HL7 Europe Imaging Study Report
0.1.0-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 0.1.0-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: Report_ImReportDocumentReference - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the Report-ImReportDocumentReference resource profile.

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

0. DocumentReference
Definition

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

ShortA reference to a document
Comments

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

Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
InvariantsdocRef-1: facilityType SHALL only be present if context is not an encounter (facilityType.empty() or context.where(resolve() is Encounter).empty())
docRef-2: practiceSetting SHALL only be present if context is not present (practiceSetting.empty() or context.where(resolve() is Encounter).empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. DocumentReference.implicitRules
Definition

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

ShortA set of rules under which this content was created
Comments

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

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

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

ShortContained, inline Resources
Comments

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

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

An Extension


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

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

ShortExtensionExtensions that cannot be ignored
Comments

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

Control0..0*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Supportfalse
Summarytrue
Requirements

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

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

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

ShortBusiness identifiers for the document
Comments

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

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

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

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on DocumentReference.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ system
  • 10. DocumentReference.identifier:entry-uuid
    Slice Nameentry-uuid
    Definition

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

    ShortBusiness identifiers for the document
    Comments

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

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..1*
    TypeIdentifier(Identifier: IHE-MHD Entry UUID)
    Is Modifierfalse
    Must Supportfalse
    Obligations
      ObligationsActor
      SHALL:populate-if-knownImaging study report provider
      Summarytrue
      Requirements

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

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

      The status of this document reference.

      Shortcurrent | superseded | entered-in-error
      Comments

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

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

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

      The status of the document reference.

      Typecode
      Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Obligations
        ObligationsActor
        SHALL:populateImaging study report provider
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. DocumentReference.modality
        Definition

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

        ShortImaging modality used
        Control10..*
        BindingUnless not suitable, these codes SHALL be taken from Modalityhttp://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
        (extensible to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html)

        Type of acquired data in the instance.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Obligations
          ObligationsActor
          SHALL:populateImaging study report provider
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          16. DocumentReference.type
          Definition

          Specifies that it refers to a Imaging Report


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

          ShortType of Imaging Diagnostic ReportKind of document (LOINC if possible)
          Comments

          Corresponds to the type of the Imaging resource.


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

          Control10..1
          BindingThe codes SHOULD be taken from HL7 EU Imaging Report Typeshttp://hl7.org/fhir/ValueSet/doc-typecodes
          (preferred to http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS)
          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Obligations
            ObligationsActor
            SHALL:populate-if-knownImaging study report provider
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            18. DocumentReference.category
            Definition

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

            ShortCategorization of document
            Comments

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

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

            High-level kind of document at a macro level.

            TypeCodeableConcept
            Is Modifierfalse
            Must Supportfalse
            Obligations
              ObligationsActor
              SHALL:populate-if-knownImaging study report provider
              Summarytrue
              Alternate Namesclass, classCode
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on DocumentReference.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ $this
              • 20. DocumentReference.category:imaging
                Slice Nameimaging
                Definition

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

                ShortCategorization of document
                Comments

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

                Control10..1*
                BindingFor example codes, see ReferencedItemCategoryValueSethttp://hl7.org/fhir/ValueSet/referenced-item-category
                (example to http://hl7.org/fhir/ValueSet/referenced-item-category)

                High-level kind of document at a macro level.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Alternate Namesclass, classCode
                Pattern Value{
                  "coding" : [{
                    "system" : "http://loinc.org",
                    "code" : "18748-4"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                22. DocumentReference.subject
                Definition

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

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

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

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

                  The anatomic structures included in the document.

