Amakomaya Nepal FHIR Implementation Guide
2.0.0 - ci-build Nepal

Amakomaya Nepal FHIR Implementation Guide - Local Development build (v2.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Resource Profile: AMKDocumentReference - Detailed Descriptions

Active as of 2026-08-21

Definitions for the amk-document-reference resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

Guidance on how to interpret the contents of this table can be foundhere

0. DocumentReference
Definition | A reference to a document of any kind for any purpose. While the term “document” implies a more narrow focus, for this resource this "document" encompasses any serialized object with a mime-type, it includes formal patient-centric documents (CDA), clinical notes, scanned paper, non-patient specific documents like policy text, as well as a photo, video, or audio recording acquired or used in healthcare. The DocumentReference resource provides metadata about the document so that the document can be discovered and managed. The actual content may be inline base64 encoded data or provided by direct reference.
Short | A reference to a document
Comments | Usually, this is used for documents other than those defined by FHIR.
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Invariants | docRef-1: facilityType SHALL only be present if context is not an encounter (facilityType.empty() or context.where(resolve() is Encounter).empty()) docRef-2: practiceSetting SHALL only be present if context is not present (practiceSetting.empty() or context.where(resolve() is Encounter).empty()) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()) dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. DocumentReference.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. For DomainResources, if more than one implicitRules policy applies, additional policies may be conveyed using the additionalImplicitRules extension.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. DocumentReference.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
6. DocumentReference.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support | false
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
Slicing | This element introduces a set of slices on `DocumentReference.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
8. DocumentReference.status
Definition | The current state of the document reference.
Short | current | superseded | entered-in-error | unknown
Comments | This is the status of the DocumentReference object, which might be independent from the docStatus element. This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|6.0.0-ballot5 (required to `http://hl7.org/fhir/ValueSet/document-reference-status|6.0.0-ballot5` ) The status of the document reference.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. DocumentReference.type
Definition | Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.
Short | Kind of document (LOINC if possible)
Comments | Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.
Control | 10..1
Binding | The codes SHOULD be taken from FHIRDocumentTypeCodes http://hl7.org/fhir/ValueSet/doc-typecodes|6.0.0-ballot5 (preferred to `http://hl7.org/fhir/ValueSet/doc-typecodes|6.0.0-ballot5` ) Precise type of clinical document.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. DocumentReference.subject
Definition | Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).
Short | Who/what is the subject of the document
Control | 10..1
Type | Reference(Patient, Resource)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. DocumentReference.context
Definition | The encounter or other triggering event during which this DocumentReference was created or to which the creation of this record is tightly associated.
Short | Encounter the document reference is part of
Comments | This will typically be the encounter the document reference was created during, but some document references may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).
Control | 0..* This element is affected by the following invariants: docRef-1, docRef-2
Type | Reference(Appointment, Encounter, EpisodeOfCare)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Links the document reference to the Encounter context. May also affect access control.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. DocumentReference.date
Definition | When the document reference was created.
Short | When this document reference was created
Comments | Referencing/indexing time is used for tracking, organizing versions and searching. Provide the most precise timestamp available.
Control | 10..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Alternate Names | indexed
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. DocumentReference.content
Definition | The document and format referenced. If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata.
Short | Document referenced
Comments | content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.
Control | 1..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | true
Requirements | Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.
Invariants | ele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
20. DocumentReference.content.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
Slicing | This element introduces a set of slices on `DocumentReference.content.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
22. DocumentReference.content.attachment
Definition | The document or URL of the document along with critical metadata to prove content has integrity.
Short | Where to access the document
Control | 1..1
Type | Attachment
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. DocumentReference.content.attachment.contentType
Definition | Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.
Short | Mime type of the content, with charset etc.
Control | 10..1 This element is affected by the following invariants: att-1
Binding | The codes SHALL be taken from MimeTypes http://hl7.org/fhir/ValueSet/mimetypes|6.0.0-ballot5 (required to `http://hl7.org/fhir/ValueSet/mimetypes|6.0.0-ballot5` ) BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Processors of the data need to be able to know how to interpret the data.
Example | General: text/plain; charset=UTF-8, image/png
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. DocumentReference.content.attachment.url
Definition | A location where the data can be accessed.
Short | Uri where the data can be found
Comments | If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service base URL, like a resource reference, rather than relative to the resource itself; for example, Patient/123 (relative) rather than http://someserver.org/Patient/123 (absolute). Urls may also be URIs only resolvable within a Bundle containing the resource with the attachment type. If a URL is provided, it SHALL resolve to actual data.
Control | 10..1
Type | url
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | The data needs to be transmitted by reference.
