CH ELM (R4)
1.3.0 - release Switzerland flag

This page is part of the Observations of notifiable communicable infectious diseases (v1.3.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: ChElmDiagnosticReport - Detailed Descriptions

Active as of 2024-05-17

Definitions for the ch-elm-diagnosticreport resource profile.

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

0. DiagnosticReport
ShortCH ELM DiagnosticReport: Laboratory Report
2. DiagnosticReport.identifier
ShortPersistent, unique identifier for the diagnostic report (UUID)
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1
4. DiagnosticReport.identifier.system
Control1..?
Pattern Valueurn:ietf:rfc:3986
6. DiagnosticReport.identifier.value
Control1..?
Example<br/><b>CH ELM</b>:urn:uuid:d494503a-7bef-4551-853c-f3dced2c518f
Invariantsch-elm-doc-identifier: The identifier must be an UUID. (startsWith('urn:uuid:'))
8. DiagnosticReport.basedOn
Control1..1
TypeReference(CH ELM ServiceRequest: Laboratory Order)
10. DiagnosticReport.status
Pattern Valuefinal
12. DiagnosticReport.subject
TypeReference(CH ELM Patient)
14. DiagnosticReport.performer
Control0..1
TypeReference(CH ELM Organization: Lab)
16. DiagnosticReport.specimen
Control1..1
TypeReference(CH ELM Specimen: Laboratory)
18. DiagnosticReport.result
Control0..1
TypeReference(CH ELM Observation Results: Laboratory)

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

0. DiagnosticReport
Definition

The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.

ShortCH ELM DiagnosticReport: Laboratory ReportA Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
Comments

This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesReport, Test, Result, Results, Labs, Laboratory
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id 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: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
ch-lab-dr1: The resource should be conform to the corresponding EU LAB profile (conformsTo('http://hl7.eu/fhir/laboratory/StructureDefinition/DiagnosticReport-eu-lab'))
2. DiagnosticReport.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. DiagnosticReport.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control10..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on DiagnosticReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. DiagnosticReport.extension:DiagnosticReportCompositionR5
    Slice NameDiagnosticReportCompositionR5
    Definition

    This extension implements the R5 composition element. It allow to link this DiagnoticReport with the Composition documenting this Laboratory Report.

    ShortAssociated Lab Report Composition
    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Extension Definition for DiagnosticReport.composition for Version 5.0) (Extension Type: Reference(Composition))
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. DiagnosticReport.extension:DiagnosticReportCompositionR5.extension
    Definition

    An Extension


    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortExtensionAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..0*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on DiagnosticReport.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 10. DiagnosticReport.extension:DiagnosticReportCompositionR5.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition
      12. DiagnosticReport.extension:DiagnosticReportCompositionR5.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control10..1
      TypeReference(CH Lab Composition: Laboratory Report), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      14. DiagnosticReport.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Summaryfalse
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. DiagnosticReport.identifier
      Definition

      Identifiers assigned to this report by the performer or other systems.

      ShortPersistent, unique identifier for the diagnostic report (UUID)Business identifier for report
      Comments

      Usually assigned by the Information System of the diagnostic service provider (filler id).

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control10..1*
      TypeIdentifier
      Is Modifierfalse
      Summarytrue
      Requirements

      Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

      Alternate NamesReportID, Filler ID, Placer ID
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. DiagnosticReport.identifier.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. DiagnosticReport.identifier.system
      Definition

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      Pattern Valueurn:ietf:rfc:3986
      Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. DiagnosticReport.identifier.value
      Definition

      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control10..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Example<br/><b>General</b>:123456 <br/><b>CH ELM</b>:urn:uuid:d494503a-7bef-4551-853c-f3dced2c518f
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ch-elm-doc-identifier: The identifier must be an UUID. (startsWith('urn:uuid:'))
      24. DiagnosticReport.basedOn
      Definition

      Details concerning a service requested.

      ShortWhat was requested
      Comments

      Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

      Control10..1*
      TypeReference(CH ELM ServiceRequest: Laboratory Order, CarePlan, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
      Is Modifierfalse
      Summaryfalse
      Requirements

      This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

      Alternate NamesRequest
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. DiagnosticReport.status
      Definition

      The status of the diagnostic report.

      Shortregistered | partial | preliminary | final +
      Control1..1
      BindingThe codes SHALL be taken from DiagnosticReportStatushttp://hl7.org/fhir/ValueSet/diagnostic-report-status|4.0.1
      (required to http://hl7.org/fhir/ValueSet/diagnostic-report-status|4.0.1)

      The status of the diagnostic report.

