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 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

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

Resource Profile: Imaging Key Image Document Reference

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

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

Usage:

• Refer to this Resource Profile: Imaging Composition

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name	Flags	Card.	Type	Description & Constraints
DocumentReference	C	0..*	DocumentReference	A reference to a document docRef-1: facilityType SHALL only be present if context is not an encounter docRef-2: practiceSetting SHALL only be present if context is not present dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
meta	Σ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
security	SΣ	0..*	Coding	Security Labels applied to this resource Binding: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language	S	0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SOΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
identifier:seriesInstanceUid	SΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging/CodeSystem/codesystem-missing-dicom-terminology
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
system	SΣ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: urn:ietf:rfc:3986
value	SΣC	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:sopClassInstanceUid	SΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
system	SΣ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: urn:ietf:rfc:3986
value	SΣC	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
Slices for basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
basedOn:imorderaccession	S	0..1	Reference(Imaging Order)	Procedure that caused this media to be created ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. ele-1: All FHIR elements must have a @value or children
modality	SOΣ	1..1	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance. ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. ele-1: All FHIR elements must have a @value or children
category:imkeyimages	SΣ	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. ele-1: All FHIR elements must have a @value or children
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children
coding:keyimagecode	SΣ	1..1	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
display		1..1	string	Representation defined by the system Fixed Value: Imaging Key Images Document
subject	SOΣ	1..1	Reference(Imaging Patient)	Who/what is the subject of the document ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content ele-1: All FHIR elements must have a @value or children
bodySite	SOΣ	0..1	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
date	SOΣ	0..1	instant	When this document reference was created ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Slices for author	SOΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
author:performer	SΣ	0..*	Reference(Practitioner Role)	Who and/or what authored the document ele-1: All FHIR elements must have a @value or children
description	SOΣ	0..1	markdown	Human-readable description ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Slices for content	SΣ	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.where( url = 'http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail' ele-1: All FHIR elements must have a @value or children
content:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	SΣ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children
content:thumbnail	SΣ	0..1	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
value[x]		1..1	boolean	Value of extension ele-1: All FHIR elements must have a @value or children Required Pattern: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	SΣ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children
content:content	SOΣ	1..1	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
value[x]		1..1	boolean	Value of extension ele-1: All FHIR elements must have a @value or children Required Pattern: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	SOΣ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
contentType	SOΣC	0..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) ele-1: All FHIR elements must have a @value or children Example General: text/plain; charset=UTF-8, image/png Obligations Actor SHALL:populate-if-known IM Producer
url	SOΣ	1..1	url	Uri where the data can be found ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/logo-small.png Obligations Actor SHALL:populate-if-known IM Producer
title	SOΣ	0..1	string	Label to display in place of the data ele-1: All FHIR elements must have a @value or children Example General: Official Corporate Logo Obligations Actor SHALL:populate-if-known IM Producer
height	SOTU	0..1	positiveInt	Height of the image in pixels (photo/video) ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
width	SOTU	0..1	positiveInt	Width of the image in pixels (photo/video) ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
frames	SOTU	0..1	positiveInt	Number of frames if > 1 (photo) ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
duration	SOTU	0..1	decimal	Length in seconds (audio / video) ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	AllSecurityLabels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.identifier:seriesInstanceUid.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 from the FHIR Standard
DocumentReference.identifier:seriesInstanceUid.type	extensible	Pattern: 00080018 http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.identifier:sopClassInstanceUid.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 from the FHIR Standard
DocumentReference.identifier:sopClassInstanceUid.type	extensible	Pattern: 112002 http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0 from the FHIR Standard
DocumentReference.modality	extensible	Modality http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
DocumentReference.category	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.category:imkeyimages	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
DocumentReference.content:content.attachment.contentType	required	MimeTypes (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|5.0.0 from the FHIR Standard

