US Veterans Health Administration FHIR Map Set Implementation Guide - Downloaded Version 1.8.0 See the Directory of published versions

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Resource Profile: Document Reference DocumentReference

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

Usages:

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

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		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)
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
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
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/8925
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Required Pattern: current
docStatus	SΣC	0..1	code	preliminary | final | amended | entered-in-error Binding: documentReferencedocStatus FHIR (required): see mapping VF_documentReferencedocStatus Constraints: drdr-34-1787, drdr-34-1788, drdr-34-1789
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding
coding	Σ	0..*	Coding	Code defined by a terminology system
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code	SΣ	0..1	code	Symbol in syntax defined by the system
text	SΣ	0..1	string	Plain text representation of the concept
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$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
Slices for relatesTo	Σ	0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:$this
relatesTo:All Slices				Content/Rules for all slices
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
relatesTo:va-parent	SΣ	0..1	BackboneElement	Relationships to other documents
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣC	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: drdr-34-882-1
target	SΣC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-882
relatesTo:va-id-parent	SΣ	0..1	BackboneElement	Relationships to other documents
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣC	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: drdr-34-884-1
target	SΣC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-884
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
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	Where to access the document Constraints: us-core-6
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. 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
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..1	Reference(US Core Encounter Profile(7.0.0))	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
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.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.status	required	Pattern Value: current http://hl7.org/fhir/ValueSet/document-reference-status From the FHIR Standard
DocumentReference.docStatus	required	DocumentReferencedocStatus http://va.gov/fhir/ValueSet/documentReferencedocStatus From this IG
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 Value: 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.relatesTo:va-parent.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.relatesTo:va-id-parent.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 Value: 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()
drdr-34-882	best practice	DocumentReference.relatesTo:va-parent.target	If not null then source value from (8925-.06) : true
drdr-34-884	best practice	DocumentReference.relatesTo:va-id-parent.target	If not null then source value from (8925-2101) : true
drdr-34-1787	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501128 INACTIVE then exclude record : true
drdr-34-1788	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501287 PURGED then exclude record : true
drdr-34-1789	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501289 TEST then exclude record : true
drdr-34-884-1	best practice	DocumentReference.relatesTo:va-id-parent.code	If not null then fixed value #append : true
drdr-34-882-1	best practice	DocumentReference.relatesTo:va-parent.code	If not null then fixed value #append : true
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    Filter: Bindings Constraints Obligations
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/$Sta3n/8925
status		1..1	code	current | superseded | entered-in-error Required Pattern: current
docStatus	SC	0..1	code	preliminary | final | amended | entered-in-error Binding: documentReferencedocStatus FHIR (required): see mapping VF_documentReferencedocStatus Constraints: drdr-34-1787, drdr-34-1788, drdr-34-1789
type		1..1	CodeableConcept	Kind of document (LOINC if possible)
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
Slices for category				Content/Rules for all slices
category:us-core		0..*	CodeableConcept	Categorization of document Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clinical-note
subject		1..1	Reference(Patient)	Who/what is the subject of the document
date		0..1	instant	When this document reference was created
author		0..*	Reference(Practitioner)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization)	Organization which maintains the document
Slices for relatesTo		0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:$this
relatesTo:va-parent	S	0..1	BackboneElement	Relationships to other documents
code	SC	1..1	code	replaces | transforms | signs | appends Constraints: drdr-34-882-1
target	SC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-882
relatesTo:va-id-parent	S	0..1	BackboneElement	Relationships to other documents
code	SC	1..1	code	replaces | transforms | signs | appends Constraints: drdr-34-884-1
target	SC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-884
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(7.0.0))	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

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.docStatus	required	DocumentReferencedocStatus http://va.gov/fhir/ValueSet/documentReferencedocStatus From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
drdr-34-882	best practice	DocumentReference.relatesTo:va-parent.target	If not null then source value from (8925-.06) : true
drdr-34-884	best practice	DocumentReference.relatesTo:va-id-parent.target	If not null then source value from (8925-2101) : true
drdr-34-1787	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501128 INACTIVE then exclude record : true
drdr-34-1788	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501287 PURGED then exclude record : true
drdr-34-1789	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501289 TEST then exclude record : true
drdr-34-884-1	best practice	DocumentReference.relatesTo:va-id-parent.code	If not null then fixed value #append : true
drdr-34-882-1	best practice	DocumentReference.relatesTo:va-parent.code	If not null then fixed value #append : true

