtension
                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on DiagnosticReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 16. DiagnosticReport.extension:artifactVersion
                        Slice NameartifactVersion
                        Definition

                        The identifier that is used to identify this version of the artifact when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the artifact author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.

                        ShortBusiness version of the artifact
                        Control0..1
                        TypeExtension(ArtifactVersion) (Extension Type: string)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        18. DiagnosticReport.extension:comparison
                        Slice Namecomparison
                        Definition

                        Studies used for comparison in part of diagnostic reporting.

                        ShortComparison studies
                        Control0..*
                        TypeExtension(HL7IDR DiagnosticReport Comparison Study) (Extension Type: Reference(ImagingStudy: General, ImagingSelection))
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        20. DiagnosticReport.extension:patientHistory
                        Slice NamepatientHistory
                        Definition

                        May have originally been extracted from the medical record by imaging staff, automated tools, or by the radiologists themselves.

                        ShortPatient history items selected by radiologist
                        Control0..*
                        TypeExtension(HL7IDR Patient History) (Extension Type: Reference)
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        22. DiagnosticReport.extension:procedure
                        Slice Nameprocedure
                        Definition

                        Imaging procedure used to acquire the study.

                        ShortImaging procedure
                        Control0..*
                        TypeExtension(HL7IDR Imaging Procedure) (Extension Type: Reference(Procedure: Imaging Acquisition))
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        24. DiagnosticReport.extension:finding
                        Slice Namefinding
                        Definition

                        Key images in the report

                        ShortKey image findings
                        Control0..*
                        TypeExtension(HL7IDR Impression) (Extension Type: Reference(DocumentReference: Key Image, ImagingSelection: Key Image))
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        26. DiagnosticReport.extension:impression
                        Slice Nameimpression
                        Definition

                        Impression in the imaging report.

                        ShortImpression
                        Control0..*
                        TypeExtension(HL7IDR Impression) (Extension Type: Reference(Observation: Imaging Finding, Condition, DocumentReference: Key Image, ImagingSelection: Key Image))
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        28. DiagnosticReport.extension:recommendation
                        Slice Namerecommendation
                        Definition

                        Recommendations a radiologist provides in the report for possible follow up actions.

                        ShortRecommendations
                        Control0..*
                        TypeExtension(HL7IDR Recommendation) (Extension Type: Reference(CarePlan, ServiceRequest))
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        30. DiagnosticReport.extension:communication
                        Slice Namecommunication
                        Definition

                        Communications captures what communications have been made with other care providers.

                        ShortCommunications with other care providers
                        Control0..*
                        TypeExtension(HL7IDR Communication) (Extension Type: Reference)
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        32. DiagnosticReport.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                        Must Supportfalse
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        34. DiagnosticReport.identifier
                        Definition

                        Identifiers assigned to this Imaging Report by the performer or other systems. It shall be common to several report versions

                        ShortReport identifier
                        Comments

                        Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists

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

                        Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

                        Alternate NamesReportID, Filler ID, Placer ID
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        36. DiagnosticReport.basedOn
                        Definition

                        Details concerning a service requested.

                        ShortWhat was requested
                        Comments

                        Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

                        Control0..*
                        TypeReference(CarePlan, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

                        Alternate NamesRequest
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on DiagnosticReport.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 38. DiagnosticReport.basedOn:imorderaccession
                          Slice Nameimorderaccession
                          Definition

                          Details concerning a service requested.

                          ShortWhat was requested
                          Comments

                          Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

                          Control0..*
                          TypeReference(ServiceRequest: Imaging Order)
                          Is Modifierfalse
                          Must Supportfalse
                          Summaryfalse
                          Requirements

                          This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

                          Alternate NamesRequest
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          40. DiagnosticReport.basedOn:imorderaccession.id
                          Definition

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

                          ShortUnique id for inter-element referencing
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          Typeid
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          42. DiagnosticReport.basedOn:imorderaccession.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on DiagnosticReport.basedOn.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 44. DiagnosticReport.basedOn:imorderaccession.reference
                            Definition

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

                            ShortLiteral reference, Relative, internal or absolute URL
                            Comments

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

                            Control0..1
                            This element is affected by the following invariants: ref-2, ref-1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            46. DiagnosticReport.basedOn:imorderaccession.type
                            Definition