Constraints

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

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints
DocumentReference			DocumentReference
meta
security	S	0..*	Coding	Security Labels applied to this resource
language	S	0..1	code	Language of the resource content
Slices for identifier	SO	0..1	ImAccessionNumberIdentifier	Business identifiers for the document Slice: Unordered, Open by value:$this Obligations Actor SHALL:populate-if-known IM Producer
identifier:seriesInstanceUid	S	0..1	ImAccessionNumberIdentifier	Business identifiers for the document
type	S	1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging/CodeSystem/codesystem-missing-dicom-terminology
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
system	S	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
value	S	1..1	string	The value that is unique
identifier:sopClassInstanceUid	S	0..1	ImAccessionNumberIdentifier	Business identifiers for the document
type	S	1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
system	S	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
value	S	1..1	string	The value that is unique
Slices for basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created Slice: Unordered, Open by type:$this
basedOn:imorderaccession	S	0..1	Reference(Imaging Order)	Procedure that caused this media to be created
status	S	1..1	code	current | superseded | entered-in-error
modality	SO	1..1	CodeableConcept	Imaging modality used Obligations Actor SHALL:populate-if-known IM Producer
Slices for category	S	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this
category:imkeyimages	S	1..1	CodeableConcept	Categorization of document
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:keyimagecode	S	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
display		1..1	string	Representation defined by the system Fixed Value: Imaging Key Images Document
subject	SO	1..1	Reference(Imaging Patient)	Who/what is the subject of the document Obligations Actor SHALL:populate-if-known IM Producer
bodySite	SO	0..1	CodeableReference(BodyStructure)	Body part included Obligations Actor SHALL:populate-if-known IM Producer
date	SO	0..1	instant	When this document reference was created Obligations Actor SHALL:populate-if-known IM Producer
Slices for author	SO	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Obligations Actor SHALL:populate-if-known IM Producer
author:performer	S	0..*	Reference(Practitioner Role)	Who and/or what authored the document
description	SO	0..1	markdown	Human-readable description Obligations Actor SHALL:populate-if-known IM Producer
Slices for content	S	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.where( url = 'http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail'
content:All Slices				Content/Rules for all slices
attachment	S	1..1	Attachment	Where to access the document
content:thumbnail	S	0..1	BackboneElement	Document referenced
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
value[x]		1..1	boolean	Value of extension Required Pattern: true
content:content	SO	1..1	BackboneElement	Document referenced Obligations Actor SHALL:populate-if-known IM Producer
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
value[x]		1..1	boolean	Value of extension Required Pattern: true
attachment	O	1..1	Attachment	Where to access the document Obligations Actor SHALL:populate-if-known IM Producer
contentType	SO	0..1	code	Mime type of the content, with charset etc. Obligations Actor SHALL:populate-if-known IM Producer
url	SO	1..1	url	Uri where the data can be found Obligations Actor SHALL:populate-if-known IM Producer
title	SO	0..1	string	Label to display in place of the data Obligations Actor SHALL:populate-if-known IM Producer
height	SOTU	0..1	positiveInt	Height of the image in pixels (photo/video) Obligations Actor SHALL:populate-if-known IM Producer
width	SOTU	0..1	positiveInt	Width of the image in pixels (photo/video) Obligations Actor SHALL:populate-if-known IM Producer
frames	SOTU	0..1	positiveInt	Number of frames if > 1 (photo) Obligations Actor SHALL:populate-if-known IM Producer
duration	SOTU	0..1	decimal	Length in seconds (audio / video) Obligations Actor SHALL:populate-if-known IM Producer
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
DocumentReference	C	0..*	DocumentReference	A reference to a document docRef-1: facilityType SHALL only be present if context is not an encounter docRef-2: practiceSetting SHALL only be present if context is not present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	SΣ	0..*	Coding	Security Labels applied to this resource Binding: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SOΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document Slice: Unordered, Open by value:$this Obligations Actor SHALL:populate-if-known IM Producer
identifier:seriesInstanceUid	SΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging/CodeSystem/codesystem-missing-dicom-terminology
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
value	SΣC	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:sopClassInstanceUid	SΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
value	SΣC	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
version	Σ	0..1	string	An explicitly assigned identifer of a variation of the content in the DocumentReference
Slices for basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created Slice: Unordered, Open by type:$this
basedOn:imorderaccession	S	0..1	Reference(Imaging Order)	Procedure that caused this media to be created
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
modality	SOΣ	1..1	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance. Obligations Actor SHALL:populate-if-known IM Producer
type	Σ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
category:imkeyimages	SΣ	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:keyimagecode	SΣ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