Example | General: http://www.acme.com/logo-small.png
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be foundhere

0. DocumentReference
2. DocumentReference.type
Control | 1..?
4. DocumentReference.subject
Control | 1..?
Type | Reference(Patient)
6. DocumentReference.date
Control | 1..?
8. DocumentReference.content
10. DocumentReference.content.attachment
12. DocumentReference.content.attachment.contentType
Control | 1..?
14. DocumentReference.content.attachment.url
Control | 1..?

Guidance on how to interpret the contents of this table can be foundhere

0. DocumentReference
Definition | A reference to a document of any kind for any purpose. While the term “document” implies a more narrow focus, for this resource this "document" encompasses any serialized object with a mime-type, it includes formal patient-centric documents (CDA), clinical notes, scanned paper, non-patient specific documents like policy text, as well as a photo, video, or audio recording acquired or used in healthcare. The DocumentReference resource provides metadata about the document so that the document can be discovered and managed. The actual content may be inline base64 encoded data or provided by direct reference.
Short | A reference to a document
Comments | Usually, this is used for documents other than those defined by FHIR.
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Invariants | docRef-1: facilityType SHALL only be present if context is not an encounter (`facilityType.empty() or context.where(resolve() is Encounter).empty()`) docRef-2: practiceSetting SHALL only be present if context is not present (`practiceSetting.empty() or context.where(resolve() is Encounter).empty()`) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (`contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()`) dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`)
2. DocumentReference.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical id of this artifact
Comments | Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resource id depends on the given use case.
Control | 0..1
Type | id
Is Modifier | false
Must Support | false
Summary | true
4. DocumentReference.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. DocumentReference.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. For DomainResources, if more than one implicitRules policy applies, additional policies may be conveyed using the additionalImplicitRules extension.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. DocumentReference.language
Definition | The base language in which the resource is written.
Short | Language of the resource content
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Control | 0..1
Binding | The codes SHALL be taken from AllLanguages (required to `http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot5` ) IETF language tag for a human language
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. DocumentReference.text
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Short | Text summary of the resource, for human interpretation
Comments | Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Control | 0..1 This element is affected by the following invariants: dom-6
Type | Narrative
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. DocumentReference.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
14. DocumentReference.extension
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
16. DocumentReference.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support | false
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
18. DocumentReference.identifier
Definition | Business identifiers assigned to this document reference by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server.
Short | Business identifiers for the document
Comments | The structure and format of this identifier would be consistent with the specification corresponding to the format of the document. (e.g. for a DICOM standard document, a 64-character numeric UID; for an HL7 CDA format, the CDA Document Id root and extension).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Is Modifier | false
Must Support | false
Summary | true
Requirements | Document identifiers usually assigned by the source of the document, or other business identifiers such as XDS DocumentEntry.uniqueId and DocumentEntry.entryUUID. These identifiers are specific to this instance of the document.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
20. DocumentReference.version
Definition | An explicitly assigned identifier of a variation of the content in the DocumentReference.
Short | An explicitly assigned identifier of a variation of the content in the DocumentReference
Comments | While each resource, including the DocumentReference itself, has its own version identifier, this is a formal identifier for the logical version of the DocumentReference as a whole. It would remain constant if the resources were moved to a new server, and all got new individual resource versions, for example.
Note | This is a business version Id, not a resource version Id (see discussion)
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
22. DocumentReference.basedOn
Definition | An activity that is fulfilled in whole or in part by the creation of this document.
Short | Activity that caused this document to be created
Control | 0..*
Type | Reference(Appointment, AppointmentResponse, CarePlan, Claim, CommunicationRequest, CoverageEligibilityRequest, DeviceRequest, MedicationRequest, NutritionOrder, RequestOrchestration, ServiceRequest, VisionPrescription)
Is Modifier | false
Must Support | false
Summary | false
Requirements | Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
Alternate Names | fulfills
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
24. DocumentReference.status
Definition | The current state of the document reference.
Short | current | superseded | entered-in-error | unknown
Comments | This is the status of the DocumentReference object, which might be independent from the docStatus element. This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from DocumentReferenceStatus (required to `http://hl7.org/fhir/ValueSet/document-reference-status|6.0.0-ballot5` ) The status of the document reference.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. DocumentReference.docStatus
Definition | The status of the underlying document.
Short | registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown
Comments | The document that is pointed to might be in various lifecycle states.
Control | 0..1
Binding | The codes SHALL be taken from CompositionStatus (required to `http://hl7.org/fhir/ValueSet/composition-status|6.0.0-ballot5` ) Status of the underlying document.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
28. DocumentReference.modality
Definition | Imaging modality used. This may include both acquisition and non-acquisition modalities.