                  ShortBody part included
                  Control0..*
                  BindingFor example codes, see SNOMEDCTBodyStructureshttp://hl7.org/fhir/ValueSet/body-site
                  (example to http://hl7.org/fhir/ValueSet/body-site)

                  SNOMED CT Body site concepts

                  TypeCodeableReference(BodyStructure)
                  Is Modifierfalse
                  Must Supportfalse
                  Obligations
                    ObligationsActor
                    SHALL:populateImaging study report provider
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    28. DocumentReference.author
                    Definition

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

                    ShortWho and/or what authored the document
                    Comments

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

                    Control0..*
                    TypeReference(Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson, CareTeam)
                    Is Modifierfalse
                    Must Supportfalse
                    Obligations
                      ObligationsActor
                      SHALL:populate-if-knownImaging study report provider
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      30. DocumentReference.custodian
                      Definition

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

                      ShortOrganization that manages the Imaging ReportOrganization which maintains the document
                      Comments

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

                      Control0..1
                      TypeReference(Organization (EU base), Organization)
                      Is Modifierfalse
                      Must Supportfalse
                      Obligations
                        ObligationsActor
                        SHALL:populate-if-knownImaging study report provider
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        32. DocumentReference.relatesTo
                        Definition

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

                        ShortRelationships to other documents
                        Comments

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

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supportfalse
                        Obligations
                          ObligationsActor
                          SHALL:populate-if-knownImaging study report provider
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          34. DocumentReference.relatesTo.modifierExtension
                          Definition

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

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

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

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

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

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

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

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

                          ShortThe relationship type with another document
                          Comments

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

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

                          The type of relationship between the documents.

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

                          The target document of this relationship.

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

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

                          ShortDocument security-tags
                          Comments

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

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

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

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

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supportfalse
                          Obligations
                            ObligationsActor
                            SHALL:populate-if-knownImaging study report provider
                            Summarytrue
                            Requirements

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

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

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

                            ShortDocument referenced
                            Comments

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

                            Control1..1*
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Requirements

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

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

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

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

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

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

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

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

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

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

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

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

                            ShortMime type of the content, with charset etc.
                            Control10..1
                            This element is affected by the following invariants: att-1
                            BindingThe codes SHALL be taken from MimeTypeshttp://hl7.org/fhir/ValueSet/mimetypes|5.0.0
                            (required to http://hl7.org/fhir/ValueSet/mimetypes|5.0.0)

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

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

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

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

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

                            ShortHuman language of the content (BCP-47)
                            Control0..1
                            BindingThe codes SHALL be taken from AllLanguageshttp://hl7.org/fhir/ValueSet/all-languages|5.0.0
                            (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
                            Obligations
                              ObligationsActor
                              SHALL:populateImaging study report provider
                              Summarytrue
                              Requirements

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

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

                              The date that the attachment was first created.

                              ShortDate attachment was first created
                              Control0..1
                              TypedateTime
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Obligations
                                ObligationsActor
                                SHALL:populateImaging study report provider
                                Summarytrue
                                Requirements

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

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

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

                                ShortContent profile rules for the document
                                Comments

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

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

                                Control10..*
                                TypeBackboneElement
                                Is Modifierfalse
                                Must Supportfalse
                                Summarytrue
                                Alternate Namesformat, formatCode
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                SlicingThis element introduces a set of slices on DocumentReference.content.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ value
                                • 56. DocumentReference.content.profile.modifierExtension
                                  Definition

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

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

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

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

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

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

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

                                  Code|uri|canonical.

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

                                  Document Format Codes.

                                  TypeChoice of: Coding, uri, canonical
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supportfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  60. DocumentReference.content.profile:hl7eu-imaging-report
                                  Slice Namehl7eu-imaging-report
                                  Definition

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

                                  ShortContent profile rules for the document
                                  Comments

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

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

                                  Control10..1*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summarytrue
                                  Alternate Namesformat, formatCode
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  62. DocumentReference.content.profile:hl7eu-imaging-report.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())
                                  64. DocumentReference.content.profile:hl7eu-imaging-report.value[x]
                                  Definition

                                  Code|uri|canonical.

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

                                  Document Format Codes.

