SGHI FHIR Profile Implementation Guide
0.1.0 - ci-build

SGHI FHIR Profile 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/sil_fhir_profile_ig/ and changes regularly. See the Directory of published versions

## Resource Profile: SGHI DocumentReference Profile.

Official URL: https://fhir.slade360.co.ke/fhir/StructureDefinition/documentreference | Version: 0.1.0
Draft as of 2026-04-27 | Computable Name: SGHIDocumentReference

A reference to a document of any kind for any purpose.

Usages:

- Refer to this Profile: SGHI DocumentReference Profile.
- Examples for this Profile: DocumentReference/ExampleSGHIDocumentReference

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 | 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
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 1..* | Identifier | Business identifiers for the document
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type | Σ | 0..1 | SGHICodeableConcept | Description of identifier Binding: SGHI Default Identifier Types (required)
system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ C | 1..1 | string | The value that is unique Example General: 123456
assigner | Σ | 1..1 | SGHIReference(SGHI Organization) | Organization that issued id (may be just text)
basedOn |  | 0..* | SGHIReference(SGHI Appointment Profile | SGHI MedicationRequest | SGHI ServiceRequest) | Procedure that caused this media to be created
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus | Σ | 1..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..* | SGHICodeableConcept | Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type | Σ | 1..1 | SGHICodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (required)
category | Σ | 0..* | SGHICodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
subject | Σ | 1..1 | SGHIReference(SGHI Patient) | Who/what is the subject of the document
context | C | 1..* | SGHIReference(SGHI Appointment Profile | SGHI Encounter | SGHI EpisodeOfCare) | Context of the document content
event |  | 0..* | SGHICodeableReference() | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite | Σ | 0..* | SGHICodeableReference(BodyStructure) | Body part included Binding: All LOINC Codes (required)
facilityType | C | 0..1 | SGHICodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | C | 0..1 | SGHICodeableConcept | 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).
date | Σ | 1..1 | instant | When this document reference was created
author | Σ | 1..1 | SGHIReference(SGHI Organization | SGHI PractitionerRole | SGHI Practitioner | SGHI Patient) | Who and/or what authored the document
custodian |  | 1..1 | SGHIReference(SGHI Organization) | Organization which maintains the document
securityLabel | Σ | 0..* | SGHICodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content | Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | Σ | 1..1 | Attachment | Where to access the document
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.identifier.​use | Base | required | IdentifierUse | 📦5.0.0 | FHIR Std.
DocumentReference.identifier.​type | Base | required | SGHI Default Identifier Types | 📦0.1.0 | This IG
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 | required | 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 v7.1
DocumentReference.bodySite | Base | required | All LOINC Codes | 📦0.1.0 | This IG
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.securityLabel | Base | example | Example set of Security Labels | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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 Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | A reference to a document
identifier |  | 1..* | Identifier | Business identifiers for the document
use |  | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type |  | 0..1 | SGHICodeableConcept | Description of identifier Binding: SGHI Default Identifier Types (required)
system |  | 1..1 | uri | The namespace for the identifier value
value |  | 1..1 | string | The value that is unique
assigner |  | 1..1 | SGHIReference(SGHI Organization) | Organization that issued id (may be just text)
basedOn |  | 0..* | SGHIReference(SGHI Appointment Profile | SGHI MedicationRequest | SGHI ServiceRequest) | Procedure that caused this media to be created
docStatus |  | 1..1 | code | registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown
modality |  | 0..* | SGHICodeableConcept | Imaging modality used
type |  | 1..1 | SGHICodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (required)
category |  | 0..* | SGHICodeableConcept | Categorization of document
subject |  | 1..1 | SGHIReference(SGHI Patient) | Who/what is the subject of the document
context |  | 1..* | SGHIReference(SGHI Appointment Profile | SGHI Encounter | SGHI EpisodeOfCare) | Context of the document content
event |  | 0..* | SGHICodeableReference() | Main clinical acts documented