Short | Imaging modality used
Control | 0..*
Binding | Unless not suitable, these codes SHALL be taken from Modality (extensible to `http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html` ) Type of acquired data in the instance.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
30. DocumentReference.type
Definition | Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.
Short | Kind of document (LOINC if possible)
Comments | Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.
Control | 1..1
Binding | The codes SHOULD be taken from FHIRDocumentTypeCodes (preferred to `http://hl7.org/fhir/ValueSet/doc-typecodes|6.0.0-ballot5` ) Precise type of clinical document.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
32. DocumentReference.category
Definition | A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.
Short | Categorization of document
Comments | Key metadata element describing the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.
Control | 0..*
Binding | For example codes, see ReferencedItemCategoryValueSet (example to `http://hl7.org/fhir/ValueSet/referenced-item-category|6.0.0-ballot5` ) High-level kind of document at a macro level.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Alternate Names | class, classCode
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
34. DocumentReference.subject
Definition | Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).
Short | Who/what is the subject of the document
Control | 1..1
Type | Reference(Patient)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. DocumentReference.context
Definition | The encounter or other triggering event during which this DocumentReference was created or to which the creation of this record is tightly associated.
Short | Encounter the document reference is part of
Comments | This will typically be the encounter the document reference was created during, but some document references may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).
Control | 0..* This element is affected by the following invariants: docRef-1, docRef-2
Type | Reference(Appointment, Encounter, EpisodeOfCare)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Links the document reference to the Encounter context. May also affect access control.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
38. DocumentReference.event
Definition | This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.
Short | Main clinical acts documented
Comments | An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation.
Control | 0..*
Binding | For example codes, see v3 Code System ActCode (example to `http://terminology.hl7.org/ValueSet/v3-ActCode` ) This list of codes represents the main clinical acts being documented.
Type | CodeableReference(Resource)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
40. DocumentReference.related
Definition | Any resource to which the creation of this record is tightly associated not involving document reference lifecycle.
Short | Related resources with this document reference not represented elsewhere
Comments | Use only for references not covered by other document reference lifecycle elements, for example references at the data or workflow level.
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children or both (`hasValue() or (children().count() > id.count())`)
42. DocumentReference.related.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
44. DocumentReference.related.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.related.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
46. DocumentReference.related.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.related.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
48. DocumentReference.related.code
Definition | Type of the relationship between the document reference and the related resource.
Short | Type of relationship to target resource
Control | 0..1
Binding | For example codes, see AssociatedReferenceType (example to `http://hl7.org/fhir/ValueSet/document-related-artifact-type|6.0.0-ballot5` ) The type of relationship between the documents.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
50. DocumentReference.related.target
Definition | The target document of the related resource.
Short | Target of the reference
Control | 1..1
Type | Reference(Resource)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. DocumentReference.bodyStructure
Definition | The anatomic structures included in the document.
Short | Body structure included
Control | 0..*
Binding | For example codes, see SNOMEDCTBodyStructures (example to `http://hl7.org/fhir/ValueSet/body-site|6.0.0-ballot5` ) SNOMED CT Body Structures
Type | CodeableReference(BodyStructure)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
54. DocumentReference.facilityType
Definition | The kind of facility where the patient was seen.
Short | Kind of facility where patient was seen
Control | 0..1 This element is affected by the following invariants: docRef-1
Binding | For example codes, see FacilityTypeCodeValueSet (example to `http://hl7.org/fhir/ValueSet/c80-facilitycodes|6.0.0-ballot5` ) XDS Facility Type.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
56. DocumentReference.practiceSetting
Definition | This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.
Short | Additional details about where the content was created (e.g. clinical specialty)
Comments | This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.
Control | 0..1 This element is affected by the following invariants: docRef-2
Binding | For example codes, see PracticeSettingCodeValueSet (example to `http://hl7.org/fhir/ValueSet/c80-practice-codes|6.0.0-ballot5` ) Additional details about where the content was created (e.g. clinical specialty).
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Requirements | This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. DocumentReference.period
Definition | The time period over which the service that is described by the document was provided.
Short | Time of service that is being documented
Control | 0..1
Type | Period
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
60. DocumentReference.date
Definition | When the document reference was created.
Short | When this document reference was created
Comments | Referencing/indexing time is used for tracking, organizing versions and searching. Provide the most precise timestamp available.
Control | 1..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Alternate Names | indexed
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
62. DocumentReference.author
Definition | Identifies who is responsible for adding the information to the document.