      Typecode
      Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

      Pattern Valuefinal
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. DiagnosticReport.category
      Definition

      A code that classifies this laboratory report.


      A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

      ShortReport CategoryService category
      Comments

      DiagnosticReport.category and Composition.category shall be aligned


      Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

      Control0..*
      BindingFor example codes, see DiagnosticServiceSectionCodeshttp://hl7.org/fhir/ValueSet/diagnostic-service-sections
      (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)

      Codes for diagnostic service sections.

      TypeCodeableConcept(Codeable Concept (IPS))
      Is Modifierfalse
      Summarytrue
      Alternate NamesDepartment, Sub-department, Service, Discipline
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • pattern @ $this
      • 30. DiagnosticReport.category:studyType
        Slice NamestudyType
        Definition

        A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

        ShortThe clinical domain of the laboratory performing the observation (e.g. microbiology, toxicology, chemistry)Service category
        Comments

        Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

        Control0..*
        BindingThe codes SHALL be taken from For example codes, see Lab Study Types in Switzerlandhttp://hl7.org/fhir/ValueSet/diagnostic-service-sections
        (required to http://fhir.ch/ig/ch-lab-report/ValueSet/ch-lab-report-lab-study-types)
        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Alternate NamesDepartment, Sub-department, Service, Discipline
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. DiagnosticReport.category:specialty
        Slice Namespecialty
        Definition

        A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

        ShortThe way of grouping of the test results into clinically meaningful groups (e.g. liver test; minerals; glucose profiles)Service category
        Comments

        Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

        Control0..*
        BindingThe codes SHALL be taken from For example codes, see Laboratory Specialtyhttp://hl7.org/fhir/ValueSet/diagnostic-service-sections
        (required to http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab)
        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Alternate NamesDepartment, Sub-department, Service, Discipline
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. DiagnosticReport.code
        Definition

        A code or name that describes this diagnostic report.

        ShortLaboratory reportName/Code for this diagnostic report
        Control1..1
        BindingThe codes SHOULD be taken from LOINCDiagnosticReportCodeshttp://hl7.org/fhir/ValueSet/report-codes
        (preferred to http://hl7.org/fhir/ValueSet/report-codes)

        Codes that describe Diagnostic Reports.

        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Alternate NamesType
        Pattern Value{
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "11502-2"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. DiagnosticReport.code.coding
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control10..*
        TypeCoding
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on DiagnosticReport.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ code
        • value @ system
        • 38. DiagnosticReport.code.coding:CodeCode
          Slice NameCodeCode
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control10..1*
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          40. DiagnosticReport.code.coding:CodeCode.system
          Definition

          The identification of the code system that defines the meaning of the symbol in the code.

          ShortIdentity of the terminology system
          Comments

          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

          Control10..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to be unambiguous about the source of the definition of the symbol.

          Fixed Valuehttp://loinc.org
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          42. DiagnosticReport.code.coding:CodeCode.code
          Definition

          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          ShortSymbol in syntax defined by the system
          Control10..1
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to refer to a particular code in the system.

          Fixed Value11502-2
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          44. DiagnosticReport.subject
          Definition

          The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.

          ShortThe subject of the report - usually, but not always, the patient
          Control10..1
          TypeReference(CH ELM Patient, Patient, Group, Device, Location)
          Is Modifierfalse
          Summarytrue
          Requirements

          SHALL know the subject context.

          Alternate NamesPatient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          46. DiagnosticReport.performer
          Definition

          The diagnostic service that is responsible for issuing the report.

          ShortResponsible Diagnostic Service
          Comments

          This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

          Control10..1*
          TypeReference(CH ELM Organization: Lab, Practitioner, PractitionerRole, Organization, CareTeam)
          Is Modifierfalse
          Summarytrue
          Requirements

          Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

          Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. DiagnosticReport.specimen
          Definition

          Details about the specimens on which this diagnostic report is based.

          ShortSpecimens this report is based on
          Comments

          If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.

          Control10..1*
          TypeReference(CH ELM Specimen: Laboratory, Specimen)
          Is Modifierfalse
          Summaryfalse
          Requirements

          Need to be able to report information about the collected specimens on which the report is based.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. DiagnosticReport.result
          Definition

          Observations that are part of this diagnostic report.