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

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

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

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

                            Control0..1
                            BindingUnless not suitable, these codes SHALL be taken from ResourceType
                            (extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

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

                            Typeuri
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            48. DiagnosticReport.basedOn:imorderaccession.identifier
                            Definition

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

                            ShortLogical reference, when literal reference is not known
                            Comments

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

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

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

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

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

                            NoteThis is a business identifier, not a resource identifier (see discussion)
                            Control1..1
                            This element is affected by the following invariants: ref-2
                            TypeIdentifier(Identifier: Accession Number)
                            Is Modifierfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            50. DiagnosticReport.basedOn:imorderaccession.display
                            Definition

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

                            ShortText alternative for the resource
                            Comments

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

                            Control0..1
                            This element is affected by the following invariants: ref-2
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            52. DiagnosticReport.status
                            Definition

                            The status of the diagnostic report.

                            ShortStatus of the Report
                            Comments

                            DiagnosticReport.status and Composition.status shall be aligned

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

                            The status of the diagnostic report.

                            Typecode
                            Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supportfalse
                            Summarytrue
                            Requirements

                            Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

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

                            A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

                            ShortService category
                            Comments

                            Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

                            Control1..*
                            BindingFor example codes, see DiagnosticServiceSectionCodes
                            (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections|5.0.0)

                            HL7 V2 table 0074

                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Alternate NamesDepartment, Sub-department, Service, Discipline
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ $this
                            • 56. DiagnosticReport.category:diagnostic-service
                              Slice Namediagnostic-service
                              Definition

                              A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

                              ShortService category
                              Comments

                              Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

                              Control1..1
                              BindingThe codes SHALL be taken from DiagnosticServiceSectionCodes
                              (required to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supportfalse
                              Summarytrue
                              Alternate NamesDepartment, Sub-department, Service, Discipline
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              58. DiagnosticReport.code
                              Definition

                              Defines the document type, it is recommended to take this from the suggested LOINC set.

                              ShortType of Imaging Diagnostic Report
                              Control1..1
                              BindingThe codes SHOULD be taken from Radiology Report Types
                              (preferred to http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supportfalse
                              Summarytrue
                              Alternate NamesType
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              60. DiagnosticReport.subject
                              Definition

                              The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.

                              ShortThe subject of the report - usually, but not always, the patient
                              Control0..1
                              TypeReference(Patient (EU core))
                              Is Modifierfalse
                              Must Supportfalse
                              Summarytrue
                              Requirements

                              SHALL know the subject context.

                              Alternate NamesPatient
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              62. DiagnosticReport.encounter
                              Definition

                              The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.

                              ShortHealth care event when test ordered
                              Comments

                              This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

                              Control0..1
                              TypeReference(Encounter)
                              Is Modifierfalse
                              Must Supportfalse
                              Summarytrue
                              Requirements

                              Links the request to the Encounter context.

                              Alternate NamesContext
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              64. DiagnosticReport.effective[x]
                              Definition

                              The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

                              ShortClinically relevant time/time-period for report
                              Comments

                              If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

                              Control0..1
                              TypeChoice of: dateTime, Period
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supportfalse
                              Summarytrue
                              Requirements

                              Need to know where in the patient history to file/present this report.

                              Alternate NamesObservation time, Effective Time, Occurrence
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              66. DiagnosticReport.issued
                              Definition

                              The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.

                              ShortDateTime this version was made
                              Comments

                              May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.

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

                              Clinicians need to be able to check the date that the report was released.

                              Alternate NamesDate published, Date Issued, Date Verified
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              68. DiagnosticReport.performer
                              Definition

                              The diagnostic service that is responsible for issuing the report.

                              ShortResponsible Diagnostic Service
                              Comments

                              This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

                              Control0..*
                              TypeReference(Practitioner, PractitionerRole, Organization, CareTeam)
                              Is Modifierfalse
                              Must Supportfalse
                              Summarytrue
                              Requirements

                              Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                              Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              SlicingThis element introduces a set of slices on DiagnosticReport.performer. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • profile @ $this
                              • 70. DiagnosticReport.performer:organization
                                Slice Nameorganization
                                Definition

                                The organization responsible for producing this report. In case practitioners produce them in their private practices, they will be accounted as an organization for this purpose.