bodySite |  | 0..* | SGHICodeableReference(BodyStructure) | Body part included Binding: All LOINC Codes (required)
facilityType |  | 0..1 | SGHICodeableConcept | Kind of facility where patient was seen
practiceSetting |  | 0..1 | SGHICodeableConcept | Additional details about where the content was created (e.g. clinical specialty)
date |  | 1..1 | instant | When this document reference was created
author |  | 1..1 | SGHIReference(SGHI Organization | SGHI PractitionerRole | SGHI Practitioner | SGHI Patient) | Who and/or what authored the document
attester |  |  |  |
mode |  | 1..1 | SGHICodeableConcept | personal | professional | legal | official
party |  | 0..1 | SGHIReference(SGHI Patient | SGHI Organization | SGHI Practitioner | SGHI PractitionerRole) | Who attested the document
custodian |  | 1..1 | SGHIReference(SGHI Organization) | Organization which maintains the document
relatesTo |  |  |  |
code |  | 1..1 | SGHICodeableConcept | The relationship type with another document
target |  | 1..1 | SGHIReference(SGHI DocumentReference Profile.) | Target of the relationship
securityLabel |  | 0..* | SGHICodeableConcept | Document security-tags
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.identifier.​use | Base | required | IdentifierUse | 📦5.0.0 | FHIR Std.
DocumentReference.identifier.​type | Base | required | SGHI Default Identifier Types | 📦0.1.0 | This IG
DocumentReference.type | Base | required | FHIR Document Type Codes | 📦5.0.0 | FHIR Std.
DocumentReference.bodySite | Base | required | All LOINC Codes | 📦0.1.0 | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 Bindings | Purpose
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 1..* | Identifier | 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)
type | Σ | 0..1 | SGHICodeableConcept | Description of identifier Binding: SGHI Default Identifier Types (required)
system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ C | 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 | 1..1 | SGHIReference(SGHI 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
basedOn |  | 0..* | SGHIReference(SGHI Appointment Profile | SGHI MedicationRequest | SGHI ServiceRequest) | Procedure that caused this media to be created
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus | Σ | 1..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..* | SGHICodeableConcept | Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type | Σ | 1..1 | SGHICodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (required)
category | Σ | 0..* | SGHICodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
subject | Σ | 1..1 | SGHIReference(SGHI Patient) | Who/what is the subject of the document
context | C | 1..* | SGHIReference(SGHI Appointment Profile | SGHI Encounter | SGHI EpisodeOfCare) | Context of the document content
event |  | 0..* | SGHICodeableReference() | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite | Σ | 0..* | SGHICodeableReference(BodyStructure) | Body part included Binding: All LOINC Codes (required)
facilityType | C | 0..1 | SGHICodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | C | 0..1 | SGHICodeableConcept | 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 | Σ | 1..1 | instant | When this document reference was created
author | Σ | 1..1 | SGHIReference(SGHI Organization | SGHI PractitionerRole | SGHI Practitioner | SGHI Patient) | 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 | SGHICodeableConcept | 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 | SGHIReference(SGHI Patient | SGHI Organization | SGHI Practitioner | SGHI PractitionerRole) | Who attested the document
custodian |  | 1..1 | SGHIReference(SGHI 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 | SGHICodeableConcept | The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
target | Σ | 1..1 | SGHIReference(SGHI DocumentReference Profile.) | Target of the relationship
description | Σ | 0..1 | markdown | Human-readable description
securityLabel | Σ | 0..* | SGHICodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content | Σ | 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 | Σ | 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) |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
DocumentReference.identifier.​use | Base | required | IdentifierUse | 📦5.0.0 | FHIR Std.
DocumentReference.identifier.​type | Base | required | SGHI Default Identifier Types | 📦0.1.0 | This IG
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 | required | 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 v7.1
DocumentReference.bodySite | Base | required | All LOINC Codes | 📦0.1.0 | This IG
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.​profile.value[x] | Base | preferred | HL7 ValueSet of Format Codes for use with Document Sharing | 📦2.1.0 | THO v7.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
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: 11 elements