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	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/$Sta3n/8925
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Required Pattern: current
docStatus	SΣC	0..1	code	preliminary | final | amended | entered-in-error Binding: documentReferencedocStatus FHIR (required): see mapping VF_documentReferencedocStatus Constraints: drdr-34-1787, drdr-34-1788, drdr-34-1789
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$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
Slices for relatesTo	Σ	0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:$this
relatesTo:All Slices				Content/Rules for all slices
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
relatesTo:va-parent	SΣ	0..1	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	SΣC	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: drdr-34-882-1
target	SΣC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-882
relatesTo:va-id-parent	SΣ	0..1	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	SΣC	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: drdr-34-884-1
target	SΣC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-884
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 Constraints: us-core-6
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(7.0.0))	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	Pattern Value: current http://hl7.org/fhir/ValueSet/document-reference-status From the FHIR Standard
DocumentReference.docStatus	required	DocumentReferencedocStatus http://va.gov/fhir/ValueSet/documentReferencedocStatus From this IG
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 Value: 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.relatesTo:va-parent.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.relatesTo:va-id-parent.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 Value: 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()
drdr-34-882	best practice	DocumentReference.relatesTo:va-parent.target	If not null then source value from (8925-.06) : true
drdr-34-884	best practice	DocumentReference.relatesTo:va-id-parent.target	If not null then source value from (8925-2101) : true
drdr-34-1787	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501128 INACTIVE then exclude record : true
drdr-34-1788	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501287 PURGED then exclude record : true
drdr-34-1789	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501289 TEST then exclude record : true
drdr-34-884-1	best practice	DocumentReference.relatesTo:va-id-parent.code	If not null then fixed value #append : true
drdr-34-882-1	best practice	DocumentReference.relatesTo:va-parent.code	If not null then fixed value #append : true
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: 24 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)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.relatesTo

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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)
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
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
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	0..1	uri	The namespace for the identifier value Required Pattern: http://va.gov/identifiers/$Sta3n/8925
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Required Pattern: current
docStatus	SΣC	0..1	code	preliminary | final | amended | entered-in-error Binding: documentReferencedocStatus FHIR (required): see mapping VF_documentReferencedocStatus Constraints: drdr-34-1787, drdr-34-1788, drdr-34-1789
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding
coding	Σ	0..*	Coding	Code defined by a terminology system
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code	SΣ	0..1	code	Symbol in syntax defined by the system
text	SΣ	0..1	string	Plain text representation of the concept
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$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
Slices for relatesTo	Σ	0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:$this
relatesTo:All Slices				Content/Rules for all slices
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
relatesTo:va-parent	SΣ	0..1	BackboneElement	Relationships to other documents
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣC	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: drdr-34-882-1
target	SΣC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-882
relatesTo:va-id-parent	SΣ	0..1	BackboneElement	Relationships to other documents
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣC	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: drdr-34-884-1
target	SΣC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-884
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
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	Where to access the document Constraints: us-core-6
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. 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
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..1	Reference(US Core Encounter Profile(7.0.0))	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
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.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.status	required	Pattern Value: current http://hl7.org/fhir/ValueSet/document-reference-status From the FHIR Standard
DocumentReference.docStatus	required	DocumentReferencedocStatus http://va.gov/fhir/ValueSet/documentReferencedocStatus From this IG
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 Value: 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.relatesTo:va-parent.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.relatesTo:va-id-parent.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 Value: 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()
drdr-34-882	best practice	DocumentReference.relatesTo:va-parent.target	If not null then source value from (8925-.06) : true
drdr-34-884	best practice	DocumentReference.relatesTo:va-id-parent.target	If not null then source value from (8925-2101) : true
drdr-34-1787	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501128 INACTIVE then exclude record : true
drdr-34-1788	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501287 PURGED then exclude record : true
drdr-34-1789	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501289 TEST then exclude record : true
drdr-34-884-1	best practice	DocumentReference.relatesTo:va-id-parent.code	If not null then fixed value #append : true
drdr-34-882-1	best practice	DocumentReference.relatesTo:va-parent.code	If not null then fixed value #append : true
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    Filter: Bindings Constraints Obligations
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/$Sta3n/8925
status		1..1	code	current | superseded | entered-in-error Required Pattern: current
docStatus	SC	0..1	code	preliminary | final | amended | entered-in-error Binding: documentReferencedocStatus FHIR (required): see mapping VF_documentReferencedocStatus Constraints: drdr-34-1787, drdr-34-1788, drdr-34-1789
type		1..1	CodeableConcept	Kind of document (LOINC if possible)
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
Slices for category				Content/Rules for all slices
category:us-core		0..*	CodeableConcept	Categorization of document Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clinical-note
subject		1..1	Reference(Patient)	Who/what is the subject of the document
date		0..1	instant	When this document reference was created
author		0..*	Reference(Practitioner)	Who and/or what authored the document
authenticator	S	0..1	Reference(Practitioner)	Who/what authenticated the document
custodian	S	0..1	Reference(Organization)	Organization which maintains the document
Slices for relatesTo		0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:$this
relatesTo:va-parent	S	0..1	BackboneElement	Relationships to other documents
code	SC	1..1	code	replaces | transforms | signs | appends Constraints: drdr-34-882-1
target	SC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-882
relatesTo:va-id-parent	S	0..1	BackboneElement	Relationships to other documents
code	SC	1..1	code	replaces | transforms | signs | appends Constraints: drdr-34-884-1
target	SC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-884
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(7.0.0))	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

