SIL HIE Implementation Guide, published by Kathurima Kimathi. 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/hie-fhir-ig-profile/ and changes regularly. See the Directory of published versions

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

Resource Profile: HIE DocumentReference

R4B DocumentReference constrained for HIE exchange. Requires strong typing, subject linkage, and well-formed attachments.

Usages:

• Refer to this Profile: HIE DocumentReference and HIE ServiceRequest
• Examples for this Profile: DocumentReference/HIEDocumentReference-example

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.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.identifier	S This element must be supported. Σ This element is included in summaries.	1..*	Identifier	Other identifiers for the document
DocumentReference.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
DocumentReference.identifier.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible) Constraints: cc-text-or-code
DocumentReference.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
DocumentReference.identifier.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
DocumentReference.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
DocumentReference.docStatus	Σ This element is included in summaries.	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required)
DocumentReference.type	S This element must be supported. Σ This element is included in summaries. C	1..1	HIECodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (extensible) Constraints: cc-text-or-code
DocumentReference.category	S This element must be supported. Σ This element is included in summaries. C	1..*	HIECodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Constraints: cc-text-or-code
DocumentReference.subject	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Patient)	Who/what is the subject of the document
DocumentReference.date	S This element must be supported. Σ This element is included in summaries.	1..1	instant	When this document reference was created
DocumentReference.author	S This element must be supported. Σ This element is included in summaries.	1..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient)	Who and/or what authored the document
DocumentReference.authenticator		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Who/what authenticated the document
DocumentReference.custodian		0..1	HIEReference(HIE Organization)	Organization which maintains the document
DocumentReference.securityLabel	Σ This element is included in summaries. C	0..*	HIECodeableConcept	Document security-tags Binding: All Security Labels (extensible) Constraints: cc-text-or-code
DocumentReference.content	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Document referenced
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.content.attachment	S This element must be supported. Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.content.attachment.contentType	S This element must be supported. Σ This element is included in summaries.	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
DocumentReference.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.3.0	FHIR Std.
DocumentReference.docStatus	Base	required	CompositionStatus	📦4.3.0	FHIR Std.
DocumentReference.type	Base	extensible	FHIR Document Type Codes	📦4.3.0	FHIR Std.
DocumentReference.category	Base	example	Document Class Value Set	📍4.3.0	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📦4.3.0	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
cc-text-or-code	warning	DocumentReference.identifier.type, DocumentReference.type, DocumentReference.category, DocumentReference.securityLabel	Text is optional, coding is required	coding.exists()
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.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.identifier	S This element must be supported.	1..*	Identifier	Other identifiers for the document
DocumentReference.identifier.use		1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
DocumentReference.identifier.type		1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
DocumentReference.identifier.system		1..1	uri	The namespace for the identifier value
DocumentReference.identifier.value	S This element must be supported.	1..1	string	The value that is unique
DocumentReference.identifier.assigner	S This element must be supported.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
DocumentReference.status	S This element must be supported.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
DocumentReference.docStatus		1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required)
DocumentReference.type	S This element must be supported.	1..1	HIECodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (extensible)
DocumentReference.category	S This element must be supported.	1..*	HIECodeableConcept	Categorization of document
DocumentReference.subject	S This element must be supported.	1..1	HIEReference(HIE Patient)	Who/what is the subject of the document
DocumentReference.date	S This element must be supported.	1..1	instant	When this document reference was created
DocumentReference.author	S This element must be supported.	1..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient)	Who and/or what authored the document
DocumentReference.authenticator		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Who/what authenticated the document
DocumentReference.custodian		0..1	HIEReference(HIE Organization)	Organization which maintains the document
DocumentReference.relatesTo
DocumentReference.relatesTo.target		1..1	HIEReference(HIE DocumentReference)	Target of the relationship
DocumentReference.securityLabel		0..*	HIECodeableConcept	Document security-tags Binding: All Security Labels (extensible)
DocumentReference.content	S This element must be supported.	1..*	BackboneElement	Document referenced
DocumentReference.content.attachment	S This element must be supported.	1..1	Attachment	Where to access the document
DocumentReference.content.attachment.contentType	S This element must be supported.	1..1	code	Mime type of the content, with charset etc.
DocumentReference.context
DocumentReference.context.encounter		1..1	HIEReference(HIE Encounter | HIE EpisodeOfCare)	Context of the document content
DocumentReference.context.event		0..*	HIECodeableConcept	Main clinical acts documented
DocumentReference.context.facilityType		0..1	HIECodeableConcept	Kind of facility where patient was seen
DocumentReference.context.practiceSetting		0..1	HIECodeableConcept	Additional details about where the content was created (e.g. clinical specialty)
DocumentReference.context.sourcePatientInfo		1..1	HIEReference(HIE Patient)	Patient demographics from source
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
DocumentReference.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.3.0	FHIR Std.
DocumentReference.docStatus	Base	required	CompositionStatus	📦4.3.0	FHIR Std.
DocumentReference.type	Base	extensible	FHIR Document Type Codes	📦4.3.0	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📦4.3.0	FHIR Std.

