Amakomaya Nepal FHIR Implementation Guide
1.0.1 - ci-build

Amakomaya Nepal FHIR Implementation Guide - Local Development build (v1.0.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Resource Profile: AMKDocumentReference

Official URL: https://fhir.amakomaya.com/StructureDefinition/amk-document-reference | Version: 1.0.1
Active as of 2026-06-15 | Computable Name: AMKDocumentReference
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

Usages:

- Examples for this Profile: DocumentReference/document-reference-anc-visit

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
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type | Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
subject | Σ | 1..1 | Reference(Patient) | Who/what is the subject of the document
context | C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content
date | Σ | 1..1 | instant | When this document reference was created
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
contentType | Σ C | 1..1 | code | Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
url | Σ | 1..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍5.0.0 | FHIR Std.
DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍5.0.0 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | Mime Types | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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
type |  | 1..1 | CodeableConcept | Kind of document (LOINC if possible)
subject |  | 1..1 | Reference(Patient) | Who/what is the subject of the document
date |  | 1..1 | instant | When this document reference was created
content |  |  |  |
attachment |  |  |  |
contentType |  | 1..1 | code | Mime type of the content, with charset etc.
url |  | 1..1 | url | Uri where the data can be found
Documentation for this format

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 | 0..* | Identifier | Business identifiers for the document
version | Σ | 0..1 | string | An explicitly assigned identifer of a variation of the content in the DocumentReference
basedOn |  | 0..* | Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) | Procedure that caused this media to be created
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus | Σ | 0..1 | code | registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
modality | Σ | 0..* | CodeableConcept | Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type | Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
category | Σ | 0..* | CodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
subject | Σ | 1..1 | Reference(Patient) | Who/what is the subject of the document
context | C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content
event |  | 0..* | CodeableReference() | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite | Σ | 0..* | CodeableReference(BodyStructure) | Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
facilityType | C | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | C | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
period | Σ | 0..1 | Period | Time of service that is being documented
date | Σ | 1..1 | instant | When this document reference was created
author | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) | Who and/or what authored the document
attester |  | 0..* | BackboneElement | Attests to accuracy of the document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
mode |  | 1..1 | CodeableConcept | personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
time |  | 0..1 | dateTime | When the document was attested
party |  | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the document
custodian |  | 0..1 | Reference(Organization) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | CodeableConcept | The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | markdown | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content | 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
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | Σ C | 1..1 | code | Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
language | Σ | 0..1 | code | Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language.
Additional Bindings | Purpose
CommonLanguages | Starter
Example General: en-AU
data | C | 0..1 | base64Binary | Data inline, base64ed
url | Σ | 1..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size | Σ | 0..1 | integer64 | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
creation | Σ | 0..1 | dateTime | Date attachment was first created
height |  | 0..1 | positiveInt | Height of the image in pixels (photo/video)
width |  | 0..1 | positiveInt | Width of the image in pixels (photo/video)
frames |  | 0..1 | positiveInt | Number of frames if > 1 (photo)
duration |  | 0..1 | decimal | Length in seconds (audio / video)
pages |  | 0..1 | positiveInt | Number of printed pages
profile | Σ | 0..* | BackboneElement | Content profile rules for the document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
value[x] | Σ | 1..1 |  | Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding |  |  | Coding |
valueUri |  |  | uri |
valueCanonical |  |  | canonical(Any) |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍5.0.0 | FHIR Std.
DocumentReference.docStatus | Base | required | Composition Status | 📍5.0.0 | FHIR Std.
DocumentReference.modality | Base | extensible | Modality | ⏿2025.3.20250714 | tx.fhir.org
DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍5.0.0 | FHIR Std.
DocumentReference.category | Base | example | Referenced Item Category Value Set | 📍5.0.0 | FHIR Std.
DocumentReference.event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v7.1
DocumentReference.bodySite | Base | example | SNOMED CT Body Structures | 📍5.0.0 | FHIR Std.
DocumentReference.facilityType | Base | example | Facility Type Code Value Set | 📍5.0.0 | FHIR Std.
DocumentReference.practiceSetting | Base | example | Practice Setting Code Value Set | 📍5.0.0 | FHIR Std.
DocumentReference.attester.​mode | Base | preferred | Composition Attestation Mode | 📍5.0.0 | FHIR Std.
DocumentReference.relatesTo.​code | Base | extensible | Document Relationship Type | 📍5.0.0 | FHIR Std.
DocumentReference.securityLabel | Base | example | Example set of Security Labels | 📍5.0.0 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | Mime Types | 📍5.0.0 | FHIR Std.
DocumentReference.content.​attachment.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
DocumentReference.content.​profile.value[x] | Base | preferred | HL7 ValueSet of Format Codes for use with Document Sharing | 📦2.1.0 | THO v7.1