Structures

This structure refers to these other structures:

- SGHI CodeableConcept (https://fhir.slade360.co.ke/fhir/StructureDefinition/codeableconcept)
- SGHI Reference (https://fhir.slade360.co.ke/fhir/StructureDefinition/reference)
- SGHI Organization (https://fhir.slade360.co.ke/fhir/StructureDefinition/organization)
- SGHI Appointment Profile (https://fhir.slade360.co.ke/fhir/StructureDefinition/appointment)
- SGHI MedicationRequest (https://fhir.slade360.co.ke/fhir/StructureDefinition/medicationrequest)
- SGHI ServiceRequest (https://fhir.slade360.co.ke/fhir/StructureDefinition/servicerequest)
- SGHI Patient (https://fhir.slade360.co.ke/fhir/StructureDefinition/patient)
- SGHI Encounter (https://fhir.slade360.co.ke/fhir/StructureDefinition/encounter)
- SGHI EpisodeOfCare (https://fhir.slade360.co.ke/fhir/StructureDefinition/episodeofcare)
- SGHI CodeableReference (https://fhir.slade360.co.ke/fhir/StructureDefinition/codeable-reference)
- SGHI PractitionerRole (https://fhir.slade360.co.ke/fhir/StructureDefinition/practitionerrole)
- SGHI Practitioner (https://fhir.slade360.co.ke/fhir/StructureDefinition/practitioner)
- SGHI DocumentReference Profile. (https://fhir.slade360.co.ke/fhir/StructureDefinition/documentreference)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 1..* | Identifier | Business identifiers for the document
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type | Σ | 0..1 | SGHICodeableConcept | Description of identifier Binding: SGHI Default Identifier Types (required)
system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ C | 1..1 | string | The value that is unique Example General: 123456
assigner | Σ | 1..1 | SGHIReference(SGHI Organization) | Organization that issued id (may be just text)
basedOn |  | 0..* | SGHIReference(SGHI Appointment Profile | SGHI MedicationRequest | SGHI ServiceRequest) | Procedure that caused this media to be created
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus | Σ | 1..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..* | SGHICodeableConcept | Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type | Σ | 1..1 | SGHICodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (required)
category | Σ | 0..* | SGHICodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
subject | Σ | 1..1 | SGHIReference(SGHI Patient) | Who/what is the subject of the document
context | C | 1..* | SGHIReference(SGHI Appointment Profile | SGHI Encounter | SGHI EpisodeOfCare) | Context of the document content
event |  | 0..* | SGHICodeableReference() | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite | Σ | 0..* | SGHICodeableReference(BodyStructure) | Body part included Binding: All LOINC Codes (required)
facilityType | C | 0..1 | SGHICodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | C | 0..1 | SGHICodeableConcept | 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).
date | Σ | 1..1 | instant | When this document reference was created
author | Σ | 1..1 | SGHIReference(SGHI Organization | SGHI PractitionerRole | SGHI Practitioner | SGHI Patient) | Who and/or what authored the document
custodian |  | 1..1 | SGHIReference(SGHI Organization) | Organization which maintains the document
securityLabel | Σ | 0..* | SGHICodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content | Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | Σ | 1..1 | Attachment | Where to access the document
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.identifier.​use | Base | required | IdentifierUse | 📦5.0.0 | FHIR Std.
DocumentReference.identifier.​type | Base | required | SGHI Default Identifier Types | 📦0.1.0 | This IG
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 | required | 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 v7.1
DocumentReference.bodySite | Base | required | All LOINC Codes | 📦0.1.0 | This IG
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.securityLabel | Base | example | Example set of Security Labels | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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 Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | A reference to a document
identifier |  | 1..* | Identifier | Business identifiers for the document
use |  | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type |  | 0..1 | SGHICodeableConcept | Description of identifier Binding: SGHI Default Identifier Types (required)
system |  | 1..1 | uri | The namespace for the identifier value
value |  | 1..1 | string | The value that is unique
assigner |  | 1..1 | SGHIReference(SGHI Organization) | Organization that issued id (may be just text)
basedOn |  | 0..* | SGHIReference(SGHI Appointment Profile | SGHI MedicationRequest | SGHI ServiceRequest) | Procedure that caused this media to be created
docStatus |  | 1..1 | code | registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown
modality |  | 0..* | SGHICodeableConcept | Imaging modality used
type |  | 1..1 | SGHICodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (required)
category |  | 0..* | SGHICodeableConcept | Categorization of document
subject |  | 1..1 | SGHIReference(SGHI Patient) | Who/what is the subject of the document
context |  | 1..* | SGHIReference(SGHI Appointment Profile | SGHI Encounter | SGHI EpisodeOfCare) | Context of the document content
event |  | 0..* | SGHICodeableReference() | Main clinical acts documented
bodySite |  | 0..* | SGHICodeableReference(BodyStructure) | Body part included Binding: All LOINC Codes (required)
facilityType |  | 0..1 | SGHICodeableConcept | Kind of facility where patient was seen
practiceSetting |  | 0..1 | SGHICodeableConcept | Additional details about where the content was created (e.g. clinical specialty)
date |  | 1..1 | instant | When this document reference was created
author |  | 1..1 | SGHIReference(SGHI Organization | SGHI PractitionerRole | SGHI Practitioner | SGHI Patient) | Who and/or what authored the document
attester |  |  |  |
mode |  | 1..1 | SGHICodeableConcept | personal | professional | legal | official
party |  | 0..1 | SGHIReference(SGHI Patient | SGHI Organization | SGHI Practitioner | SGHI PractitionerRole) | Who attested the document
custodian |  | 1..1 | SGHIReference(SGHI Organization) | Organization which maintains the document
relatesTo |  |  |  |
code |  | 1..1 | SGHICodeableConcept | The relationship type with another document
target |  | 1..1 | SGHIReference(SGHI DocumentReference Profile.) | Target of the relationship
securityLabel |  | 0..* | SGHICodeableConcept | Document security-tags
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.identifier.​use | Base | required | IdentifierUse | 📦5.0.0 | FHIR Std.
DocumentReference.identifier.​type | Base | required | SGHI Default Identifier Types | 📦0.1.0 | This IG
DocumentReference.type | Base | required | FHIR Document Type Codes | 📦5.0.0 | FHIR Std.
DocumentReference.bodySite | Base | required | All LOINC Codes | 📦0.1.0 | This IG