Short | Who and/or what authored the document
Comments | Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant). Using Group is only allowed in the circumstance where the group represents a family or a household, and should not represent groups of Practitioners.
Control | 0..*
Type | Reference(Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson, CareTeam, Group)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
64. DocumentReference.attester
Definition | A participant who has authenticated the accuracy of the document.
Short | Attests to accuracy of the document
Comments | Only list each attester once.
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Requirements | Identifies responsibility for the accuracy of the document content.
Invariants | ele-1: All FHIR elements must have a @value or children or both (`hasValue() or (children().count() > id.count())`)
66. DocumentReference.attester.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
68. DocumentReference.attester.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.attester.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
70. DocumentReference.attester.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.attester.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
72. DocumentReference.attester.mode
Definition | The type of attestation the authenticator offers.
Short | personal | professional | legal | official
Control | 1..1
Binding | The codes SHOULD be taken from Composition Attestation Mode (preferred to `http://terminology.hl7.org/ValueSet/composition-attestation-mode` ) The way in which a person authenticated a document.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Requirements | Indicates the level of authority of the attestation.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
74. DocumentReference.attester.time
Definition | When the document was attested by the party.
Short | When the document was attested
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | Identifies when the information in the document was deemed accurate. (Things may have changed since then.).
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
76. DocumentReference.attester.party
Definition | Who attested the document in the specified way.
Short | Who attested the document
Comments | Using Group is only allowed in the circumstance where the group represents a family or a household, and should not represent groups of Practitioners.
Control | 0..1
Type | Reference(Patient, RelatedPerson, Practitioner, PractitionerRole, Organization, Group)
Is Modifier | false
Must Support | false
Summary | false
Requirements | Identifies who has taken on the responsibility for accuracy of the document content.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
78. DocumentReference.custodian
Definition | Identifies the organization who is responsible for ongoing maintenance of and access to the document.
Short | Organization which maintains the document
Comments | Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.
Control | 0..1
Type | Reference(Organization)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
80. DocumentReference.relatesTo
Definition | Relationships that this document reference has with other document references that already exist.
Short | Relationships to other document references and their lifecycle changes
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children or both (`hasValue() or (children().count() > id.count())`)
82. DocumentReference.relatesTo.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
84. DocumentReference.relatesTo.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.relatesTo.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
86. DocumentReference.relatesTo.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.relatesTo.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
88. DocumentReference.relatesTo.code
Definition | The type of relationship that this document has with anther document.
Short | The relationship type with another document
Comments | If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from Document Relationship Type (extensible to `http://terminology.hl7.org/ValueSet/document-relationship-type` ) The type of relationship between the documents.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
90. DocumentReference.relatesTo.target
Definition | The target document of this relationship.
Short | Target of the relationship
Control | 1..1
Type | Reference(DocumentReference)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
92. DocumentReference.description
Definition | Human-readable description of the source document.
Short | Human-readable description
Comments | What the document is about, a terse summary of the document.
Control | 0..1
Type | markdown
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | Helps humans to assess whether the document is of interest.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
94. DocumentReference.securityLabel
Definition | A set of Security-Tag codes specifying the level of privacy/security of the Document found at DocumentReference.content.attachment.url. Note that DocumentReference.meta.security contains the security labels of the data elements in DocumentReference, while DocumentReference.securityLabel contains the security labels for the document the reference refers to. The distinction recognizes that the document may contain sensitive information, while the DocumentReference is metadata about the document and thus might not be as sensitive as the document. For example: a psychotherapy episode may contain highly sensitive information, while the metadata may simply indicate that some episode happened.
Short | Document security-tags
Comments | The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce. In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.
Control | 0..*
Binding | For example codes, see SecurityLabelExamples (example to `http://hl7.org/fhir/ValueSet/security-label-example|6.0.0-ballot5` ) Example Security Labels from the Healthcare Privacy and Security Classification System.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Requirements | Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
96. DocumentReference.content
Definition | The document and format referenced. If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata.
Short | Document referenced
Comments | content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.
Control | 1..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | true
Requirements | Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.
Invariants | ele-1: All FHIR elements must have a @value or children or both (`hasValue() or (children().count() > id.count())`)
98. DocumentReference.content.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
100. DocumentReference.content.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.content.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
102. DocumentReference.content.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.content.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
104. DocumentReference.content.attachment
Definition | The document or URL of the document along with critical metadata to prove content has integrity.
Short | Where to access the document
Control | 1..1
Type | Attachment
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
106. DocumentReference.content.attachment.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
108. DocumentReference.content.attachment.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.content.attachment.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
110. DocumentReference.content.attachment.contentType
Definition | Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.