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.docStatus	required	DocumentReferencedocStatus http://va.gov/fhir/ValueSet/documentReferencedocStatus From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
drdr-34-882	best practice	DocumentReference.relatesTo:va-parent.target	If not null then source value from (8925-.06) : true
drdr-34-884	best practice	DocumentReference.relatesTo:va-id-parent.target	If not null then source value from (8925-2101) : true
drdr-34-1787	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501128 INACTIVE then exclude record : true
drdr-34-1788	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501287 PURGED then exclude record : true
drdr-34-1789	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501289 TEST then exclude record : true
drdr-34-884-1	best practice	DocumentReference.relatesTo:va-id-parent.code	If not null then fixed value #append : true
drdr-34-882-1	best practice	DocumentReference.relatesTo:va-parent.code	If not null then fixed value #append : true

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	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/$Sta3n/8925
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Required Pattern: current
docStatus	SΣC	0..1	code	preliminary | final | amended | entered-in-error Binding: documentReferencedocStatus FHIR (required): see mapping VF_documentReferencedocStatus Constraints: drdr-34-1787, drdr-34-1788, drdr-34-1789
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown' Additional Bindings Purpose US Core Clinical Note Type Min Binding
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
Slices for category	SΣ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by pattern:$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
Slices for relatesTo	Σ	0..*	BackboneElement	Relationships to other documents Slice: Unordered, Open by value:$this
relatesTo:All Slices				Content/Rules for all slices
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
relatesTo:va-parent	SΣ	0..1	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	SΣC	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: drdr-34-882-1
target	SΣC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-882
relatesTo:va-id-parent	SΣ	0..1	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	SΣC	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: drdr-34-884-1
target	SΣC	1..1	Reference(DocumentReference)	Target of the relationship Constraints: drdr-34-884
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 Constraints: us-core-6
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(7.0.0))	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	Pattern Value: current http://hl7.org/fhir/ValueSet/document-reference-status From the FHIR Standard
DocumentReference.docStatus	required	DocumentReferencedocStatus http://va.gov/fhir/ValueSet/documentReferencedocStatus From this IG
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 Value: 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.relatesTo:va-parent.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.relatesTo:va-id-parent.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 Value: 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()
drdr-34-882	best practice	DocumentReference.relatesTo:va-parent.target	If not null then source value from (8925-.06) : true
drdr-34-884	best practice	DocumentReference.relatesTo:va-id-parent.target	If not null then source value from (8925-2101) : true
drdr-34-1787	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501128 INACTIVE then exclude record : true
drdr-34-1788	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501287 PURGED then exclude record : true
drdr-34-1789	best practice	DocumentReference.docStatus	If (8925-.05 > 8925.6-.01) is 4501289 TEST then exclude record : true
drdr-34-884-1	best practice	DocumentReference.relatesTo:va-id-parent.code	If not null then fixed value #append : true
drdr-34-882-1	best practice	DocumentReference.relatesTo:va-parent.code	If not null then fixed value #append : true
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: 24 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)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.relatesTo