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
DocumentReference.contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
DocumentReference.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.masterIdentifier	Σ This element is included in summaries.	0..1	Identifier	Master Version Specific Identifier
DocumentReference.identifier	S This element must be supported. Σ This element is included in summaries.	1..*	Identifier	Other identifiers for the document
DocumentReference.identifier.id		0..1	id	Unique id for inter-element referencing
DocumentReference.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
DocumentReference.identifier.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible) Constraints: cc-text-or-code
DocumentReference.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
DocumentReference.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
DocumentReference.identifier.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
DocumentReference.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
DocumentReference.docStatus	Σ This element is included in summaries.	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required)
DocumentReference.type	S This element must be supported. Σ This element is included in summaries. C	1..1	HIECodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (extensible) Constraints: cc-text-or-code
DocumentReference.category	S This element must be supported. Σ This element is included in summaries. C	1..*	HIECodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Constraints: cc-text-or-code
DocumentReference.subject	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Patient)	Who/what is the subject of the document
DocumentReference.date	S This element must be supported. Σ This element is included in summaries.	1..1	instant	When this document reference was created
DocumentReference.author	S This element must be supported. Σ This element is included in summaries.	1..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient)	Who and/or what authored the document
DocumentReference.authenticator		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Who/what authenticated the document
DocumentReference.custodian		0..1	HIEReference(HIE Organization)	Organization which maintains the document
DocumentReference.relatesTo	Σ This element is included in summaries.	0..*	BackboneElement	Relationships to other documents
DocumentReference.relatesTo.id		0..1	string	Unique id for inter-element referencing
DocumentReference.relatesTo.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.relatesTo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.relatesTo.code	Σ This element is included in summaries.	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
DocumentReference.relatesTo.target	Σ This element is included in summaries.	1..1	HIEReference(HIE DocumentReference)	Target of the relationship
DocumentReference.description	Σ This element is included in summaries.	0..1	string	Human-readable description
DocumentReference.securityLabel	Σ This element is included in summaries. C	0..*	HIECodeableConcept	Document security-tags Binding: All Security Labels (extensible) Constraints: cc-text-or-code
DocumentReference.content	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Document referenced
DocumentReference.content.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.content.attachment	S This element must be supported. Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.content.attachment.id		0..1	id	Unique id for inter-element referencing
DocumentReference.content.attachment.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.content.attachment.contentType	S This element must be supported. Σ This element is included in summaries.	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
DocumentReference.content.attachment.language	Σ This element is included in summaries.	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
DocumentReference.content.attachment.data		0..1	base64Binary	Data inline, base64ed
DocumentReference.content.attachment.url	Σ This element is included in summaries.	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
DocumentReference.content.attachment.size	Σ This element is included in summaries.	0..1	unsignedInt	Number of bytes of content (if url provided)
DocumentReference.content.attachment.hash	Σ This element is included in summaries.	0..1	base64Binary	Hash of the data (sha-1, base64ed)
DocumentReference.content.attachment.title	Σ This element is included in summaries.	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
DocumentReference.content.attachment.creation	Σ This element is included in summaries.	0..1	dateTime	Date attachment was first created
DocumentReference.content.format	Σ This element is included in summaries.	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
DocumentReference.context	Σ This element is included in summaries.	0..1	BackboneElement	Clinical context of document
DocumentReference.context.id		0..1	string	Unique id for inter-element referencing
DocumentReference.context.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.context.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.context.encounter		1..1	HIEReference(HIE Encounter | HIE EpisodeOfCare)	Context of the document content
DocumentReference.context.event	C	0..*	HIECodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. Constraints: cc-text-or-code
DocumentReference.context.period	Σ This element is included in summaries.	0..1	Period	Time of service that is being documented
DocumentReference.context.facilityType	C	0..1	HIECodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. Constraints: cc-text-or-code
DocumentReference.context.practiceSetting	C	0..1	HIECodeableConcept	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). Constraints: cc-text-or-code
DocumentReference.context.sourcePatientInfo		1..1	HIEReference(HIE Patient)	Patient demographics from source
DocumentReference.context.related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
DocumentReference.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
DocumentReference.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.3.0	FHIR Std.
DocumentReference.docStatus	Base	required	CompositionStatus	📦4.3.0	FHIR Std.
DocumentReference.type	Base	extensible	FHIR Document Type Codes	📦4.3.0	FHIR Std.
DocumentReference.category	Base	example	Document Class Value Set	📍4.3.0	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.3.0	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📦4.3.0	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.3.0	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
DocumentReference.content.​format	Base	preferred	DocumentReference Format Code Set	📍4.3.0	FHIR Std.
DocumentReference.context.​event	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.4
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.3.0	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
cc-text-or-code	warning	DocumentReference.identifier.type, DocumentReference.type, DocumentReference.category, DocumentReference.securityLabel, DocumentReference.context.event, DocumentReference.context.facilityType, DocumentReference.context.practiceSetting	Text is optional, coding is required	coding.exists()
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.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').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()
dom-r4b	warning	DocumentReference.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems	($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
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: 13 elements(2 nested mandatory elements)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