                                ShortThe organization producer of this report
                                Comments

                                This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

                                Control0..*
                                TypeReference(Organization (EU core))
                                Is Modifierfalse
                                Must Supportfalse
                                Summarytrue
                                Requirements

                                Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                                Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                72. DiagnosticReport.resultsInterpreter
                                Definition

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

                                ShortPrimary result interpreter
                                Comments

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

                                Control0..*
                                TypeReference(Practitioner, PractitionerRole, Organization, CareTeam)
                                Is Modifierfalse
                                Must Supportfalse
                                Summarytrue
                                Requirements

                                Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                                Alternate NamesAnalyzed by, Reported by
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                SlicingThis element introduces a set of slices on DiagnosticReport.resultsInterpreter. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • profile @ resolve()
                                • 74. DiagnosticReport.resultsInterpreter:author
                                  Slice Nameauthor
                                  Definition

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

                                  ShortPrimary result interpreter
                                  Comments

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

                                  Control0..*
                                  TypeReference(PractitionerRole (EU core))
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summarytrue
                                  Requirements

                                  Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                                  Alternate NamesAnalyzed by, Reported by
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  76. DiagnosticReport.specimen
                                  Definition

                                  Details about the specimens on which this diagnostic report is based.

                                  ShortSpecimens this report is based on
                                  Comments

                                  If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.

                                  Control0..*
                                  TypeReference(Specimen)
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Requirements

                                  Need to be able to report information about the collected specimens on which the report is based.

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

                                  Detailed description of the findings on the imaging study. The findings should be described in a clear and concise manner, using standardized anatomic, pathologic, and radiologic terminology whenever possible.

                                  ShortFindings
                                  Comments

                                  Observations can contain observations.

                                  Control0..*
                                  This element is affected by the following invariants: dgr-1
                                  TypeReference(Observation: Imaging Finding)
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Requirements

                                  Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

                                  Alternate NamesData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  80. DiagnosticReport.note
                                  Definition

                                  Comments about the diagnostic report.

                                  ShortComments about the diagnostic report
                                  Comments

                                  May include general statements about the diagnostic report, or statements about significant, unexpected or unreliable results values contained within the diagnostic report, or information about its source when relevant to its interpretation.

                                  Control0..*
                                  TypeAnnotation
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Requirements

                                  Need to be able to provide free text additional information.

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

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

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  This element is affected by the following invariants: ele-1
                                  Typeid
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  84. DiagnosticReport.note.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  SlicingThis element introduces a set of slices on DiagnosticReport.note.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 86. DiagnosticReport.note.extension:annotation-type
                                    Slice Nameannotation-type
                                    Definition

                                    The type of annotation. This extension can be used to map the v2 NTE-4 comment type field.

                                    ShortThe type of annotation
                                    Comments

                                    This is used to identify the type of annotation.

                                    Control0..*
                                    TypeExtension(Annotation type) (Extension Type: CodeableConcept)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    88. DiagnosticReport.note.extension:annotation-type.id
                                    Definition

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

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    This element is affected by the following invariants: ele-1
                                    Typeid
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    90. DiagnosticReport.note.extension:annotation-type.extension
                                    Definition

                                    An Extension

                                    ShortExtension
                                    Control0..0
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    SlicingThis element introduces a set of slices on DiagnosticReport.note.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 92. DiagnosticReport.note.extension:annotation-type.url
                                      Definition

                                      Source of the definition for the extension code - a logical name or a URL.

                                      Shortidentifies the meaning of the extension
                                      Comments

                                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                      Control1..1
                                      Typeuri
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      Fixed Valuehttp://hl7.org/fhir/StructureDefinition/annotationType
                                      94. DiagnosticReport.note.extension:annotation-type.value[x]
                                      Definition

                                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                      ShortValue of extension
                                      Control1..1
                                      This element is affected by the following invariants: ext-1
                                      BindingThe codes SHOULD be taken from Section codes used to label annotations.
                                      (preferred to http://hl7.eu/fhir/imaging-r5/ValueSet/valueset-diagnosticreport-notes)
                                      TypeCodeableConcept
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      96. DiagnosticReport.note.author[x]
                                      Definition

                                      The individual responsible for making the annotation.