                                  TypeChoice of: Coding, uri, canonical
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supportfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  SlicingThis element introduces a set of slices on DocumentReference.content.profile.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • type @ $this
                                  • 66. DocumentReference.content.profile:hl7eu-imaging-report.value[x]:valueCanonical
                                    Slice NamevalueCanonical
                                    Definition

                                    Code|uri|canonical.

                                    ShortCode|uri|canonical
                                    Control01..1
                                    Typecanonical, Coding, uri
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supportfalse
                                    Summarytrue
                                    Pattern Valuehttp://hl7.eu/fhir/imaging-r5/StructureDefinition/ImReport
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

                                    0. DocumentReference
                                    2. DocumentReference.identifier:entry-uuid
                                    Slice Nameentry-uuid
                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                    Obligations
                                      ObligationsActor
                                      SHALL:populate-if-knownImaging study report provider
                                      4. DocumentReference.status
                                      Obligations
                                        ObligationsActor
                                        SHALL:populateImaging study report provider
                                        6. DocumentReference.modality
                                        Obligations
                                          ObligationsActor
                                          SHALL:populateImaging study report provider
                                          8. DocumentReference.type
                                          Obligations
                                            ObligationsActor
                                            SHALL:populate-if-knownImaging study report provider
                                            10. DocumentReference.category
                                            Obligations
                                              ObligationsActor
                                              SHALL:populate-if-knownImaging study report provider
                                              12. DocumentReference.subject
                                              Obligations
                                                ObligationsActor
                                                SHALL:populate-if-knownImaging study report provider
                                                14. DocumentReference.bodySite
                                                Obligations
                                                  ObligationsActor
                                                  SHALL:populateImaging study report provider
                                                  16. DocumentReference.author
                                                  Obligations
                                                    ObligationsActor
                                                    SHALL:populate-if-knownImaging study report provider
                                                    18. DocumentReference.custodian
                                                    Obligations
                                                      ObligationsActor
                                                      SHALL:populate-if-knownImaging study report provider
                                                      20. DocumentReference.relatesTo
                                                      Obligations
                                                        ObligationsActor
                                                        SHALL:populate-if-knownImaging study report provider
                                                        22. DocumentReference.securityLabel
                                                        Obligations
                                                          ObligationsActor
                                                          SHALL:populate-if-knownImaging study report provider
                                                          24. DocumentReference.content
                                                          26. DocumentReference.content.attachment
                                                          28. DocumentReference.content.attachment.language
                                                          Obligations
                                                            ObligationsActor
                                                            SHALL:populateImaging study report provider
                                                            30. DocumentReference.content.attachment.creation
                                                            Obligations
                                                              ObligationsActor
                                                              SHALL:populateImaging study report provider

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

                                                              0. DocumentReference
                                                              Definition

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

                                                              ShortA reference to a document
                                                              Comments

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

                                                              Control0..*
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              InvariantsdocRef-1: facilityType SHALL only be present if context is not an encounter (facilityType.empty() or context.where(resolve() is Encounter).empty())
                                                              docRef-2: practiceSetting SHALL only be present if context is not present (practiceSetting.empty() or context.where(resolve() is Encounter).empty())
                                                              dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                                                              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                                                              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                                                              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                                                              dom-6: A resource should have narrative for robust management (text.`div`.exists())
                                                              2. DocumentReference.id
                                                              Definition

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

                                                              ShortLogical id of this artifact
                                                              Comments

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

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

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

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

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

                                                              ShortA set of rules under which this content was created
                                                              Comments

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

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

                                                              The base language in which the resource is written.