Short | Mime type of the content, with charset etc.
Control | 1..1 This element is affected by the following invariants: att-1
Binding | The codes SHALL be taken from MimeTypes (required to `http://hl7.org/fhir/ValueSet/mimetypes|6.0.0-ballot5` ) BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Processors of the data need to be able to know how to interpret the data.
Example | General: text/plain; charset=UTF-8, image/png
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
112. DocumentReference.content.attachment.language
Definition | The human language of the content. The value can be any valid value according to BCP 47.
Short | Human language of the content (BCP-47)
Control | 0..1
Binding | The codes SHALL be taken from AllLanguages (required to `http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot5` ) IETF language tag for a human language.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Users need to be able to choose between the languages in a set of attachments.
Example | General: en-AU
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
114. DocumentReference.content.attachment.data
Definition | The actual data of the attachment - a sequence of bytes, base64 encoded.
Short | Data inline, base64ed
Comments | The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.
Control | 0..1 This element is affected by the following invariants: att-1
Type | base64Binary
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Requirements | The data needs to able to be transmitted inline.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
116. DocumentReference.content.attachment.url
Definition | A location where the data can be accessed.
Short | Uri where the data can be found
Comments | If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service base URL, like a resource reference, rather than relative to the resource itself; for example, Patient/123 (relative) rather than http://someserver.org/Patient/123 (absolute). Urls may also be URIs only resolvable within a Bundle containing the resource with the attachment type. If a URL is provided, it SHALL resolve to actual data.
Control | 1..1
Type | url
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | The data needs to be transmitted by reference.
Example | General: http://www.acme.com/logo-small.png
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
118. DocumentReference.content.attachment.size
Definition | The number of bytes of data that make up this attachment (before base64 encoding, if that is done).
Short | Number of bytes of content (if url provided)
Comments | The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.
Control | 0..1
Type | integer64
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
120. DocumentReference.content.attachment.hash
Definition | The calculated hash of the data using SHA-1. Represented using base64.
Short | Hash of the data (sha-1, base64ed)
Comments | The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.
Control | 0..1
Type | base64Binary
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
122. DocumentReference.content.attachment.title
Definition | A label or set of text to display in place of the data.
Short | Label to display in place of the data
Comments | May sometimes be derived from the source filename.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.
Example | General: Official Corporate Logo
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
124. DocumentReference.content.attachment.creation
Definition | The date that the attachment was first created.
Short | Date attachment was first created
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | This is often tracked as an integrity issue for use of the attachment.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
126. DocumentReference.content.attachment.height
Definition | Height of the image in pixels (photo/video).
Short | Height of the image in pixels (photo/video)
Control | 0..1
Type | positiveInt
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
128. DocumentReference.content.attachment.width
Definition | Width of the image in pixels (photo/video).
Short | Width of the image in pixels (photo/video)
Control | 0..1
Type | positiveInt
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
130. DocumentReference.content.attachment.frames
Definition | The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gif. If there is more than one frame, this SHALL have a value in order to alert interface software that a multi-frame capable rendering widget is required.
Short | Number of frames if > 1 (photo)
Comments | if the number of frames is not supplied, the value may be unknown. Applications should not assume that there is only one frame unless it is explicitly stated.
Control | 0..1
Type | positiveInt
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
132. DocumentReference.content.attachment.duration
Definition | The duration of the recording in seconds - for audio and video.
Short | Length in seconds (audio / video)
Comments | The duration might differ from occurrencePeriod if recording was paused.
Control | 0..1
Type | decimal
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
134. DocumentReference.content.attachment.pages
Definition | The number of pages when printed.
Short | Number of printed pages
Control | 0..1
Type | positiveInt
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
136. DocumentReference.content.profile
Definition | An identifier of the document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.
Short | Content profile rules for the document
Comments | Note that IHE often issues URNs for formatCode codes, not all documents can be identified by a URI. For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that the content complies with.
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | true
Alternate Names | format, formatCode
Invariants | ele-1: All FHIR elements must have a @value or children or both (`hasValue() or (children().count() > id.count())`)
138. DocumentReference.content.profile.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
140. DocumentReference.content.profile.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.content.profile.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
142. DocumentReference.content.profile.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.content.profile.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
144. DocumentReference.content.profile.value[x]
Definition | Code|uri|canonical.
Short | Code|uri|canonical
Control | 1..1
Binding | The codes SHOULD be taken from HL7 ValueSet of Format Codes for use with Document Sharing (preferred to `http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes` ) Document Format Codes.
Type | Choice of: Coding, uri, canonical
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)