Healthy Route Implementation Guide
0.1.0 - ci-build

Healthy Route Implementation Guide, published by Savannah Informatics. 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/savannahghi/healthy-route-ig/ and changes regularly. See the Directory of published versions

Resource Profile: Healthy Route Document

Official URL: https://fhir.savannahghi.org/ig/healthy-route/StructureDefinition/hr-document-reference Version: 0.1.0
Draft as of 2026-09-04 Computable Name: HRDocumentReference

Any document held by the study, in the form common to all of them.

Carries the constraints that hold for every document regardless of its purpose, so that they are inherited rather than restated. Profiles derived from it narrow it to a particular kind of document; it is usable directly for documents that need no further constraint.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:tenant S 1..1 Identifier Owning site tenant
URL: https://fhir.savannahghi.org/ig/healthy-route/StructureDefinition/hr-tenant
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
... subject SΣ 0..1 Reference(Healthy Route Patient) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... date SΣ 1..1 instant When the document was registered
... custodian S 1..1 Reference(Healthy Route Organization) Organisation holding the original
... content SΣ 1..* BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣ 1..1 Attachment Where to access the document
..... contentType SΣC 1..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
..... url SΣ 1..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... hash SΣ 0..1 base64Binary SHA-1 hash of the file

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

This structure is derived from DocumentReference

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:tenant S 1..1 Identifier Owning site tenant
URL: https://fhir.savannahghi.org/ig/healthy-route/StructureDefinition/hr-tenant
... status S 1..1 code current | superseded | entered-in-error
... subject S 0..1 Reference(Healthy Route Patient) Who/what is the subject of the document
... custodian S 1..1 Reference(Healthy Route Organization) Organisation holding the original
... content S 1..* BackboneElement Document referenced
.... attachment S 1..1 Attachment Where to access the document
..... contentType S 1..1 code Mime type of the content, with charset etc.
..... data 0..0 Data inline, base64ed
..... url S 1..1 url Uri where the data can be found
..... hash S 0..1 base64Binary SHA-1 hash of the file

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:tenant S 1..1 Identifier Owning site tenant
URL: https://fhir.savannahghi.org/ig/healthy-route/StructureDefinition/hr-tenant
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business identifiers for the document
... version Σ 0..1 string An explicitly assigned identifer of a variation of the content in the DocumentReference
... 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
... 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 Σ 0..* CodeableConcept Imaging modality used
Binding: Modality . (extensible): Type of acquired data in the instance.
... type Σ 0..1 CodeableConcept Kind of document (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
... category Σ 0..* CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
... subject SΣ 0..1 Reference(Healthy Route Patient) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... event 0..* CodeableReference() Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
... bodySite Σ 0..* CodeableReference(BodyStructure) Body part included
Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
... facilityType C 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
... practiceSetting C 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty)
Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
... period Σ 0..1 Period Time of service that is being documented
... date SΣ 1..1 instant When the document was registered
... author Σ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) 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 S 1..1 Reference(Healthy Route Organization) Organisation holding the original
... relatesTo Σ 0..* BackboneElement Relationships to other documents
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept The relationship type with another document
Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 markdown Human-readable description
... securityLabel Σ 0..* CodeableConcept Document security-tags
Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
... content SΣ 1..* BackboneElement Document referenced
.... 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
..... 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 SΣC 1..1 code Mime type of the content, with charset etc.
Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Example General: text/plain; charset=UTF-8, image/png
..... language Σ 0..1 code Human language of the content (BCP-47)
Binding: AllLanguages (required): IETF language tag for a human language.
Additional BindingsPurpose
CommonLanguages Starter

Example General: en-AU
..... url SΣ 1..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... size Σ 0..1 integer64 Number of bytes of content (if url provided)
..... hash SΣ 0..1 base64Binary SHA-1 hash of the file
..... title Σ 0..1 string Label to display in place of the data
Example General: Official Corporate Logo
..... creation Σ 0..1 dateTime Date attachment was first created
..... height 0..1 positiveInt Height of the image in pixels (photo/video)
..... width 0..1 positiveInt Width of the image in pixels (photo/video)
..... frames 0..1 positiveInt Number of frames if > 1 (photo)
..... duration 0..1 decimal Length in seconds (audio / video)
..... pages 0..1 positiveInt Number of printed pages
.... profile Σ 0..* BackboneElement Content profile rules for the document
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... value[x] Σ 1..1 Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
...... valueCoding Coding
...... valueUri uri
...... valueCanonical canonical(Any)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.docStatus Base required Composition Status 📍5.0.0 FHIR Std.
DocumentReference.modality Base extensible Modality . ⏿2025.3.20250714 tx.fhir.org
DocumentReference.type Base preferred FHIR Document Type Codes 📍5.0.0 FHIR Std.
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.event Base example v3 Code System ActCode 📦3.0.0 THO v7.3
DocumentReference.bodySite Base example SNOMED CT Body Structures 📍5.0.0 FHIR Std.
DocumentReference.facilityType Base example Facility Type Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.practiceSetting Base example Practice Setting Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.attester.​mode Base preferred Composition Attestation Mode 📍5.0.0 FHIR Std.
DocumentReference.relatesTo.​code Base extensible Document Relationship Type 📍5.0.0 FHIR Std.
DocumentReference.securityLabel Base example Example set of Security Labels 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v7.3