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 Bindings | Purpose
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 1..* | Identifier | 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)
type | Σ | 0..1 | SGHICodeableConcept | Description of identifier Binding: SGHI Default Identifier Types (required)
system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ C | 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 | 1..1 | SGHIReference(SGHI 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
basedOn |  | 0..* | SGHIReference(SGHI Appointment Profile | SGHI MedicationRequest | SGHI ServiceRequest) | Procedure that caused this media to be created
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus | Σ | 1..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..* | SGHICodeableConcept | Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type | Σ | 1..1 | SGHICodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (required)
category | Σ | 0..* | SGHICodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
subject | Σ | 1..1 | SGHIReference(SGHI Patient) | Who/what is the subject of the document
context | C | 1..* | SGHIReference(SGHI Appointment Profile | SGHI Encounter | SGHI EpisodeOfCare) | Context of the document content
event |  | 0..* | SGHICodeableReference() | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite | Σ | 0..* | SGHICodeableReference(BodyStructure) | Body part included Binding: All LOINC Codes (required)
facilityType | C | 0..1 | SGHICodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | C | 0..1 | SGHICodeableConcept | 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 | Σ | 1..1 | instant | When this document reference was created
author | Σ | 1..1 | SGHIReference(SGHI Organization | SGHI PractitionerRole | SGHI Practitioner | SGHI Patient) | 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 | SGHICodeableConcept | 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 | SGHIReference(SGHI Patient | SGHI Organization | SGHI Practitioner | SGHI PractitionerRole) | Who attested the document
custodian |  | 1..1 | SGHIReference(SGHI 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 | SGHICodeableConcept | The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
target | Σ | 1..1 | SGHIReference(SGHI DocumentReference Profile.) | Target of the relationship
description | Σ | 0..1 | markdown | Human-readable description
securityLabel | Σ | 0..* | SGHICodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content | Σ | 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 | Σ | 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) |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
DocumentReference.identifier.​use | Base | required | IdentifierUse | 📦5.0.0 | FHIR Std.
DocumentReference.identifier.​type | Base | required | SGHI Default Identifier Types | 📦0.1.0 | This IG
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 | required | 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 v7.1
DocumentReference.bodySite | Base | required | All LOINC Codes | 📦0.1.0 | This IG
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.​profile.value[x] | Base | preferred | HL7 ValueSet of Format Codes for use with Document Sharing | 📦2.1.0 | THO v7.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
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: 11 elements

Structures

This structure refers to these other structures:

- SGHI CodeableConcept (https://fhir.slade360.co.ke/fhir/StructureDefinition/codeableconcept)
- SGHI Reference (https://fhir.slade360.co.ke/fhir/StructureDefinition/reference)
- SGHI Organization (https://fhir.slade360.co.ke/fhir/StructureDefinition/organization)
- SGHI Appointment Profile (https://fhir.slade360.co.ke/fhir/StructureDefinition/appointment)
- SGHI MedicationRequest (https://fhir.slade360.co.ke/fhir/StructureDefinition/medicationrequest)
- SGHI ServiceRequest (https://fhir.slade360.co.ke/fhir/StructureDefinition/servicerequest)
- SGHI Patient (https://fhir.slade360.co.ke/fhir/StructureDefinition/patient)
- SGHI Encounter (https://fhir.slade360.co.ke/fhir/StructureDefinition/encounter)
- SGHI EpisodeOfCare (https://fhir.slade360.co.ke/fhir/StructureDefinition/episodeofcare)
- SGHI CodeableReference (https://fhir.slade360.co.ke/fhir/StructureDefinition/codeable-reference)
- SGHI PractitionerRole (https://fhir.slade360.co.ke/fhir/StructureDefinition/practitionerrole)
- SGHI Practitioner (https://fhir.slade360.co.ke/fhir/StructureDefinition/practitioner)
- SGHI DocumentReference Profile. (https://fhir.slade360.co.ke/fhir/StructureDefinition/documentreference)

Other representations of profile: CSV, Excel, Schematron