                                      ShortIndividual responsible for the annotation
                                      Comments

                                      Organization is used when there's no need for specific attribution as to who made the comment.

                                      Control0..1
                                      TypeChoice of: Reference(Practitioner, PractitionerRole, Patient, RelatedPerson, Organization), string
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      98. DiagnosticReport.note.time
                                      Definition

                                      Indicates when this particular annotation was made.

                                      ShortWhen the annotation was made
                                      Control0..1
                                      TypedateTime
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      100. DiagnosticReport.note.text
                                      Definition

                                      The text of the annotation in markdown format.

                                      ShortThe annotation - text content (as markdown)
                                      Control1..1
                                      Typemarkdown
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      102. DiagnosticReport.study
                                      Definition

                                      Study subject to this report. Note: Any associated study (e.g. comparison studies) used during reporting should be tracked in the associatedStudy extension.

                                      ShortStudy subject to this report
                                      Comments

                                      For laboratory-type studies like GenomeStudy, type resources will be used for tracking additional metadata and workflow aspects of complex studies. ImagingStudy and the media element are somewhat overlapping - typically, the list of image references in the media element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.

                                      Control0..*
                                      TypeReference(ImagingStudy: General)
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      104. DiagnosticReport.supportingInfo
                                      Definition

                                      This backbone element contains supporting information that was used in the creation of the report not included in the results already included in the report.

                                      ShortAdditional information supporting the diagnostic report
                                      Control0..*
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      106. DiagnosticReport.supportingInfo.id
                                      Definition

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

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      This element is affected by the following invariants: ele-1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      108. DiagnosticReport.supportingInfo.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      110. DiagnosticReport.supportingInfo.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      112. DiagnosticReport.supportingInfo.type
                                      Definition

                                      The code value for the role of the supporting information in the diagnostic report.

                                      ShortSupporting information role code
                                      Control1..1
                                      BindingFor example codes, see hl7VS-VS-observationType
                                      (example to http://terminology.hl7.org/ValueSet/v2-0936)

                                      The code value for the role of the supporting information in the diagnostic report.

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

                                      The reference for the supporting information in the diagnostic report.

                                      ShortSupporting information reference
                                      Control1..1
                                      TypeReference(Procedure, Observation, DiagnosticReport, Citation)
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      116. DiagnosticReport.media
                                      Definition

                                      A list of key images or data associated with this report. The images or data are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).

                                      ShortKey images or data associated with this report
                                      Control0..0
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summarytrue
                                      Requirements

                                      Many diagnostic services include images or data in the report as part of their service.

                                      Alternate NamesDICOM, Slides, Scans
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      123. DiagnosticReport.composition
                                      Definition

                                      Reference to a Composition resource instance that provides structure for organizing the contents of the DiagnosticReport.

                                      ShortImaging Diagnostic Report
                                      Comments

                                      The Composition provides structure to the content of the DiagnosticReport (and only contains contents referenced in the DiagnosticReport) - e.g., to order the sections of an anatomic pathology structured report.

                                      Control1..1
                                      This element is affected by the following invariants: dgr-1
                                      TypeReference(Composition: Imaging Report)
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      125. DiagnosticReport.conclusion
                                      Definition

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

                                      ShortClinical conclusion (interpretation) of test results
                                      Control0..1
                                      Typemarkdown
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supportfalse
                                      Summaryfalse
                                      Requirements

                                      Need to be able to provide a conclusion that is not lost among the basic result data.

                                      Alternate NamesReport
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      127. DiagnosticReport.conclusionCode
                                      Definition

                                      One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.

                                      ShortCodes for the clinical conclusion of test results
                                      Control0..*
                                      BindingFor example codes, see SNOMEDCTClinicalFindings
                                      (example to http://hl7.org/fhir/ValueSet/clinical-findings|5.0.0)

                                      SNOMED CT Clinical Findings

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

                                      Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.

                                      ShortEntire report as issued
                                      Comments

                                      "application/pdf" is recommended as the most reliable and interoperable in this context.

                                      Control0..*
                                      TypeAttachment
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Requirements

                                      Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

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