          ShortObservations
          Comments

          Observations can contain observations.

          Control10..1*
          TypeReference(CH ELM Observation Results: Laboratory, Observation)
          Is Modifierfalse
          Summaryfalse
          Requirements

          Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

          Alternate NamesData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

          0. DiagnosticReport
          Definition

          The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.

          ShortCH ELM DiagnosticReport: Laboratory Report
          Comments

          This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

          Control0..*
          Is Modifierfalse
          Summaryfalse
          Alternate NamesReport, Test, Result, Results, Labs, Laboratory
          Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
          dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id 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: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
          dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
          dom-6: A resource should have narrative for robust management (text.`div`.exists())
          ch-lab-dr1: The resource should be conform to the corresponding EU LAB profile (conformsTo('http://hl7.eu/fhir/laboratory/StructureDefinition/DiagnosticReport-eu-lab'))
          2. DiagnosticReport.id
          Definition

          The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

          ShortLogical id of this artifact
          Comments

          The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

          Control0..1
          Typeid
          Is Modifierfalse
          Summarytrue
          4. DiagnosticReport.meta
          Definition

          The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

          ShortMetadata about the resource
          Control0..1
          TypeMeta
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          6. DiagnosticReport.implicitRules
          Definition

          A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

          ShortA set of rules under which this content was created
          Comments

          Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

          Control0..1
          Typeuri
          Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          8. DiagnosticReport.language
          Definition

          The base language in which the resource is written.

          ShortLanguage of the resource content
          Comments

          Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

          Control0..1
          BindingThe codes SHOULD be taken from CommonLanguages
          (preferred to http://hl7.org/fhir/ValueSet/languages)

          A human language.

          Additional BindingsPurpose
          AllLanguagesMax Binding
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          10. DiagnosticReport.text
          Definition

          A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

          ShortText summary of the resource, for human interpretation
          Comments

          Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

          Control0..1
          TypeNarrative
          Is Modifierfalse
          Summaryfalse
          Alternate Namesnarrative, html, xhtml, display
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          12. DiagnosticReport.contained
          Definition

          These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

          ShortContained, inline Resources
          Comments

          This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

          Control0..*
          TypeResource
          Is Modifierfalse
          Summaryfalse
          Alternate Namesinline resources, anonymous resources, contained resources
          14. DiagnosticReport.extension
          Definition

          An Extension

          ShortExtension
          Control1..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on DiagnosticReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 16. DiagnosticReport.extension:DiagnosticReportCompositionR5
            Slice NameDiagnosticReportCompositionR5
            Definition

            This extension implements the R5 composition element. It allow to link this DiagnoticReport with the Composition documenting this Laboratory Report.

            ShortAssociated Lab Report Composition
            Control1..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Extension Definition for DiagnosticReport.composition for Version 5.0) (Extension Type: Reference(Composition))
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            18. DiagnosticReport.extension:DiagnosticReportCompositionR5.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            20. DiagnosticReport.extension:DiagnosticReportCompositionR5.extension
            Definition

            An Extension

            ShortExtension
            Control0..0
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on DiagnosticReport.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 22. DiagnosticReport.extension:DiagnosticReportCompositionR5.url
              Definition

              Source of the definition for the extension code - a logical name or a URL.

              Shortidentifies the meaning of the extension
              Comments

              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

              Control1..1
              Typeuri
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition
              24. DiagnosticReport.extension:DiagnosticReportCompositionR5.value[x]
              Definition

              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

              ShortValue of extension
              Control1..1
              TypeReference(CH Lab Composition: Laboratory Report)
              [x] NoteSee Choice of Data Types for further information about how to use [x]
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              26. DiagnosticReport.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
              Summaryfalse
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              28. DiagnosticReport.identifier
              Definition

              Identifiers assigned to this report by the performer or other systems.

              ShortPersistent, unique identifier for the diagnostic report (UUID)
              Comments

              Usually assigned by the Information System of the diagnostic service provider (filler id).

              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control1..1
              TypeIdentifier
              Is Modifierfalse
              Summarytrue
              Requirements

              Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

              Alternate NamesReportID, Filler ID, Placer ID
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              30. DiagnosticReport.identifier.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              32. DiagnosticReport.identifier.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on DiagnosticReport.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 34. DiagnosticReport.identifier.use
                Definition

                The purpose of this identifier.