#### 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: 5 elements

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
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type | Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
subject | Σ | 1..1 | Reference(Patient) | Who/what is the subject of the document
context | C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content
date | Σ | 1..1 | instant | When this document reference was created
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
contentType | Σ C | 1..1 | code | Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
url | Σ | 1..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍5.0.0 | FHIR Std.
DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍5.0.0 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | Mime Types | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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
type |  | 1..1 | CodeableConcept | Kind of document (LOINC if possible)
subject |  | 1..1 | Reference(Patient) | Who/what is the subject of the document
date |  | 1..1 | instant | When this document reference was created
content |  |  |  |
attachment |  |  |  |
contentType |  | 1..1 | code | Mime type of the content, with charset etc.
url |  | 1..1 | url | Uri where the data can be found
Documentation for this format

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 | 0..* | Identifier | Business identifiers for the document
version | Σ | 0..1 | string | An explicitly assigned identifer of a variation of the content in the DocumentReference
basedOn |  | 0..* | Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) | Procedure that caused this media to be created
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus | Σ | 0..1 | code | registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
modality | Σ | 0..* | CodeableConcept | Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type | Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
category | Σ | 0..* | CodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
subject | Σ | 1..1 | Reference(Patient) | Who/what is the subject of the document
context | C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content
event |  | 0..* | CodeableReference() | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite | Σ | 0..* | CodeableReference(BodyStructure) | Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
facilityType | C | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting | C | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
period | Σ | 0..1 | Period | Time of service that is being documented
date | Σ | 1..1 | instant | When this document reference was created
author | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) | Who and/or what authored the document
attester |  | 0..* | BackboneElement | Attests to accuracy of the document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
mode |  | 1..1 | CodeableConcept | personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
time |  | 0..1 | dateTime | When the document was attested
party |  | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the document
custodian |  | 0..1 | Reference(Organization) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | CodeableConcept | The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | markdown | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content | 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
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | Σ C | 1..1 | code | Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
language | Σ | 0..1 | code | Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language.
Additional Bindings | Purpose
CommonLanguages | Starter
Example General: en-AU
data | C | 0..1 | base64Binary | Data inline, base64ed
url | Σ | 1..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size | Σ | 0..1 | integer64 | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
creation | Σ | 0..1 | dateTime | Date attachment was first created
height |  | 0..1 | positiveInt | Height of the image in pixels (photo/video)
width |  | 0..1 | positiveInt | Width of the image in pixels (photo/video)
frames |  | 0..1 | positiveInt | Number of frames if > 1 (photo)
duration |  | 0..1 | decimal | Length in seconds (audio / video)
pages |  | 0..1 | positiveInt | Number of printed pages
profile | Σ | 0..* | BackboneElement | Content profile rules for the document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
value[x] | Σ | 1..1 |  | Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding |  |  | Coding |
valueUri |  |  | uri |
valueCanonical |  |  | canonical(Any) |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍5.0.0 | FHIR Std.
DocumentReference.docStatus | Base | required | Composition Status | 📍5.0.0 | FHIR Std.
DocumentReference.modality | Base | extensible | Modality | ⏿2025.3.20250714 | tx.fhir.org
DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍5.0.0 | FHIR Std.
DocumentReference.category | Base | example | Referenced Item Category Value Set | 📍5.0.0 | FHIR Std.
DocumentReference.event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v7.1
DocumentReference.bodySite | Base | example | SNOMED CT Body Structures | 📍5.0.0 | FHIR Std.
DocumentReference.facilityType | Base | example | Facility Type Code Value Set | 📍5.0.0 | FHIR Std.
DocumentReference.practiceSetting | Base | example | Practice Setting Code Value Set | 📍5.0.0 | FHIR Std.
DocumentReference.attester.​mode | Base | preferred | Composition Attestation Mode | 📍5.0.0 | FHIR Std.
DocumentReference.relatesTo.​code | Base | extensible | Document Relationship Type | 📍5.0.0 | FHIR Std.
DocumentReference.securityLabel | Base | example | Example set of Security Labels | 📍5.0.0 | FHIR Std.
DocumentReference.content.​attachment.contentType | Base | required | Mime Types | 📍5.0.0 | FHIR Std.
DocumentReference.content.​attachment.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
DocumentReference.content.​profile.value[x] | Base | preferred | HL7 ValueSet of Format Codes for use with Document Sharing | 📦2.1.0 | THO v7.1

#### 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: 5 elements

Other representations of profile: CSV, Excel, Schematron