                                                              ShortLanguage of the resource content
                                                              Comments

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

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

                                                              IETF language tag for a human language

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

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

                                                              ShortText summary of the resource, for human interpretation
                                                              Comments

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

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

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

                                                              ShortContained, inline Resources
                                                              Comments

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

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

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

                                                              ShortAdditional content defined by implementations
                                                              Comments

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

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

                                                              An Extension

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

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

                                                              ShortBusiness identifiers for the document
                                                              Comments

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

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

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

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              SlicingThis element introduces a set of slices on DocumentReference.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ system
                                                              • 20. DocumentReference.identifier:entry-uuid
                                                                Slice Nameentry-uuid
                                                                Definition

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

                                                                ShortBusiness identifiers for the document
                                                                Comments

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

                                                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                Control1..1
                                                                TypeIdentifier(Identifier: IHE-MHD Entry UUID)
                                                                Is Modifierfalse
                                                                Must Supportfalse
                                                                Obligations
                                                                  ObligationsActor
                                                                  SHALL:populate-if-knownImaging study report provider
                                                                  Summarytrue
                                                                  Requirements

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

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

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

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

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

                                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supportfalse
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  24. DocumentReference.basedOn
                                                                  Definition

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

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

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

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

                                                                  The status of this document reference.

                                                                  Shortcurrent | superseded | entered-in-error
                                                                  Comments

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

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

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

                                                                  The status of the document reference.

                                                                  Typecode
                                                                  Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supportfalse
                                                                  Obligations
                                                                    ObligationsActor
                                                                    SHALL:populateImaging study report provider
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    28. DocumentReference.docStatus
                                                                    Definition

                                                                    The status of the underlying document.

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

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

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

                                                                    Status of the underlying document.

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

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

                                                                    ShortImaging modality used
                                                                    Control1..*
                                                                    BindingUnless not suitable, these codes SHALL be taken from Modality
                                                                    (extensible to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html)

                                                                    Type of acquired data in the instance.

                                                                    TypeCodeableConcept
                                                                    Is Modifierfalse
                                                                    Must Supportfalse
                                                                    Obligations
                                                                      ObligationsActor
                                                                      SHALL:populateImaging study report provider
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      32. DocumentReference.type
                                                                      Definition

                                                                      Specifies that it refers to a Imaging Report

                                                                      ShortType of Imaging Diagnostic Report
                                                                      Comments

                                                                      Corresponds to the type of the Imaging resource.

                                                                      Control1..1
                                                                      BindingThe codes SHOULD be taken from HL7 EU Imaging Report Types
                                                                      (preferred to http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS)
                                                                      TypeCodeableConcept
                                                                      Is Modifierfalse
                                                                      Must Supportfalse
                                                                      Obligations
                                                                        ObligationsActor
                                                                        SHALL:populate-if-knownImaging study report provider
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        34. DocumentReference.category
                                                                        Definition

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

                                                                        ShortCategorization of document
                                                                        Comments

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

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

                                                                        High-level kind of document at a macro level.

                                                                        TypeCodeableConcept
                                                                        Is Modifierfalse
                                                                        Must Supportfalse
                                                                        Obligations
                                                                          ObligationsActor
                                                                          SHALL:populate-if-knownImaging study report provider
                                                                          Summarytrue
                                                                          Alternate Namesclass, classCode
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          SlicingThis element introduces a set of slices on DocumentReference.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ $this
                                                                          • 36. DocumentReference.category:imaging
                                                                            Slice Nameimaging
                                                                            Definition

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

                                                                            ShortCategorization of document
                                                                            Comments

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

                                                                            Control1..1
                                                                            BindingFor example codes, see ReferencedItemCategoryValueSet
                                                                            (example to http://hl7.org/fhir/ValueSet/referenced-item-category)

                                                                            High-level kind of document at a macro level.

                                                                            TypeCodeableConcept
                                                                            Is Modifierfalse
                                                                            Must Supportfalse
                                                                            Summarytrue
                                                                            Alternate Namesclass, classCode
                                                                            Pattern Value{
                                                                              "coding" : [{
                                                                                "system" : "http://loinc.org",
                                                                                "code" : "18748-4"
                                                                              }]
                                                                            }
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            38. DocumentReference.subject
                                                                            Definition

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

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

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

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

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

                                                                              ShortMain clinical acts documented
                                                                              Comments

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

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

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

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

                                                                              The anatomic structures included in the document.