                Shortusual | official | temp | secondary | old (If known)
                Comments

                Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                Control0..1
                BindingThe codes SHALL be taken from IdentifierUse
                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                Identifies the purpose for this identifier, if known .

                Typecode
                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                36. DiagnosticReport.identifier.type
                Definition

                A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                ShortDescription of identifier
                Comments

                This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Requirements

                Allows users to make use of identifiers when the identifier system is not known.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                38. DiagnosticReport.identifier.system
                Definition

                Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                ShortThe namespace for the identifier value
                Comments

                Identifier.system is always case sensitive.

                Control1..1
                Typeuri
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                Pattern Valueurn:ietf:rfc:3986
                Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                40. DiagnosticReport.identifier.value
                Definition

                The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                ShortThe value that is unique
                Comments

                If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                Control1..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Example<br/><b>General</b>:123456 <br/><b>CH ELM</b>:urn:uuid:d494503a-7bef-4551-853c-f3dced2c518f
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ch-elm-doc-identifier: The identifier must be an UUID. (startsWith('urn:uuid:'))
                42. DiagnosticReport.identifier.period
                Definition

                Time period during which identifier is/was valid for use.

                ShortTime period when id is/was valid for use
                Control0..1
                TypePeriod
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                44. DiagnosticReport.identifier.assigner
                Definition

                Organization that issued/manages the identifier.

                ShortOrganization that issued id (may be just text)
                Comments

                The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                Control0..1
                TypeReference(Organization)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                46. DiagnosticReport.basedOn
                Definition

                Details concerning a service requested.

                ShortWhat was requested
                Comments

                Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

                Control1..1
                TypeReference(CH ELM ServiceRequest: Laboratory Order)
                Is Modifierfalse
                Summaryfalse
                Requirements

                This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

                Alternate NamesRequest
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                48. DiagnosticReport.status
                Definition

                The status of the diagnostic report.

                Shortregistered | partial | preliminary | final +
                Control1..1
                BindingThe codes SHALL be taken from DiagnosticReportStatus
                (required to http://hl7.org/fhir/ValueSet/diagnostic-report-status|4.0.1)

                The status of the diagnostic report.

                Typecode
                Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

                Pattern Valuefinal
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                50. DiagnosticReport.category
                Definition

                A code that classifies this laboratory report.

                ShortReport Category
                Comments

                DiagnosticReport.category and Composition.category shall be aligned

                Control0..*
                BindingFor example codes, see DiagnosticServiceSectionCodes
                (example to http://hl7.org/fhir/ValueSet/diagnostic-service-sections)

                Codes for diagnostic service sections.

                TypeCodeableConcept(Codeable Concept (IPS))
                Is Modifierfalse
                Summarytrue
                Alternate NamesDepartment, Sub-department, Service, Discipline
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • pattern @ $this
                • 52. DiagnosticReport.category:studyType
                  Slice NamestudyType
                  Definition

                  A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

                  ShortThe clinical domain of the laboratory performing the observation (e.g. microbiology, toxicology, chemistry)
                  Comments

                  Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

                  Control0..*
                  BindingThe codes SHALL be taken from Lab Study Types in Switzerland
                  (required to http://fhir.ch/ig/ch-lab-report/ValueSet/ch-lab-report-lab-study-types)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Alternate NamesDepartment, Sub-department, Service, Discipline
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  54. DiagnosticReport.category:specialty
                  Slice Namespecialty
                  Definition

                  A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.

                  ShortThe way of grouping of the test results into clinically meaningful groups (e.g. liver test; minerals; glucose profiles)
                  Comments

                  Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

                  Control0..*
                  BindingThe codes SHALL be taken from Laboratory Specialty
                  (required to http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Alternate NamesDepartment, Sub-department, Service, Discipline
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  56. DiagnosticReport.code
                  Definition

                  A code or name that describes this diagnostic report.

                  ShortLaboratory report
                  Control1..1
                  BindingThe codes SHOULD be taken from LOINCDiagnosticReportCodes
                  (preferred to http://hl7.org/fhir/ValueSet/report-codes)

                  Codes that describe Diagnostic Reports.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Alternate NamesType
                  Pattern Value{
                    "coding" : [{
                      "system" : "http://loinc.org",
                      "code" : "11502-2"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  58. DiagnosticReport.code.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  60. DiagnosticReport.code.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on DiagnosticReport.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 62. DiagnosticReport.code.coding
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                    Control1..*
                    TypeCoding
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Allows for alternative encodings within a code system, and translations to other code systems.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on DiagnosticReport.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ code
                    • value @ system
                    • 64. DiagnosticReport.code.coding:CodeCode
                      Slice NameCodeCode
                      Definition

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                      Control1..1
                      TypeCoding
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Allows for alternative encodings within a code system, and translations to other code systems.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      66. DiagnosticReport.code.coding:CodeCode.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      68. DiagnosticReport.code.coding:CodeCode.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on DiagnosticReport.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 70. DiagnosticReport.code.coding:CodeCode.system
                        Definition

                        The identification of the code system that defines the meaning of the symbol in the code.

