Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport	C	0..*	USCoreDiagnosticReportProfileNoteExchange(5.0.1)	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management us-core-10: effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended'
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	Σ	0..*	Identifier	Business identifier for report ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: http://va.gov/identifiers/$Sta3n/63.52
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
basedOn	S	0..*	Reference(ServiceRequest)	What was requested ele-1: All FHIR elements must have a @value or children
status	?!SΣC	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportLabStatus FHIR (required): see mapping VF_DiagnosticReportLabStatus ele-1: All FHIR elements must have a @value or children
Slices for category	SΣ	1..*	CodeableConcept	Service category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LP7839-6
display		1..1	string	Representation defined by the system Fixed Value: Pathology
category:us-core	SΣ	0..*	CodeableConcept	Service category Binding: US Core Diagnostic Report Category Codes (required) ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	US Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 50668-3
display		1..1	string	Representation defined by the system Fixed Value: Microscopic observation in Specimen by Electron microscopy Narrative
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://loinc.org
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(Patient)	The subject of the report - usually, but not always, the patient ele-1: All FHIR elements must have a @value or children
encounter	SΣ	0..1	Reference(Encounter: Outpatient)	Health care event when test ordered ele-1: All FHIR elements must have a @value or children
Slices for effective[x]	SΣC	0..1		Diagnostically relevant time (typically the time of the procedure) Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
effectiveDateTime			dateTime
effective[x]:effectiveDateTime	SΣC	0..1	dateTime	Diagnostically relevant time (typically the time of the procedure) ele-1: All FHIR elements must have a @value or children
issued	SΣ	0..1	instant	DateTime this version was made ele-1: All FHIR elements must have a @value or children
Slices for performer	SΣ	0..*	Reference(US Core Practitioner Profile(5.0.1) | US Core Organization Profile(5.0.1))	Responsible Diagnostic Service Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children
performer:va-by	SΣ	0..1	Reference(Practitioner)	Responsible Diagnostic Service ele-1: All FHIR elements must have a @value or children
performer:va-at	SΣ	0..1	Reference(Organization)	Responsible Diagnostic Service ele-1: All FHIR elements must have a @value or children
resultsInterpreter	SΣ	0..*	Reference(Practitioner)	Primary result interpreter ele-1: All FHIR elements must have a @value or children
specimen	S	0..*	Reference(Diagnostic Report Note: Electron Microscopy Specimen)	Specimens this report is based on ele-1: All FHIR elements must have a @value or children
result	S	0..*	Reference(US Core Laboratory Result Observation Profile(5.0.1) | US Core Observation Clinical Test Result Profile | US Core Observation Imaging Result Profile)	Observations ele-1: All FHIR elements must have a @value or children
media	SΣ	0..*	BackboneElement	Key images associated with this report ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
link	SΣ	1..1	Reference(Media)	Reference to the image source ele-1: All FHIR elements must have a @value or children
conclusion	S	0..1	string	Clinical conclusion (interpretation) of test results ele-1: All FHIR elements must have a @value or children
presentedForm	S	0..*	Attachment	Entire report as issued ele-1: All FHIR elements must have a @value or children
data	S	0..1	base64Binary	Data inline, base64ed ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DiagnosticReport.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DiagnosticReport.status	required	DiagnosticReportLabStatus http://va.gov/fhir/ValueSet/DiagnosticReportLabStatus from this IG
DiagnosticReport.category	example	Pattern: LOINC Code LP7839-6("Pathology") http://hl7.org/fhir/ValueSet/diagnostic-service-sections from the FHIR Standard
DiagnosticReport.category:us-core	required	USCoreDiagnosticReportCategory http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-category
DiagnosticReport.code	extensible	Pattern: LOINC Code 50668-3("Microscopic observation in Specimen by Electron microscopy Narrative") http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-report-and-note-codes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DiagnosticReport	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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DiagnosticReport	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	DiagnosticReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DiagnosticReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-10	error	DiagnosticReport	effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' : (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	USCoreDiagnosticReportProfileNoteExchange(5.0.1)	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
identifier
system	S	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/63.52
value	S	0..1	string	The value that is unique
basedOn	S	0..*	Reference(ServiceRequest)	What was requested
status		1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportLabStatus FHIR (required): see mapping VF_DiagnosticReportLabStatus
category		1..*	CodeableConcept	Service category Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LP7839-6
display		1..1	string	Representation defined by the system Fixed Value: Pathology
code		1..1	CodeableConcept	US Core Report Code Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 50668-3
display		1..1	string	Representation defined by the system Fixed Value: Microscopic observation in Specimen by Electron microscopy Narrative
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
subject		1..1	Reference(Patient)	The subject of the report - usually, but not always, the patient
encounter		0..1	Reference(Encounter: Outpatient)	Health care event when test ordered
Slices for effective[x]		0..1	dateTime, Period	Diagnostically relevant time (typically the time of the procedure) Slice: Unordered, Open by type:$this
effective[x]:effectiveDateTime	S	0..1	dateTime S	Diagnostically relevant time (typically the time of the procedure)
issued		0..1	instant	DateTime this version was made
Slices for performer		0..*	Reference(US Core Practitioner Profile(5.0.1) | US Core Organization Profile(5.0.1) | US Core PractitionerRole Profile(5.0.1) | US Core CareTeam Profile(5.0.1))	Responsible Diagnostic Service Slice: Unordered, Open by value:$this
performer:va-by	S	0..1	Reference(Practitioner)	Responsible Diagnostic Service
performer:va-at	S	0..1	Reference(Organization)	Responsible Diagnostic Service
resultsInterpreter	S	0..*	Reference(Practitioner)	Primary result interpreter
specimen	S	0..*	Reference(Diagnostic Report Note: Electron Microscopy Specimen)	Specimens this report is based on
media
link		1..1	Reference(Media)	Reference to the image source
conclusion	S	0..1	string	Clinical conclusion (interpretation) of test results
presentedForm
data	S	0..1	base64Binary	Data inline, base64ed
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DiagnosticReport.status	required	DiagnosticReportLabStatus http://va.gov/fhir/ValueSet/DiagnosticReportLabStatus from this IG

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport	C	0..*	USCoreDiagnosticReportProfileNoteExchange(5.0.1)	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports us-core-10: effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended'
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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier for report
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/63.52
value	SΣ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
basedOn	S	0..*	Reference(ServiceRequest)	What was requested
status	?!SΣC	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportLabStatus FHIR (required): see mapping VF_DiagnosticReportLabStatus
Slices for category	SΣ	1..*	CodeableConcept	Service category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LP7839-6
display		1..1	string	Representation defined by the system Fixed Value: Pathology
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:us-core	SΣ	0..*	CodeableConcept	Service category Binding: US Core Diagnostic Report Category Codes (required)
code	SΣ	1..1	CodeableConcept	US Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 50668-3
display		1..1	string	Representation defined by the system Fixed Value: Microscopic observation in Specimen by Electron microscopy Narrative
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	The subject of the report - usually, but not always, the patient
encounter	SΣ	0..1	Reference(Encounter: Outpatient)	Health care event when test ordered
Slices for effective[x]	SΣC	0..1		Diagnostically relevant time (typically the time of the procedure) Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime S
effectivePeriod			Period
effective[x]:effectiveDateTime	SΣC	0..1	dateTime S	Diagnostically relevant time (typically the time of the procedure)
issued	SΣ	0..1	instant	DateTime this version was made
Slices for performer	SΣ	0..*	Reference(US Core Practitioner Profile(5.0.1) S | US Core Organization Profile(5.0.1) S | US Core PractitionerRole Profile(5.0.1) | US Core CareTeam Profile(5.0.1))	Responsible Diagnostic Service Slice: Unordered, Open by value:$this
performer:va-by	SΣ	0..1	Reference(Practitioner)	Responsible Diagnostic Service
performer:va-at	SΣ	0..1	Reference(Organization)	Responsible Diagnostic Service
resultsInterpreter	SΣ	0..*	Reference(Practitioner)	Primary result interpreter
specimen	S	0..*	Reference(Diagnostic Report Note: Electron Microscopy Specimen)	Specimens this report is based on
result	S	0..*	Reference(US Core Laboratory Result Observation Profile(5.0.1) S | US Core Observation Clinical Test Result Profile S | US Core Observation Imaging Result Profile S)	Observations
imagingStudy		0..*	Reference(ImagingStudy)	Reference to full details of imaging associated with the diagnostic report
media	SΣ	0..*	BackboneElement	Key images associated with this report
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
comment		0..1	string	Comment about the image (e.g. explanation)
link	SΣ	1..1	Reference(Media)	Reference to the image source
conclusion	S	0..1	string	Clinical conclusion (interpretation) of test results
conclusionCode		0..*	CodeableConcept	Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm	S	0..*	Attachment	Entire report as issued
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	Σ	0..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DiagnosticReport.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DiagnosticReport.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DiagnosticReport.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DiagnosticReport.status	required	DiagnosticReportLabStatus http://va.gov/fhir/ValueSet/DiagnosticReportLabStatus from this IG
DiagnosticReport.category	example	Pattern: LOINC Code LP7839-6("Pathology") http://hl7.org/fhir/ValueSet/diagnostic-service-sections from the FHIR Standard
DiagnosticReport.category:us-core	required	USCoreDiagnosticReportCategory http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-category
DiagnosticReport.code	extensible	Pattern: LOINC Code 50668-3("Microscopic observation in Specimen by Electron microscopy Narrative") http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-report-and-note-codes
DiagnosticReport.conclusionCode	example	SNOMEDCTClinicalFindings http://hl7.org/fhir/ValueSet/clinical-findings from the FHIR Standard
DiagnosticReport.presentedForm.contentType	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard
DiagnosticReport.presentedForm.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DiagnosticReport	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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DiagnosticReport	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	DiagnosticReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DiagnosticReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-10	error	DiagnosticReport	effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' : (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

Summary

Must-Support: 13 elements

Structures

This structure refers to these other structures:

• Patient (http://va.gov/fhir/StructureDefinition/Patient)
• Encounter: Outpatient (http://va.gov/fhir/StructureDefinition/EncounterOutpatient)
• Practitioner (http://va.gov/fhir/StructureDefinition/Practitioner)
• Organization (http://va.gov/fhir/StructureDefinition/Organization)
• Diagnostic Report Note: Electron Microscopy Specimen (http://va.gov/fhir/StructureDefinition/DiagnosticReportNoteElectronMicroscopySpecimen)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DiagnosticReport.effective[x]
• The element 1 is sliced based on the value of DiagnosticReport.performer

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport	C	0..*	USCoreDiagnosticReportProfileNoteExchange(5.0.1)	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management us-core-10: effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended'
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	Σ	0..*	Identifier	Business identifier for report ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: http://va.gov/identifiers/$Sta3n/63.52
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
basedOn	S	0..*	Reference(ServiceRequest)	What was requested ele-1: All FHIR elements must have a @value or children
status	?!SΣC	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportLabStatus FHIR (required): see mapping VF_DiagnosticReportLabStatus ele-1: All FHIR elements must have a @value or children
Slices for category	SΣ	1..*	CodeableConcept	Service category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LP7839-6
display		1..1	string	Representation defined by the system Fixed Value: Pathology
category:us-core	SΣ	0..*	CodeableConcept	Service category Binding: US Core Diagnostic Report Category Codes (required) ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	US Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 50668-3
display		1..1	string	Representation defined by the system Fixed Value: Microscopic observation in Specimen by Electron microscopy Narrative
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://loinc.org
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(Patient)	The subject of the report - usually, but not always, the patient ele-1: All FHIR elements must have a @value or children
encounter	SΣ	0..1	Reference(Encounter: Outpatient)	Health care event when test ordered ele-1: All FHIR elements must have a @value or children
Slices for effective[x]	SΣC	0..1		Diagnostically relevant time (typically the time of the procedure) Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
effectiveDateTime			dateTime
effective[x]:effectiveDateTime	SΣC	0..1	dateTime	Diagnostically relevant time (typically the time of the procedure) ele-1: All FHIR elements must have a @value or children
issued	SΣ	0..1	instant	DateTime this version was made ele-1: All FHIR elements must have a @value or children
Slices for performer	SΣ	0..*	Reference(US Core Practitioner Profile(5.0.1) | US Core Organization Profile(5.0.1))	Responsible Diagnostic Service Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children
performer:va-by	SΣ	0..1	Reference(Practitioner)	Responsible Diagnostic Service ele-1: All FHIR elements must have a @value or children
performer:va-at	SΣ	0..1	Reference(Organization)	Responsible Diagnostic Service ele-1: All FHIR elements must have a @value or children
resultsInterpreter	SΣ	0..*	Reference(Practitioner)	Primary result interpreter ele-1: All FHIR elements must have a @value or children
specimen	S	0..*	Reference(Diagnostic Report Note: Electron Microscopy Specimen)	Specimens this report is based on ele-1: All FHIR elements must have a @value or children
result	S	0..*	Reference(US Core Laboratory Result Observation Profile(5.0.1) | US Core Observation Clinical Test Result Profile | US Core Observation Imaging Result Profile)	Observations ele-1: All FHIR elements must have a @value or children
media	SΣ	0..*	BackboneElement	Key images associated with this report ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
link	SΣ	1..1	Reference(Media)	Reference to the image source ele-1: All FHIR elements must have a @value or children
conclusion	S	0..1	string	Clinical conclusion (interpretation) of test results ele-1: All FHIR elements must have a @value or children
presentedForm	S	0..*	Attachment	Entire report as issued ele-1: All FHIR elements must have a @value or children
data	S	0..1	base64Binary	Data inline, base64ed ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DiagnosticReport.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DiagnosticReport.status	required	DiagnosticReportLabStatus http://va.gov/fhir/ValueSet/DiagnosticReportLabStatus from this IG
DiagnosticReport.category	example	Pattern: LOINC Code LP7839-6("Pathology") http://hl7.org/fhir/ValueSet/diagnostic-service-sections from the FHIR Standard
DiagnosticReport.category:us-core	required	USCoreDiagnosticReportCategory http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-category
DiagnosticReport.code	extensible	Pattern: LOINC Code 50668-3("Microscopic observation in Specimen by Electron microscopy Narrative") http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-report-and-note-codes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DiagnosticReport	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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DiagnosticReport	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	DiagnosticReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DiagnosticReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-10	error	DiagnosticReport	effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' : (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	USCoreDiagnosticReportProfileNoteExchange(5.0.1)	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
identifier
system	S	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/63.52
value	S	0..1	string	The value that is unique
basedOn	S	0..*	Reference(ServiceRequest)	What was requested
status		1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportLabStatus FHIR (required): see mapping VF_DiagnosticReportLabStatus
category		1..*	CodeableConcept	Service category Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LP7839-6
display		1..1	string	Representation defined by the system Fixed Value: Pathology
code		1..1	CodeableConcept	US Core Report Code Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 50668-3
display		1..1	string	Representation defined by the system Fixed Value: Microscopic observation in Specimen by Electron microscopy Narrative
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
subject		1..1	Reference(Patient)	The subject of the report - usually, but not always, the patient
encounter		0..1	Reference(Encounter: Outpatient)	Health care event when test ordered
Slices for effective[x]		0..1	dateTime, Period	Diagnostically relevant time (typically the time of the procedure) Slice: Unordered, Open by type:$this
effective[x]:effectiveDateTime	S	0..1	dateTime S	Diagnostically relevant time (typically the time of the procedure)
issued		0..1	instant	DateTime this version was made
Slices for performer		0..*	Reference(US Core Practitioner Profile(5.0.1) | US Core Organization Profile(5.0.1) | US Core PractitionerRole Profile(5.0.1) | US Core CareTeam Profile(5.0.1))	Responsible Diagnostic Service Slice: Unordered, Open by value:$this
performer:va-by	S	0..1	Reference(Practitioner)	Responsible Diagnostic Service
performer:va-at	S	0..1	Reference(Organization)	Responsible Diagnostic Service
resultsInterpreter	S	0..*	Reference(Practitioner)	Primary result interpreter
specimen	S	0..*	Reference(Diagnostic Report Note: Electron Microscopy Specimen)	Specimens this report is based on
media
link		1..1	Reference(Media)	Reference to the image source
conclusion	S	0..1	string	Clinical conclusion (interpretation) of test results
presentedForm
data	S	0..1	base64Binary	Data inline, base64ed
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DiagnosticReport.status	required	DiagnosticReportLabStatus http://va.gov/fhir/ValueSet/DiagnosticReportLabStatus from this IG

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport	C	0..*	USCoreDiagnosticReportProfileNoteExchange(5.0.1)	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports us-core-10: effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended'
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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier for report
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/63.52
value	SΣ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
basedOn	S	0..*	Reference(ServiceRequest)	What was requested
status	?!SΣC	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportLabStatus FHIR (required): see mapping VF_DiagnosticReportLabStatus
Slices for category	SΣ	1..*	CodeableConcept	Service category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LP7839-6
display		1..1	string	Representation defined by the system Fixed Value: Pathology
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:us-core	SΣ	0..*	CodeableConcept	Service category Binding: US Core Diagnostic Report Category Codes (required)
code	SΣ	1..1	CodeableConcept	US Core Report Code Binding: US Core Non Laboratory Codes (extensible): LOINC codes Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 50668-3
display		1..1	string	Representation defined by the system Fixed Value: Microscopic observation in Specimen by Electron microscopy Narrative
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	The subject of the report - usually, but not always, the patient
encounter	SΣ	0..1	Reference(Encounter: Outpatient)	Health care event when test ordered
Slices for effective[x]	SΣC	0..1		Diagnostically relevant time (typically the time of the procedure) Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime S
effectivePeriod			Period
effective[x]:effectiveDateTime	SΣC	0..1	dateTime S	Diagnostically relevant time (typically the time of the procedure)
issued	SΣ	0..1	instant	DateTime this version was made
Slices for performer	SΣ	0..*	Reference(US Core Practitioner Profile(5.0.1) S | US Core Organization Profile(5.0.1) S | US Core PractitionerRole Profile(5.0.1) | US Core CareTeam Profile(5.0.1))	Responsible Diagnostic Service Slice: Unordered, Open by value:$this
performer:va-by	SΣ	0..1	Reference(Practitioner)	Responsible Diagnostic Service
performer:va-at	SΣ	0..1	Reference(Organization)	Responsible Diagnostic Service
resultsInterpreter	SΣ	0..*	Reference(Practitioner)	Primary result interpreter
specimen	S	0..*	Reference(Diagnostic Report Note: Electron Microscopy Specimen)	Specimens this report is based on
result	S	0..*	Reference(US Core Laboratory Result Observation Profile(5.0.1) S | US Core Observation Clinical Test Result Profile S | US Core Observation Imaging Result Profile S)	Observations
imagingStudy		0..*	Reference(ImagingStudy)	Reference to full details of imaging associated with the diagnostic report
media	SΣ	0..*	BackboneElement	Key images associated with this report
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
comment		0..1	string	Comment about the image (e.g. explanation)
link	SΣ	1..1	Reference(Media)	Reference to the image source
conclusion	S	0..1	string	Clinical conclusion (interpretation) of test results
conclusionCode		0..*	CodeableConcept	Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm	S	0..*	Attachment	Entire report as issued
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	Σ	0..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	unsignedInt	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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DiagnosticReport.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DiagnosticReport.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DiagnosticReport.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DiagnosticReport.status	required	DiagnosticReportLabStatus http://va.gov/fhir/ValueSet/DiagnosticReportLabStatus from this IG
DiagnosticReport.category	example	Pattern: LOINC Code LP7839-6("Pathology") http://hl7.org/fhir/ValueSet/diagnostic-service-sections from the FHIR Standard
DiagnosticReport.category:us-core	required	USCoreDiagnosticReportCategory http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-category
DiagnosticReport.code	extensible	Pattern: LOINC Code 50668-3("Microscopic observation in Specimen by Electron microscopy Narrative") http://hl7.org/fhir/us/core/ValueSet/us-core-diagnosticreport-report-and-note-codes
DiagnosticReport.conclusionCode	example	SNOMEDCTClinicalFindings http://hl7.org/fhir/ValueSet/clinical-findings from the FHIR Standard
DiagnosticReport.presentedForm.contentType	required	Mime Types (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard
DiagnosticReport.presentedForm.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DiagnosticReport	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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DiagnosticReport	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	DiagnosticReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DiagnosticReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-10	error	DiagnosticReport	effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' : (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

Summary

Must-Support: 13 elements

Structures

This structure refers to these other structures:

• Patient (http://va.gov/fhir/StructureDefinition/Patient)
• Encounter: Outpatient (http://va.gov/fhir/StructureDefinition/EncounterOutpatient)
• Practitioner (http://va.gov/fhir/StructureDefinition/Practitioner)
• Organization (http://va.gov/fhir/StructureDefinition/Organization)
• Diagnostic Report Note: Electron Microscopy Specimen (http://va.gov/fhir/StructureDefinition/DiagnosticReportNoteElectronMicroscopySpecimen)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DiagnosticReport.effective[x]
• The element 1 is sliced based on the value of DiagnosticReport.performer