• HIE CodeableConcept (https://nshr.dha.go.ke/fhir/StructureDefinition/codeable-concept)
• HIE Reference (https://nshr.dha.go.ke/fhir/StructureDefinition/reference)
• HIE Organization (https://nshr.dha.go.ke/fhir/StructureDefinition/organization)
• HIE Patient (https://nshr.dha.go.ke/fhir/StructureDefinition/patient)
• HIE Practitioner (https://nshr.dha.go.ke/fhir/StructureDefinition/practitioner)
• HIE DocumentReference (https://nshr.dha.go.ke/fhir/StructureDefinition/documentreference)
• HIE Encounter (https://nshr.dha.go.ke/fhir/StructureDefinition/encounter)
• HIE EpisodeOfCare (https://nshr.dha.go.ke/fhir/StructureDefinition/episodeofcare)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.identifier	S This element must be supported. Σ This element is included in summaries.	1..*	Identifier	Other identifiers for the document
DocumentReference.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
DocumentReference.identifier.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible) Constraints: cc-text-or-code
DocumentReference.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
DocumentReference.identifier.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
DocumentReference.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
DocumentReference.docStatus	Σ This element is included in summaries.	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required)
DocumentReference.type	S This element must be supported. Σ This element is included in summaries. C	1..1	HIECodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (extensible) Constraints: cc-text-or-code
DocumentReference.category	S This element must be supported. Σ This element is included in summaries. C	1..*	HIECodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Constraints: cc-text-or-code
DocumentReference.subject	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Patient)	Who/what is the subject of the document
DocumentReference.date	S This element must be supported. Σ This element is included in summaries.	1..1	instant	When this document reference was created
DocumentReference.author	S This element must be supported. Σ This element is included in summaries.	1..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient)	Who and/or what authored the document
DocumentReference.authenticator		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Who/what authenticated the document
DocumentReference.custodian		0..1	HIEReference(HIE Organization)	Organization which maintains the document
DocumentReference.securityLabel	Σ This element is included in summaries. C	0..*	HIECodeableConcept	Document security-tags Binding: All Security Labels (extensible) Constraints: cc-text-or-code
DocumentReference.content	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Document referenced
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.content.attachment	S This element must be supported. Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.content.attachment.contentType	S This element must be supported. Σ This element is included in summaries.	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
DocumentReference.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.3.0	FHIR Std.
DocumentReference.docStatus	Base	required	CompositionStatus	📦4.3.0	FHIR Std.
DocumentReference.type	Base	extensible	FHIR Document Type Codes	📦4.3.0	FHIR Std.
DocumentReference.category	Base	example	Document Class Value Set	📍4.3.0	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📦4.3.0	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
cc-text-or-code	warning	DocumentReference.identifier.type, DocumentReference.type, DocumentReference.category, DocumentReference.securityLabel	Text is optional, coding is required	coding.exists()
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.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.identifier	S This element must be supported.	1..*	Identifier	Other identifiers for the document
DocumentReference.identifier.use		1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
DocumentReference.identifier.type		1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
DocumentReference.identifier.system		1..1	uri	The namespace for the identifier value
DocumentReference.identifier.value	S This element must be supported.	1..1	string	The value that is unique
DocumentReference.identifier.assigner	S This element must be supported.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
DocumentReference.status	S This element must be supported.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
DocumentReference.docStatus		1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required)
DocumentReference.type	S This element must be supported.	1..1	HIECodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (extensible)
DocumentReference.category	S This element must be supported.	1..*	HIECodeableConcept	Categorization of document
DocumentReference.subject	S This element must be supported.	1..1	HIEReference(HIE Patient)	Who/what is the subject of the document
DocumentReference.date	S This element must be supported.	1..1	instant	When this document reference was created
DocumentReference.author	S This element must be supported.	1..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient)	Who and/or what authored the document
DocumentReference.authenticator		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Who/what authenticated the document
DocumentReference.custodian		0..1	HIEReference(HIE Organization)	Organization which maintains the document
DocumentReference.relatesTo
DocumentReference.relatesTo.target		1..1	HIEReference(HIE DocumentReference)	Target of the relationship
DocumentReference.securityLabel		0..*	HIECodeableConcept	Document security-tags Binding: All Security Labels (extensible)
DocumentReference.content	S This element must be supported.	1..*	BackboneElement	Document referenced
DocumentReference.content.attachment	S This element must be supported.	1..1	Attachment	Where to access the document
DocumentReference.content.attachment.contentType	S This element must be supported.	1..1	code	Mime type of the content, with charset etc.
DocumentReference.context
DocumentReference.context.encounter		1..1	HIEReference(HIE Encounter | HIE EpisodeOfCare)	Context of the document content
DocumentReference.context.event		0..*	HIECodeableConcept	Main clinical acts documented
DocumentReference.context.facilityType		0..1	HIECodeableConcept	Kind of facility where patient was seen
DocumentReference.context.practiceSetting		0..1	HIECodeableConcept	Additional details about where the content was created (e.g. clinical specialty)
DocumentReference.context.sourcePatientInfo		1..1	HIEReference(HIE Patient)	Patient demographics from source
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
DocumentReference.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.3.0	FHIR Std.
DocumentReference.docStatus	Base	required	CompositionStatus	📦4.3.0	FHIR Std.
DocumentReference.type	Base	extensible	FHIR Document Type Codes	📦4.3.0	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📦4.3.0	FHIR Std.