Constraints

Id Grade Path(s) Description Expression

This structure is derived from DocumentReference

Summary

Mandatory: 6 elements
Must-Support: 10 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:tenant S 1..1 Identifier Owning site tenant
URL: https://fhir.savannahghi.org/ig/healthy-route/StructureDefinition/hr-tenant
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required): The status of the document reference.
... subject SΣ 0..1 Reference(Healthy Route Patient) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... date SΣ 1..1 instant When the document was registered
... custodian S 1..1 Reference(Healthy Route Organization) Organisation holding the original
... content SΣ 1..* BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣ 1..1 Attachment Where to access the document
..... contentType SΣC 1..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
..... url SΣ 1..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... hash SΣ 0..1 base64Binary SHA-1 hash of the file

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

Differential View

This structure is derived from DocumentReference

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:tenant S 1..1 Identifier Owning site tenant
URL: https://fhir.savannahghi.org/ig/healthy-route/StructureDefinition/hr-tenant
... status S 1..1 code current | superseded | entered-in-error
... subject S 0..1 Reference(Healthy Route Patient) Who/what is the subject of the document
... custodian S 1..1 Reference(Healthy Route Organization) Organisation holding the original
... content S 1..* BackboneElement Document referenced
.... attachment S 1..1 Attachment Where to access the document
..... contentType S 1..1 code Mime type of the content, with charset etc.
..... data 0..0 Data inline, base64ed
..... url S 1..1 url Uri where the data can be found
..... hash S 0..1 base64Binary SHA-1 hash of the file

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference C 0..* DocumentReference A reference to a document
Constraints: docRef-1, docRef-2
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:tenant S 1..1 Identifier Owning site tenant
URL: https://fhir.savannahghi.org/ig/healthy-route/StructureDefinition/hr-tenant
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business identifiers for the document
... version Σ 0..1 string An explicitly assigned identifer of a variation of the content in the DocumentReference
... 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
... 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 Σ 0..* CodeableConcept Imaging modality used
Binding: Modality . (extensible): Type of acquired data in the instance.
... type Σ 0..1 CodeableConcept Kind of document (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
... category Σ 0..* CodeableConcept Categorization of document
Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
... subject SΣ 0..1 Reference(Healthy Route Patient) Who/what is the subject of the document
... context C 0..* Reference(Appointment | Encounter | EpisodeOfCare) Context of the document content
... event 0..* CodeableReference() Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
... bodySite Σ 0..* CodeableReference(BodyStructure) Body part included
Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
... facilityType C 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
... practiceSetting C 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty)
Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
... period Σ 0..1 Period Time of service that is being documented
... date SΣ 1..1 instant When the document was registered
... author Σ 0..* Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) 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 S 1..1 Reference(Healthy Route Organization) Organisation holding the original
... relatesTo Σ 0..* BackboneElement Relationships to other documents
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept The relationship type with another document
Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 markdown Human-readable description
... securityLabel Σ 0..* CodeableConcept Document security-tags
Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
... content SΣ 1..* BackboneElement Document referenced
.... 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
..... 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 SΣC 1..1 code Mime type of the content, with charset etc.
Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Example General: text/plain; charset=UTF-8, image/png
..... language Σ 0..1 code Human language of the content (BCP-47)
Binding: AllLanguages (required): IETF language tag for a human language.
Additional BindingsPurpose
CommonLanguages Starter

Example General: en-AU
..... url SΣ 1..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... size Σ 0..1 integer64 Number of bytes of content (if url provided)
..... hash SΣ 0..1 base64Binary SHA-1 hash of the file
..... title Σ 0..1 string Label to display in place of the data
Example General: Official Corporate Logo
..... creation Σ 0..1 dateTime Date attachment was first created
..... height 0..1 positiveInt Height of the image in pixels (photo/video)
..... width 0..1 positiveInt Width of the image in pixels (photo/video)
..... frames 0..1 positiveInt Number of frames if > 1 (photo)
..... duration 0..1 decimal Length in seconds (audio / video)
..... pages 0..1 positiveInt Number of printed pages
.... profile Σ 0..* BackboneElement Content profile rules for the document
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... value[x] Σ 1..1 Code|uri|canonical
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
...... valueCoding Coding
...... valueUri uri
...... valueCanonical canonical(Any)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📍5.0.0 FHIR Std.
DocumentReference.docStatus Base required Composition Status 📍5.0.0 FHIR Std.
DocumentReference.modality Base extensible Modality . ⏿2025.3.20250714 tx.fhir.org
DocumentReference.type Base preferred FHIR Document Type Codes 📍5.0.0 FHIR Std.
DocumentReference.category Base example Referenced Item Category Value Set 📍5.0.0 FHIR Std.
DocumentReference.event Base example v3 Code System ActCode 📦3.0.0 THO v7.3
DocumentReference.bodySite Base example SNOMED CT Body Structures 📍5.0.0 FHIR Std.
DocumentReference.facilityType Base example Facility Type Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.practiceSetting Base example Practice Setting Code Value Set 📍5.0.0 FHIR Std.
DocumentReference.attester.​mode Base preferred Composition Attestation Mode 📍5.0.0 FHIR Std.
DocumentReference.relatesTo.​code Base extensible Document Relationship Type 📍5.0.0 FHIR Std.
DocumentReference.securityLabel Base example Example set of Security Labels 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.contentType Base required Mime Types 📍5.0.0 FHIR Std.
DocumentReference.content.​attachment.language Base required All Languages 📍5.0.0 FHIR Std.
DocumentReference.content.​profile.value[x] Base preferred HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v7.3

Constraints

Id Grade Path(s) Description Expression

This structure is derived from DocumentReference

Summary

Mandatory: 6 elements
Must-Support: 10 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron