Publication Build: This will be filled in by the publication tooling

• Content
• Detailed Descriptions
• Mappings
• JSON
• History

Resource Profile: Document Reference DocumentReference

This StructureDefinition contains the maps for VistA file TIU DOCUMENT (8925) to us-core-documentreference.

Usage:

• CapabilityStatements using this Resource Profile: Lighthouse Patient Health API
• This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile(5.0.1)	A reference to a document This profile also complies with the profiles US Core DocumentReference Profile (6.1.0) and US Core DocumentReference Profile (7.0.0) 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
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
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier ele-1: All FHIR elements must have a @value or children
identifier	SΣ	0..*	Identifier	Other identifiers for the document 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/$Sta3n/8925
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding ele-1: All FHIR elements must have a @value or children
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://loinc.org
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. ele-1: All FHIR elements must have a @value or children
category:us-core	SΣ	0..*	CodeableConcept	Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes. 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://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clinical-note
subject	SΣ	1..1	Reference(Patient)	Who/what is the subject of the document ele-1: All FHIR elements must have a @value or children
date	SΣ	0..1	instant	When this document reference was created ele-1: All FHIR elements must have a @value or children
author	SΣ	0..*	Reference(Practitioner)	Who and/or what authored the document ele-1: All FHIR elements must have a @value or children
authenticator	S	0..1	Reference(Practitioner)	Who/what authenticated the document ele-1: All FHIR elements must have a @value or children
custodian	S	0..1	Reference(Organization)	Organization which maintains the document ele-1: All FHIR elements must have a @value or children
description	SΣ	0..1	string	Human-readable description ele-1: All FHIR elements must have a @value or children
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children
content	SΣ	1..*	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
id		0..1	string	Unique id for inter-element referencing
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
attachment	SΣC	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
id	S	0..1	string	Unique id for inter-element referencing
contentType	SΣ	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. ele-1: All FHIR elements must have a @value or children Required Pattern: text/plain
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding ele-1: All FHIR elements must have a @value or children Example General: en-AU
data	SC	0..1	base64Binary	Data inline, base64ed ele-1: All FHIR elements must have a @value or children
url	SΣC	0..1	url	Uri where the data can be found ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/logo-small.png
size	SΣ	0..1	unsignedInt	Number of bytes of content (if url provided) ele-1: All FHIR elements must have a @value or children
hash	SΣ	0..1	base64Binary	Hash of the data (sha-1, base64ed) ele-1: All FHIR elements must have a @value or children
title	SΣ	0..1	string	Label to display in place of the data ele-1: All FHIR elements must have a @value or children Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created ele-1: All FHIR elements must have a @value or children
format	SΣ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible) ele-1: All FHIR elements must have a @value or children
context	SΣ	0..1	BackboneElement	Clinical context of document ele-1: All FHIR elements must have a @value or children
id		0..1	string	Unique id for inter-element referencing
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
encounter	S	0..1	Reference(US Core Encounter Profile(5.0.1))	Context of the document content ele-1: All FHIR elements must have a @value or children
event	S	0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. ele-1: All FHIR elements must have a @value or children
period	SΣ	0..1	Period	Time of service that is being documented ele-1: All FHIR elements must have a @value or children
start	SΣC	0..1	dateTime	Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. ele-1: All FHIR elements must have a @value or children
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty). ele-1: All FHIR elements must have a @value or children
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source ele-1: All FHIR elements must have a @value or children
related		0..*	Reference(Resource)	Related identifiers or resources ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status from the FHIR Standard
DocumentReference.type	required	USCoreDocumentReferenceType http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type Additional Bindings Purpose US Core Clinical Note Type Min Binding
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.category:us-core	required	Pattern: clinical-note http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	Pattern: text/plain http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	extensible	DocumentReferenceFormatCodeSet (a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes from the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-6	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()

This structure is derived from USCoreDocumentReferenceProfile

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile(5.0.1)	A reference to a document This profile also complies with the profiles US Core DocumentReference Profile (6.1.0) and US Core DocumentReference Profile (7.0.0)
masterIdentifier		0..1	Identifier	Master Version Specific Identifier
identifier		0..*	Identifier	Other identifiers for the document
system	S	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/8925
type		1..1	CodeableConcept	Kind of document (LOINC if possible)
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
Slices for category				Content/Rules for all slices
category:us-core		0..*	CodeableConcept	Categorization of document 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://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clinical-note
subject		1..1	Reference(Patient)	Who/what is the subject of the document
date		0..1	instant	When this document reference was created
author		0..*	Reference(Practitioner)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization)	Organization which maintains the document
description	S	0..1	string	Human-readable description
securityLabel		0..*	CodeableConcept	Document security-tags
content
id		0..1	string	Unique id for inter-element referencing
attachment
id	S	0..1	string	Unique id for inter-element referencing
contentType		0..1	code	Mime type of the content, with charset etc. Required Pattern: text/plain
language		0..1	code	Human language of the content (BCP-47)
url		0..1	url	Uri where the data can be found
size	S	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	S	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	S	0..1	string	Label to display in place of the data
creation	S	0..1	dateTime	Date attachment was first created
format		0..1	Coding	Format/content rules for the document
context
id		0..1	string	Unique id for inter-element referencing
encounter		0..1	Reference(US Core Encounter Profile(5.0.1))	Context of the document content
event	S	0..*	CodeableConcept	Main clinical acts documented
period
start	S	0..1	dateTime	Starting time with inclusive boundary
end	S	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty)
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile(5.0.1)	A reference to a document This profile also complies with the profiles US Core DocumentReference Profile (6.1.0) and US Core DocumentReference Profile (7.0.0)
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
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
identifier	SΣ	0..*	Identifier	Other identifiers for the document
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/$Sta3n/8925
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus	Σ	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category:us-core	SΣ	0..*	CodeableConcept	Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes. 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://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clinical-note
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	Who/what is the subject of the document
date	SΣ	0..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization)	Organization which maintains the document
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	SΣ	0..1	string	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	Where to access the document us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
id	S	0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	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. Required Pattern: text/plain
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	SC	0..1	base64Binary	Data inline, base64ed
url	SΣC	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	SΣ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	SΣ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	SΣ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
context	SΣ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..1	Reference(US Core Encounter Profile(5.0.1))	Context of the document content
event	S	0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time of service that is being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	0..1	dateTime	Starting time with inclusive boundary
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
DocumentReference.type	required	USCoreDocumentReferenceType http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type Additional Bindings Purpose US Core Clinical Note Type Min Binding
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.category:us-core	required	Pattern: clinical-note http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	Pattern: text/plain http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	extensible	DocumentReferenceFormatCodeSet (a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes from the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-6	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()

This structure is derived from USCoreDocumentReferenceProfile

Summary

Must-Support: 17 elements

Structures

This structure refers to these other structures:

• Patient (http://va.gov/fhir/StructureDefinition/Patient)
• Practitioner (http://va.gov/fhir/StructureDefinition/Practitioner)
• Organization (http://va.gov/fhir/StructureDefinition/Organization)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile(5.0.1)	A reference to a document This profile also complies with the profiles US Core DocumentReference Profile (6.1.0) and US Core DocumentReference Profile (7.0.0) 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
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
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier ele-1: All FHIR elements must have a @value or children
identifier	SΣ	0..*	Identifier	Other identifiers for the document 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/$Sta3n/8925
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding ele-1: All FHIR elements must have a @value or children
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://loinc.org
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. ele-1: All FHIR elements must have a @value or children
category:us-core	SΣ	0..*	CodeableConcept	Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes. 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://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clinical-note
subject	SΣ	1..1	Reference(Patient)	Who/what is the subject of the document ele-1: All FHIR elements must have a @value or children
date	SΣ	0..1	instant	When this document reference was created ele-1: All FHIR elements must have a @value or children
author	SΣ	0..*	Reference(Practitioner)	Who and/or what authored the document ele-1: All FHIR elements must have a @value or children
authenticator	S	0..1	Reference(Practitioner)	Who/what authenticated the document ele-1: All FHIR elements must have a @value or children
custodian	S	0..1	Reference(Organization)	Organization which maintains the document ele-1: All FHIR elements must have a @value or children
description	SΣ	0..1	string	Human-readable description ele-1: All FHIR elements must have a @value or children
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children
content	SΣ	1..*	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
id		0..1	string	Unique id for inter-element referencing
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
attachment	SΣC	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
id	S	0..1	string	Unique id for inter-element referencing
contentType	SΣ	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. ele-1: All FHIR elements must have a @value or children Required Pattern: text/plain
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding ele-1: All FHIR elements must have a @value or children Example General: en-AU
data	SC	0..1	base64Binary	Data inline, base64ed ele-1: All FHIR elements must have a @value or children
url	SΣC	0..1	url	Uri where the data can be found ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/logo-small.png
size	SΣ	0..1	unsignedInt	Number of bytes of content (if url provided) ele-1: All FHIR elements must have a @value or children
hash	SΣ	0..1	base64Binary	Hash of the data (sha-1, base64ed) ele-1: All FHIR elements must have a @value or children
title	SΣ	0..1	string	Label to display in place of the data ele-1: All FHIR elements must have a @value or children Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created ele-1: All FHIR elements must have a @value or children
format	SΣ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible) ele-1: All FHIR elements must have a @value or children
context	SΣ	0..1	BackboneElement	Clinical context of document ele-1: All FHIR elements must have a @value or children
id		0..1	string	Unique id for inter-element referencing
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
encounter	S	0..1	Reference(US Core Encounter Profile(5.0.1))	Context of the document content ele-1: All FHIR elements must have a @value or children
event	S	0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. ele-1: All FHIR elements must have a @value or children
period	SΣ	0..1	Period	Time of service that is being documented ele-1: All FHIR elements must have a @value or children
start	SΣC	0..1	dateTime	Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. ele-1: All FHIR elements must have a @value or children
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty). ele-1: All FHIR elements must have a @value or children
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source ele-1: All FHIR elements must have a @value or children
related		0..*	Reference(Resource)	Related identifiers or resources ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status from the FHIR Standard
DocumentReference.type	required	USCoreDocumentReferenceType http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type Additional Bindings Purpose US Core Clinical Note Type Min Binding
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.category:us-core	required	Pattern: clinical-note http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	Pattern: text/plain http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	extensible	DocumentReferenceFormatCodeSet (a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes from the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-6	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()