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference	A reference to a document
DocumentReference.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
DocumentReference.contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
DocumentReference.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.masterIdentifier	Σ This element is included in summaries.	0..1	Identifier	Master Version Specific Identifier
DocumentReference.identifier	S This element must be supported. Σ This element is included in summaries.	1..*	Identifier	Other identifiers for the document
DocumentReference.identifier.id		0..1	id	Unique id for inter-element referencing
DocumentReference.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
DocumentReference.identifier.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible) Constraints: cc-text-or-code
DocumentReference.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
DocumentReference.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
DocumentReference.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
DocumentReference.identifier.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
DocumentReference.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
DocumentReference.docStatus	Σ This element is included in summaries.	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required)
DocumentReference.type	S This element must be supported. Σ This element is included in summaries. C	1..1	HIECodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (extensible) Constraints: cc-text-or-code
DocumentReference.category	S This element must be supported. Σ This element is included in summaries. C	1..*	HIECodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Constraints: cc-text-or-code
DocumentReference.subject	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Patient)	Who/what is the subject of the document
DocumentReference.date	S This element must be supported. Σ This element is included in summaries.	1..1	instant	When this document reference was created
DocumentReference.author	S This element must be supported. Σ This element is included in summaries.	1..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient)	Who and/or what authored the document
DocumentReference.authenticator		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Who/what authenticated the document
DocumentReference.custodian		0..1	HIEReference(HIE Organization)	Organization which maintains the document
DocumentReference.relatesTo	Σ This element is included in summaries.	0..*	BackboneElement	Relationships to other documents
DocumentReference.relatesTo.id		0..1	string	Unique id for inter-element referencing
DocumentReference.relatesTo.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.relatesTo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.relatesTo.code	Σ This element is included in summaries.	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
DocumentReference.relatesTo.target	Σ This element is included in summaries.	1..1	HIEReference(HIE DocumentReference)	Target of the relationship
DocumentReference.description	Σ This element is included in summaries.	0..1	string	Human-readable description
DocumentReference.securityLabel	Σ This element is included in summaries. C	0..*	HIECodeableConcept	Document security-tags Binding: All Security Labels (extensible) Constraints: cc-text-or-code
DocumentReference.content	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Document referenced
DocumentReference.content.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.content.attachment	S This element must be supported. Σ This element is included in summaries.	1..1	Attachment	Where to access the document
DocumentReference.content.attachment.id		0..1	id	Unique id for inter-element referencing
DocumentReference.content.attachment.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.content.attachment.contentType	S This element must be supported. Σ This element is included in summaries.	1..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
DocumentReference.content.attachment.language	Σ This element is included in summaries.	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
DocumentReference.content.attachment.data		0..1	base64Binary	Data inline, base64ed
DocumentReference.content.attachment.url	Σ This element is included in summaries.	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