                                                                              ShortBody part included
                                                                              Control0..*
                                                                              BindingFor example codes, see SNOMEDCTBodyStructures
                                                                              (example to http://hl7.org/fhir/ValueSet/body-site)

                                                                              SNOMED CT Body site concepts

                                                                              TypeCodeableReference(BodyStructure)
                                                                              Is Modifierfalse
                                                                              Must Supportfalse
                                                                              Obligations
                                                                                ObligationsActor
                                                                                SHALL:populateImaging study report provider
                                                                                Summarytrue
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                46. DocumentReference.facilityType
                                                                                Definition

                                                                                The kind of facility where the patient was seen.

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

                                                                                XDS Facility Type.

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

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

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

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

                                                                                Control0..1
                                                                                This element is affected by the following invariants: docRef-2
                                                                                BindingFor example codes, see PracticeSettingCodeValueSet
                                                                                (example to http://hl7.org/fhir/ValueSet/c80-practice-codes)

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

                                                                                TypeCodeableConcept
                                                                                Is Modifierfalse
                                                                                Must Supportfalse
                                                                                Summaryfalse
                                                                                Requirements

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

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

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

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

                                                                                When the document reference was created.

                                                                                ShortWhen this document reference was created
                                                                                Comments

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

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

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

                                                                                ShortWho and/or what authored the document
                                                                                Comments

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

                                                                                Control0..*
                                                                                TypeReference(Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson, CareTeam)
                                                                                Is Modifierfalse
                                                                                Must Supportfalse
                                                                                Obligations
                                                                                  ObligationsActor
                                                                                  SHALL:populate-if-knownImaging study report provider
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  56. DocumentReference.attester
                                                                                  Definition

                                                                                  A participant who has authenticated the accuracy of the document.

                                                                                  ShortAttests to accuracy of the document
                                                                                  Comments

                                                                                  Only list each attester once.

                                                                                  Control0..*
                                                                                  TypeBackboneElement
                                                                                  Is Modifierfalse
                                                                                  Must Supportfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Identifies responsibility for the accuracy of the document content.

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

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

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

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

                                                                                  ShortAdditional content defined by implementations
                                                                                  Comments

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

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

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

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

                                                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                                                  Comments

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

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

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

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

                                                                                  The type of attestation the authenticator offers.

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

                                                                                  The way in which a person authenticated a document.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Must Supportfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Indicates the level of authority of the attestation.

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

                                                                                  When the document was attested by the party.

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

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

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

                                                                                  Who attested the document in the specified way.

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

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

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

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

                                                                                  ShortOrganization that manages the Imaging Report
                                                                                  Comments

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

                                                                                  Control0..1
                                                                                  TypeReference(Organization (EU base))
                                                                                  Is Modifierfalse
                                                                                  Must Supportfalse
                                                                                  Obligations
                                                                                    ObligationsActor
                                                                                    SHALL:populate-if-knownImaging study report provider
                                                                                    Summaryfalse
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    72. DocumentReference.relatesTo
                                                                                    Definition

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

                                                                                    ShortRelationships to other documents
                                                                                    Comments

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

                                                                                    Control0..*
                                                                                    TypeBackboneElement
                                                                                    Is Modifierfalse
                                                                                    Must Supportfalse
                                                                                    Obligations
                                                                                      ObligationsActor
                                                                                      SHALL:populate-if-knownImaging study report provider
                                                                                      Summarytrue
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      74. DocumentReference.relatesTo.id
                                                                                      Definition

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

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

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

                                                                                      ShortAdditional content defined by implementations
                                                                                      Comments

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

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

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

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

                                                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                                                      Comments

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

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

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

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

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

                                                                                      ShortThe relationship type with another document
                                                                                      Comments

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

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

                                                                                      The type of relationship between the documents.

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

                                                                                      The target document of this relationship.

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

                                                                                      Human-readable description of the source document.

                                                                                      ShortHuman-readable description
                                                                                      Comments

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

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

                                                                                      Helps humans to assess whether the document is of interest.

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

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

                                                                                      ShortDocument security-tags
                                                                                      Comments

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

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

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

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

                                                                                      TypeCodeableConcept
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Obligations
                                                                                        ObligationsActor
                                                                                        SHALL:populate-if-knownImaging study report provider
                                                                                        Summarytrue
                                                                                        Requirements

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

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

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

                                                                                        ShortDocument referenced
                                                                                        Comments

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

                                                                                        Control1..1
                                                                                        TypeBackboneElement
                                                                                        Is Modifierfalse
                                                                                        Must Supportfalse
                                                                                        Summarytrue
                                                                                        Requirements

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

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

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

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

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

                                                                                        ShortAdditional content defined by implementations
                                                                                        Comments

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

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

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

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

                                                                                        ShortExtensions that cannot be ignored even if unrecognized
                                                                                        Comments

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

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

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

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

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

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

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

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

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

                                                                                        ShortAdditional content defined by implementations
                                                                                        Comments

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

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

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

                                                                                          ShortMime type of the content, with charset etc.
                                                                                          Control1..1
                                                                                          This element is affected by the following invariants: att-1
                                                                                          BindingThe codes SHALL be taken from MimeTypes
                                                                                          (required to http://hl7.org/fhir/ValueSet/mimetypes|5.0.0)

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

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

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

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

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

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

                                                                                          IETF language tag for a human language.

                                                                                          Typecode
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Obligations
                                                                                            ObligationsActor
                                                                                            SHALL:populateImaging study report provider
                                                                                            Summarytrue
                                                                                            Requirements

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

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

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

                                                                                            ShortData inline, base64ed
                                                                                            Comments

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

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

                                                                                            The data needs to able to be transmitted inline.

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

                                                                                            A location where the data can be accessed.

                                                                                            ShortUri where the data can be found
                                                                                            Comments

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

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

                                                                                            The data needs to be transmitted by reference.

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

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

                                                                                            ShortNumber of bytes of content (if url provided)
                                                                                            Comments

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

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

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

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

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

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

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

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

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

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

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

                                                                                            ShortLabel to display in place of the data
                                                                                            Comments

                                                                                            May sometimes be derived from the source filename.

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

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

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

                                                                                            The date that the attachment was first created.

                                                                                            ShortDate attachment was first created
                                                                                            Control0..1
                                                                                            TypedateTime
                                                                                            Is Modifierfalse
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Obligations
                                                                                              ObligationsActor
                                                                                              SHALL:populateImaging study report provider
                                                                                              Summarytrue
                                                                                              Requirements

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

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

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

                                                                                              ShortHeight of the image in pixels (photo/video)
                                                                                              Control0..1
                                                                                              TypepositiveInt
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summaryfalse
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              120. DocumentReference.content.attachment.width
                                                                                              Definition

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

                                                                                              ShortWidth of the image in pixels (photo/video)
                                                                                              Control0..1
                                                                                              TypepositiveInt
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summaryfalse
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              122. DocumentReference.content.attachment.frames
                                                                                              Definition

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

                                                                                              ShortNumber of frames if > 1 (photo)
                                                                                              Comments

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

                                                                                              Control0..1
                                                                                              TypepositiveInt
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summaryfalse
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              124. DocumentReference.content.attachment.duration
                                                                                              Definition

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

                                                                                              ShortLength in seconds (audio / video)
                                                                                              Comments

                                                                                              The duration might differ from occurrencePeriod if recording was paused.

                                                                                              Control0..1
                                                                                              Typedecimal
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summaryfalse
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              126. DocumentReference.content.attachment.pages
                                                                                              Definition

                                                                                              The number of pages when printed.

                                                                                              ShortNumber of printed pages
                                                                                              Control0..1
                                                                                              TypepositiveInt
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summaryfalse
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              128. DocumentReference.content.profile
                                                                                              Definition

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

                                                                                              ShortContent profile rules for the document
                                                                                              Comments

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

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

                                                                                              Control1..*
                                                                                              TypeBackboneElement
                                                                                              Is Modifierfalse
                                                                                              Must Supportfalse
                                                                                              Summarytrue
                                                                                              Alternate Namesformat, formatCode
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              SlicingThis element introduces a set of slices on DocumentReference.content.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                              • value @ value
                                                                                              • 130. DocumentReference.content.profile.id
                                                                                                Definition

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

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

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

                                                                                                ShortAdditional content defined by implementations
                                                                                                Comments

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

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

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

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

                                                                                                ShortExtensions that cannot be ignored even if unrecognized
                                                                                                Comments

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

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

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

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

                                                                                                Code|uri|canonical.

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

                                                                                                Document Format Codes.

                                                                                                TypeChoice of: Coding, uri, canonical
                                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                Is Modifierfalse
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                Must Supportfalse
                                                                                                Summarytrue
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                138. DocumentReference.content.profile:hl7eu-imaging-report
                                                                                                Slice Namehl7eu-imaging-report
                                                                                                Definition

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

                                                                                                ShortContent profile rules for the document
                                                                                                Comments

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

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

                                                                                                Control1..1
                                                                                                TypeBackboneElement
                                                                                                Is Modifierfalse
                                                                                                Must Supportfalse
                                                                                                Summarytrue
                                                                                                Alternate Namesformat, formatCode
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                140. DocumentReference.content.profile:hl7eu-imaging-report.id
                                                                                                Definition

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

                                                                                                ShortUnique id for inter-element referencing
                                                                                                Control0..1
                                                                                                This element is affected by the following invariants: ele-1
                                                                                                Typestring
                                                                                                Is Modifierfalse
                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                Summaryfalse
                                                                                                142. DocumentReference.content.profile:hl7eu-imaging-report.extension
                                                                                                Definition

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

                                                                                                ShortAdditional content defined by implementations
                                                                                                Comments

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

                                                                                                Control0..*
                                                                                                TypeExtension
                                                                                                Is Modifierfalse
                                                                                                Summaryfalse
                                                                                                Alternate Namesextensions, user content
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                144. DocumentReference.content.profile:hl7eu-imaging-report.modifierExtension
                                                                                                Definition

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

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

                                                                                                ShortExtensions that cannot be ignored even if unrecognized
                                                                                                Comments

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

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

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

                                                                                                Alternate Namesextensions, user content, modifiers
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                146. DocumentReference.content.profile:hl7eu-imaging-report.value[x]
                                                                                                Definition

                                                                                                Code|uri|canonical.

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

                                                                                                Document Format Codes.

                                                                                                TypeChoice of: Coding, uri, canonical
                                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                Is Modifierfalse
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                Must Supportfalse
                                                                                                Summarytrue
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                SlicingThis element introduces a set of slices on DocumentReference.content.profile.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                • type @ $this
                                                                                                • 148. DocumentReference.content.profile:hl7eu-imaging-report.value[x]:valueCanonical
                                                                                                  Slice NamevalueCanonical
                                                                                                  Definition

                                                                                                  Code|uri|canonical.

                                                                                                  ShortCode|uri|canonical
                                                                                                  Control0..1
                                                                                                  Typecanonical
                                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                  Is Modifierfalse
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Must Supportfalse
                                                                                                  Summarytrue
                                                                                                  Pattern Valuehttp://hl7.eu/fhir/imaging-r5/StructureDefinition/ImReport
                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))