Differential View

This structure is derived from USCoreDocumentReferenceProfile

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile(5.0.1)	A reference to a document This profile also complies with the profiles US Core DocumentReference Profile (6.1.0) and US Core DocumentReference Profile (7.0.0)
masterIdentifier		0..1	Identifier	Master Version Specific Identifier
identifier		0..*	Identifier	Other identifiers for the document
system	S	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/8925
type		1..1	CodeableConcept	Kind of document (LOINC if possible)
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
Slices for category				Content/Rules for all slices
category:us-core		0..*	CodeableConcept	Categorization of document 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://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clinical-note
subject		1..1	Reference(Patient)	Who/what is the subject of the document
date		0..1	instant	When this document reference was created
author		0..*	Reference(Practitioner)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization)	Organization which maintains the document
description	S	0..1	string	Human-readable description
securityLabel		0..*	CodeableConcept	Document security-tags
content
id		0..1	string	Unique id for inter-element referencing
attachment
id	S	0..1	string	Unique id for inter-element referencing
contentType		0..1	code	Mime type of the content, with charset etc. Required Pattern: text/plain
language		0..1	code	Human language of the content (BCP-47)
url		0..1	url	Uri where the data can be found
size	S	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	S	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	S	0..1	string	Label to display in place of the data
creation	S	0..1	dateTime	Date attachment was first created
format		0..1	Coding	Format/content rules for the document
context
id		0..1	string	Unique id for inter-element referencing
encounter		0..1	Reference(US Core Encounter Profile(5.0.1))	Context of the document content
event	S	0..*	CodeableConcept	Main clinical acts documented
period
start	S	0..1	dateTime	Starting time with inclusive boundary
end	S	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty)
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	USCoreDocumentReferenceProfile(5.0.1)	A reference to a document This profile also complies with the profiles US Core DocumentReference Profile (6.1.0) and US Core DocumentReference Profile (7.0.0)
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
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
identifier	SΣ	0..*	Identifier	Other identifiers for the document
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/$Sta3n/8925
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus	Σ	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category:us-core	SΣ	0..*	CodeableConcept	Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes. 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://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clinical-note
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	Who/what is the subject of the document
date	SΣ	0..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization)	Organization which maintains the document
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	SΣ	0..1	string	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	Where to access the document us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
id	S	0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	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. Required Pattern: text/plain
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	SC	0..1	base64Binary	Data inline, base64ed
url	SΣC	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	SΣ	0..1	unsignedInt	Number of bytes of content (if url provided)
hash	SΣ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	SΣ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	SΣ	0..1	dateTime	Date attachment was first created
format	SΣ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
context	SΣ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..1	Reference(US Core Encounter Profile(5.0.1))	Context of the document content
event	S	0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time of service that is being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	0..1	dateTime	Starting time with inclusive boundary
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType	S	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	S	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
DocumentReference.type	required	USCoreDocumentReferenceType http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type Additional Bindings Purpose US Core Clinical Note Type Min Binding
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.category:us-core	required	Pattern: clinical-note http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	Pattern: text/plain http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 from the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	extensible	DocumentReferenceFormatCodeSet (a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes from the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-6	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists()

This structure is derived from USCoreDocumentReferenceProfile

Summary

Must-Support: 17 elements

Structures

This structure refers to these other structures:

• Patient (http://va.gov/fhir/StructureDefinition/Patient)
• Practitioner (http://va.gov/fhir/StructureDefinition/Practitioner)
• Organization (http://va.gov/fhir/StructureDefinition/Organization)

Other representations of profile: CSV, Excel, Schematron