DocumentReference.content.attachment.size	Σ This element is included in summaries.	0..1	unsignedInt	Number of bytes of content (if url provided)
DocumentReference.content.attachment.hash	Σ This element is included in summaries.	0..1	base64Binary	Hash of the data (sha-1, base64ed)
DocumentReference.content.attachment.title	Σ This element is included in summaries.	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
DocumentReference.content.attachment.creation	Σ This element is included in summaries.	0..1	dateTime	Date attachment was first created
DocumentReference.content.format	Σ This element is included in summaries.	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
DocumentReference.context	Σ This element is included in summaries.	0..1	BackboneElement	Clinical context of document
DocumentReference.context.id		0..1	string	Unique id for inter-element referencing
DocumentReference.context.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.context.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.context.encounter		1..1	HIEReference(HIE Encounter | HIE EpisodeOfCare)	Context of the document content
DocumentReference.context.event	C	0..*	HIECodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. Constraints: cc-text-or-code
DocumentReference.context.period	Σ This element is included in summaries.	0..1	Period	Time of service that is being documented
DocumentReference.context.facilityType	C	0..1	HIECodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. Constraints: cc-text-or-code
DocumentReference.context.practiceSetting	C	0..1	HIECodeableConcept	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). Constraints: cc-text-or-code
DocumentReference.context.sourcePatientInfo		1..1	HIEReference(HIE Patient)	Patient demographics from source
DocumentReference.context.related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
DocumentReference.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
DocumentReference.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.3.0	FHIR Std.
DocumentReference.docStatus	Base	required	CompositionStatus	📦4.3.0	FHIR Std.
DocumentReference.type	Base	extensible	FHIR Document Type Codes	📦4.3.0	FHIR Std.
DocumentReference.category	Base	example	Document Class Value Set	📍4.3.0	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.3.0	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📦4.3.0	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.3.0	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
DocumentReference.content.​format	Base	preferred	DocumentReference Format Code Set	📍4.3.0	FHIR Std.
DocumentReference.context.​event	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.4
DocumentReference.context.​facilityType	Base	example	Facility Type Code Value Set	📍4.3.0	FHIR Std.
DocumentReference.context.​practiceSetting	Base	example	Practice Setting Code Value Set	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
cc-text-or-code	warning	DocumentReference.identifier.type, DocumentReference.type, DocumentReference.category, DocumentReference.securityLabel, DocumentReference.context.event, DocumentReference.context.facilityType, DocumentReference.context.practiceSetting	Text is optional, coding is required	coding.exists()
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.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').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()
dom-r4b	warning	DocumentReference.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems	($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
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: 13 elements(2 nested mandatory elements)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

• HIE CodeableConcept (https://nshr.dha.go.ke/fhir/StructureDefinition/codeable-concept)
• HIE Reference (https://nshr.dha.go.ke/fhir/StructureDefinition/reference)
• HIE Organization (https://nshr.dha.go.ke/fhir/StructureDefinition/organization)
• HIE Patient (https://nshr.dha.go.ke/fhir/StructureDefinition/patient)
• HIE Practitioner (https://nshr.dha.go.ke/fhir/StructureDefinition/practitioner)
• HIE DocumentReference (https://nshr.dha.go.ke/fhir/StructureDefinition/documentreference)
• HIE Encounter (https://nshr.dha.go.ke/fhir/StructureDefinition/encounter)
• HIE EpisodeOfCare (https://nshr.dha.go.ke/fhir/StructureDefinition/episodeofcare)

Other representations of profile: CSV, Excel, Schematron