display		1..1	string	Representation defined by the system Fixed Value: Imaging Key Images Document
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(Imaging Patient)	Who/what is the subject of the document Obligations Actor SHALL:populate-if-known IM Producer
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableReference()	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite	SOΣ	0..1	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts Obligations Actor SHALL:populate-if-known IM Producer
facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	C	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
period	Σ	0..1	Period	Time of service that is being documented
date	SOΣ	0..1	instant	When this document reference was created Obligations Actor SHALL:populate-if-known IM Producer
Slices for author	SOΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Obligations Actor SHALL:populate-if-known IM Producer
author:performer	SΣ	0..*	Reference(Practitioner Role)	Who and/or what authored the document
attester		0..*	BackboneElement	Attests to accuracy of the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	CodeableConcept	personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
time		0..1	dateTime	When the document was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	SOΣ	0..1	markdown	Human-readable description Obligations Actor SHALL:populate-if-known IM Producer
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
Slices for content	SΣ	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.where( url = 'http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail'
content:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣ	1..1	Attachment	Where to access the document
profile	Σ	0..*	BackboneElement	Content profile rules for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
content:thumbnail	SΣ	0..1	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
value[x]		1..1	boolean	Value of extension Required Pattern: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣ	1..1	Attachment	Where to access the document
profile	Σ	0..*	BackboneElement	Content profile rules for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
content:content	SOΣ	1..1	BackboneElement	Document referenced Obligations Actor SHALL:populate-if-known IM Producer
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
value[x]		1..1	boolean	Value of extension Required Pattern: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SOΣ	1..1	Attachment	Where to access the document Obligations Actor SHALL:populate-if-known IM Producer
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SOΣC	0..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png Obligations Actor SHALL:populate-if-known IM Producer
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language. Additional Bindings Purpose CommonLanguages Starter Set Example General: en-AU
data	C	0..1	base64Binary	Data inline, base64ed
url	SOΣ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png Obligations Actor SHALL:populate-if-known IM Producer
size	Σ	0..1	integer64	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	SOΣ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo Obligations Actor SHALL:populate-if-known IM Producer
creation	Σ	0..1	dateTime	Date attachment was first created
height	SOTU	0..1	positiveInt	Height of the image in pixels (photo/video) Obligations Actor SHALL:populate-if-known IM Producer
width	SOTU	0..1	positiveInt	Width of the image in pixels (photo/video) Obligations Actor SHALL:populate-if-known IM Producer
frames	SOTU	0..1	positiveInt	Number of frames if > 1 (photo) Obligations Actor SHALL:populate-if-known IM Producer
duration	SOTU	0..1	decimal	Length in seconds (audio / video) Obligations Actor SHALL:populate-if-known IM Producer
pages		0..1	positiveInt	Number of printed pages
profile	Σ	0..*	BackboneElement	Content profile rules for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	AllSecurityLabels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
DocumentReference.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.identifier:seriesInstanceUid.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 from the FHIR Standard
DocumentReference.identifier:seriesInstanceUid.type	extensible	Pattern: 00080018 http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.identifier:sopClassInstanceUid.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 from the FHIR Standard
DocumentReference.identifier:sopClassInstanceUid.type	extensible	Pattern: 112002 http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0 from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|5.0.0 from the FHIR Standard
DocumentReference.modality	extensible	Modality http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
DocumentReference.type	preferred	FHIRDocumentTypeCodes http://hl7.org/fhir/ValueSet/doc-typecodes from the FHIR Standard
DocumentReference.category	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.category:imkeyimages	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
DocumentReference.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard
DocumentReference.attester.mode	preferred	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode from the FHIR Standard
DocumentReference.relatesTo.code	extensible	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type from the FHIR Standard
DocumentReference.securityLabel	example	SecurityLabelExamples http://hl7.org/fhir/ValueSet/security-label-examples from the FHIR Standard
DocumentReference.content.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
DocumentReference.content:thumbnail.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
DocumentReference.content:content.attachment.contentType	required	MimeTypes (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|5.0.0 from the FHIR Standard
DocumentReference.content:content.attachment.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.content:content.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

Constraints

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

This structure is derived from DocumentReference

Summary

Mandatory: 10 elements(8 nested mandatory elements)
Must-Support: 36 elements

Structures

This structure refers to these other structures:

• Imaging Accession Number Identifier (http://hl7.eu/fhir/imaging/StructureDefinition/im-accession-number-identifier)
• Imaging Order (http://hl7.eu/fhir/imaging/StructureDefinition/im-order)
• Imaging Patient (http://hl7.eu/fhir/imaging/StructureDefinition/im-patient)
• Practitioner Role (http://hl7.eu/fhir/imaging/StructureDefinition/im-practitioner-role)

Extensions

This structure refers to these extensions:

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

Slices

This structure defines the following Slices:

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

Maturity: 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference	C	0..*	DocumentReference	A reference to a document docRef-1: facilityType SHALL only be present if context is not an encounter docRef-2: practiceSetting SHALL only be present if context is not present dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
meta	Σ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
security	SΣ	0..*	Coding	Security Labels applied to this resource Binding: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language	S	0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SOΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
identifier:seriesInstanceUid	SΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging/CodeSystem/codesystem-missing-dicom-terminology
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
system	SΣ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: urn:ietf:rfc:3986
value	SΣC	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:sopClassInstanceUid	SΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
system	SΣ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: urn:ietf:rfc:3986
value	SΣC	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
Slices for basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
basedOn:imorderaccession	S	0..1	Reference(Imaging Order)	Procedure that caused this media to be created ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. ele-1: All FHIR elements must have a @value or children
modality	SOΣ	1..1	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance. ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. ele-1: All FHIR elements must have a @value or children
category:imkeyimages	SΣ	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. ele-1: All FHIR elements must have a @value or children
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children
coding:keyimagecode	SΣ	1..1	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
display		1..1	string	Representation defined by the system Fixed Value: Imaging Key Images Document
subject	SOΣ	1..1	Reference(Imaging Patient)	Who/what is the subject of the document ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content ele-1: All FHIR elements must have a @value or children
bodySite	SOΣ	0..1	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
date	SOΣ	0..1	instant	When this document reference was created ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Slices for author	SOΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
author:performer	SΣ	0..*	Reference(Practitioner Role)	Who and/or what authored the document ele-1: All FHIR elements must have a @value or children
description	SOΣ	0..1	markdown	Human-readable description ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Slices for content	SΣ	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.where( url = 'http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail' ele-1: All FHIR elements must have a @value or children
content:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	SΣ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children
content:thumbnail	SΣ	0..1	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
value[x]		1..1	boolean	Value of extension ele-1: All FHIR elements must have a @value or children Required Pattern: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	SΣ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children
content:content	SOΣ	1..1	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
value[x]		1..1	boolean	Value of extension ele-1: All FHIR elements must have a @value or children Required Pattern: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	SOΣ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
contentType	SOΣC	0..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) ele-1: All FHIR elements must have a @value or children Example General: text/plain; charset=UTF-8, image/png Obligations Actor SHALL:populate-if-known IM Producer
url	SOΣ	1..1	url	Uri where the data can be found ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/logo-small.png Obligations Actor SHALL:populate-if-known IM Producer
title	SOΣ	0..1	string	Label to display in place of the data ele-1: All FHIR elements must have a @value or children Example General: Official Corporate Logo Obligations Actor SHALL:populate-if-known IM Producer
height	SOTU	0..1	positiveInt	Height of the image in pixels (photo/video) ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
width	SOTU	0..1	positiveInt	Width of the image in pixels (photo/video) ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
frames	SOTU	0..1	positiveInt	Number of frames if > 1 (photo) ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
duration	SOTU	0..1	decimal	Length in seconds (audio / video) ele-1: All FHIR elements must have a @value or children Obligations Actor SHALL:populate-if-known IM Producer
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	AllSecurityLabels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.identifier:seriesInstanceUid.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 from the FHIR Standard
DocumentReference.identifier:seriesInstanceUid.type	extensible	Pattern: 00080018 http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.identifier:sopClassInstanceUid.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 from the FHIR Standard
DocumentReference.identifier:sopClassInstanceUid.type	extensible	Pattern: 112002 http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0 from the FHIR Standard
DocumentReference.modality	extensible	Modality http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
DocumentReference.category	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.category:imkeyimages	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
DocumentReference.content:content.attachment.contentType	required	MimeTypes (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|5.0.0 from the FHIR Standard

Constraints

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

Differential View

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints
DocumentReference			DocumentReference
meta
security	S	0..*	Coding	Security Labels applied to this resource
language	S	0..1	code	Language of the resource content
Slices for identifier	SO	0..1	ImAccessionNumberIdentifier	Business identifiers for the document Slice: Unordered, Open by value:$this Obligations Actor SHALL:populate-if-known IM Producer
identifier:seriesInstanceUid	S	0..1	ImAccessionNumberIdentifier	Business identifiers for the document
type	S	1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging/CodeSystem/codesystem-missing-dicom-terminology
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
system	S	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
value	S	1..1	string	The value that is unique
identifier:sopClassInstanceUid	S	0..1	ImAccessionNumberIdentifier	Business identifiers for the document
type	S	1..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
system	S	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
value	S	1..1	string	The value that is unique
Slices for basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created Slice: Unordered, Open by type:$this
basedOn:imorderaccession	S	0..1	Reference(Imaging Order)	Procedure that caused this media to be created
status	S	1..1	code	current | superseded | entered-in-error
modality	SO	1..1	CodeableConcept	Imaging modality used Obligations Actor SHALL:populate-if-known IM Producer
Slices for category	S	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this
category:imkeyimages	S	1..1	CodeableConcept	Categorization of document
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:keyimagecode	S	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
display		1..1	string	Representation defined by the system Fixed Value: Imaging Key Images Document
subject	SO	1..1	Reference(Imaging Patient)	Who/what is the subject of the document Obligations Actor SHALL:populate-if-known IM Producer
bodySite	SO	0..1	CodeableReference(BodyStructure)	Body part included Obligations Actor SHALL:populate-if-known IM Producer
date	SO	0..1	instant	When this document reference was created Obligations Actor SHALL:populate-if-known IM Producer
Slices for author	SO	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Obligations Actor SHALL:populate-if-known IM Producer
author:performer	S	0..*	Reference(Practitioner Role)	Who and/or what authored the document
description	SO	0..1	markdown	Human-readable description Obligations Actor SHALL:populate-if-known IM Producer
Slices for content	S	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.where( url = 'http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail'
content:All Slices				Content/Rules for all slices
attachment	S	1..1	Attachment	Where to access the document
content:thumbnail	S	0..1	BackboneElement	Document referenced
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
value[x]		1..1	boolean	Value of extension Required Pattern: true
content:content	SO	1..1	BackboneElement	Document referenced Obligations Actor SHALL:populate-if-known IM Producer
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
value[x]		1..1	boolean	Value of extension Required Pattern: true
attachment	O	1..1	Attachment	Where to access the document Obligations Actor SHALL:populate-if-known IM Producer
contentType	SO	0..1	code	Mime type of the content, with charset etc. Obligations Actor SHALL:populate-if-known IM Producer
url	SO	1..1	url	Uri where the data can be found Obligations Actor SHALL:populate-if-known IM Producer
title	SO	0..1	string	Label to display in place of the data Obligations Actor SHALL:populate-if-known IM Producer
height	SOTU	0..1	positiveInt	Height of the image in pixels (photo/video) Obligations Actor SHALL:populate-if-known IM Producer
width	SOTU	0..1	positiveInt	Width of the image in pixels (photo/video) Obligations Actor SHALL:populate-if-known IM Producer
frames	SOTU	0..1	positiveInt	Number of frames if > 1 (photo) Obligations Actor SHALL:populate-if-known IM Producer
duration	SOTU	0..1	decimal	Length in seconds (audio / video) Obligations Actor SHALL:populate-if-known IM Producer
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference	C	0..*	DocumentReference	A reference to a document docRef-1: facilityType SHALL only be present if context is not an encounter docRef-2: practiceSetting SHALL only be present if context is not present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	SΣ	0..*	Coding	Security Labels applied to this resource Binding: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SOΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document Slice: Unordered, Open by value:$this Obligations Actor SHALL:populate-if-known IM Producer
identifier:seriesInstanceUid	SΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging/CodeSystem/codesystem-missing-dicom-terminology
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 00080018
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
value	SΣC	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:sopClassInstanceUid	SΣ	0..1	ImAccessionNumberIdentifier	Business identifiers for the document
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://dicom.nema.org/resources/ontology/DCM
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 112002
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	The namespace for the identifier value Required Pattern: urn:ietf:rfc:3986
value	SΣC	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
version	Σ	0..1	string	An explicitly assigned identifer of a variation of the content in the DocumentReference
Slices for basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created Slice: Unordered, Open by type:$this
basedOn:imorderaccession	S	0..1	Reference(Imaging Order)	Procedure that caused this media to be created
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
modality	SOΣ	1..1	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance. Obligations Actor SHALL:populate-if-known IM Producer
type	Σ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by profile:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
category:imkeyimages	SΣ	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:keyimagecode	SΣ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55113-5
display		1..1	string	Representation defined by the system Fixed Value: Imaging Key Images Document
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(Imaging Patient)	Who/what is the subject of the document Obligations Actor SHALL:populate-if-known IM Producer
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableReference()	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite	SOΣ	0..1	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts Obligations Actor SHALL:populate-if-known IM Producer
facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	C	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
period	Σ	0..1	Period	Time of service that is being documented
date	SOΣ	0..1	instant	When this document reference was created Obligations Actor SHALL:populate-if-known IM Producer
Slices for author	SOΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document Slice: Unordered, Open by profile:$this Obligations Actor SHALL:populate-if-known IM Producer
author:performer	SΣ	0..*	Reference(Practitioner Role)	Who and/or what authored the document
attester		0..*	BackboneElement	Attests to accuracy of the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	CodeableConcept	personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
time		0..1	dateTime	When the document was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	SOΣ	0..1	markdown	Human-readable description Obligations Actor SHALL:populate-if-known IM Producer
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
Slices for content	SΣ	1..*	BackboneElement	Document referenced Slice: Unordered, Open by value:extension.where( url = 'http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail'
content:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣ	1..1	Attachment	Where to access the document
profile	Σ	0..*	BackboneElement	Content profile rules for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
content:thumbnail	SΣ	0..1	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
value[x]		1..1	boolean	Value of extension Required Pattern: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣ	1..1	Attachment	Where to access the document
profile	Σ	0..*	BackboneElement	Content profile rules for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
content:content	SOΣ	1..1	BackboneElement	Document referenced Obligations Actor SHALL:populate-if-known IM Producer
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:thumbnail	S	1..1	(Complex)	Thumbnail state URL: http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/documentreference-thumbnail"
value[x]		1..1	boolean	Value of extension Required Pattern: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SOΣ	1..1	Attachment	Where to access the document Obligations Actor SHALL:populate-if-known IM Producer
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SOΣC	0..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png Obligations Actor SHALL:populate-if-known IM Producer
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language. Additional Bindings Purpose CommonLanguages Starter Set Example General: en-AU
data	C	0..1	base64Binary	Data inline, base64ed
url	SOΣ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png Obligations Actor SHALL:populate-if-known IM Producer
size	Σ	0..1	integer64	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	SOΣ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo Obligations Actor SHALL:populate-if-known IM Producer
creation	Σ	0..1	dateTime	Date attachment was first created
height	SOTU	0..1	positiveInt	Height of the image in pixels (photo/video) Obligations Actor SHALL:populate-if-known IM Producer
width	SOTU	0..1	positiveInt	Width of the image in pixels (photo/video) Obligations Actor SHALL:populate-if-known IM Producer
frames	SOTU	0..1	positiveInt	Number of frames if > 1 (photo) Obligations Actor SHALL:populate-if-known IM Producer
duration	SOTU	0..1	decimal	Length in seconds (audio / video) Obligations Actor SHALL:populate-if-known IM Producer
pages		0..1	positiveInt	Number of printed pages
profile	Σ	0..*	BackboneElement	Content profile rules for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	AllSecurityLabels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
DocumentReference.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.identifier:seriesInstanceUid.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 from the FHIR Standard
DocumentReference.identifier:seriesInstanceUid.type	extensible	Pattern: 00080018 http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.identifier:sopClassInstanceUid.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 from the FHIR Standard
DocumentReference.identifier:sopClassInstanceUid.type	extensible	Pattern: 112002 http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0 from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|5.0.0 from the FHIR Standard
DocumentReference.modality	extensible	Modality http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
DocumentReference.type	preferred	FHIRDocumentTypeCodes http://hl7.org/fhir/ValueSet/doc-typecodes from the FHIR Standard
DocumentReference.category	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.category:imkeyimages	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
DocumentReference.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard
DocumentReference.attester.mode	preferred	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode from the FHIR Standard
DocumentReference.relatesTo.code	extensible	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type from the FHIR Standard
DocumentReference.securityLabel	example	SecurityLabelExamples http://hl7.org/fhir/ValueSet/security-label-examples from the FHIR Standard
DocumentReference.content.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
DocumentReference.content:thumbnail.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
DocumentReference.content:content.attachment.contentType	required	MimeTypes (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|5.0.0 from the FHIR Standard
DocumentReference.content:content.attachment.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.content:content.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

Constraints

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

This structure is derived from DocumentReference

Summary

Mandatory: 10 elements(8 nested mandatory elements)
Must-Support: 36 elements

Structures

This structure refers to these other structures:

• Imaging Accession Number Identifier (http://hl7.eu/fhir/imaging/StructureDefinition/im-accession-number-identifier)
• Imaging Order (http://hl7.eu/fhir/imaging/StructureDefinition/im-order)
• Imaging Patient (http://hl7.eu/fhir/imaging/StructureDefinition/im-patient)
• Practitioner Role (http://hl7.eu/fhir/imaging/StructureDefinition/im-practitioner-role)

Extensions

This structure refers to these extensions:

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

Slices

This structure defines the following Slices:

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

Maturity: 1