                        ShortIdentity of the terminology system
                        Comments

                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                        Control1..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to be unambiguous about the source of the definition of the symbol.

                        Fixed Valuehttp://loinc.org
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        72. DiagnosticReport.code.coding:CodeCode.version
                        Definition

                        The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                        ShortVersion of the system - if relevant
                        Comments

                        Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                        NoteThis is a business version Id, not a resource version Id (see discussion)
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        74. DiagnosticReport.code.coding:CodeCode.code
                        Definition

                        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                        ShortSymbol in syntax defined by the system
                        Control1..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        Fixed Value11502-2
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        76. DiagnosticReport.code.coding:CodeCode.display
                        Definition

                        A representation of the meaning of the code in the system, following the rules of the system.

                        ShortRepresentation defined by the system
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        78. DiagnosticReport.code.coding:CodeCode.userSelected
                        Definition

                        Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                        ShortIf this coding was chosen directly by the user
                        Comments

                        Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                        Control0..1
                        Typeboolean
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        80. DiagnosticReport.code.text
                        Definition

                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                        ShortPlain text representation of the concept
                        Comments

                        Very often the text is the same as a displayName of one of the codings.

                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        82. DiagnosticReport.subject
                        Definition

                        The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.

                        ShortThe subject of the report - usually, but not always, the patient
                        Control1..1
                        TypeReference(CH ELM Patient)
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        SHALL know the subject context.

                        Alternate NamesPatient
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        84. DiagnosticReport.encounter
                        Definition

                        The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.

                        ShortHealth care event when test ordered
                        Comments

                        This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

                        Control0..1
                        TypeReference(Encounter)
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Links the request to the Encounter context.

                        Alternate NamesContext
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        86. DiagnosticReport.effective[x]
                        Definition

                        The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.

                        ShortClinically relevant time/time-period for report
                        Comments

                        If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

                        Control0..1
                        TypeChoice of: dateTime, Period
                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to know where in the patient history to file/present this report.

                        Alternate NamesObservation time, Effective Time, Occurrence
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        88. DiagnosticReport.issued
                        Definition

                        The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.

                        ShortDateTime this version was made
                        Comments

                        May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.

                        Control0..1
                        Typeinstant
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Clinicians need to be able to check the date that the report was released.

                        Alternate NamesDate published, Date Issued, Date Verified
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        90. DiagnosticReport.performer
                        Definition

                        The diagnostic service that is responsible for issuing the report.

                        ShortResponsible Diagnostic Service
                        Comments

                        This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

                        Control1..1
                        TypeReference(CH ELM Organization: Lab)
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                        Alternate NamesLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        92. DiagnosticReport.resultsInterpreter
                        Definition

                        The practitioner or organization that is responsible for the report's conclusions and interpretations.

                        ShortPrimary result interpreter
                        Comments

                        Might not be the same entity that takes responsibility for the clinical report.

                        Control0..*
                        TypeReference(Practitioner, PractitionerRole, Organization, CareTeam)
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

                        Alternate NamesAnalyzed by, Reported by
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        94. DiagnosticReport.specimen
                        Definition

                        Details about the specimens on which this diagnostic report is based.

                        ShortSpecimens this report is based on
                        Comments

                        If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.

                        Control1..1
                        TypeReference(CH ELM Specimen: Laboratory)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Need to be able to report information about the collected specimens on which the report is based.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        96. DiagnosticReport.result
                        Definition

                        Observations that are part of this diagnostic report.

                        ShortObservations
                        Comments

                        Observations can contain observations.

                        Control1..1
                        TypeReference(CH ELM Observation Results: Laboratory)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

                        Alternate NamesData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        98. DiagnosticReport.imagingStudy
                        Definition

                        One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.

                        ShortReference to full details of imaging associated with the diagnostic report
                        Comments

                        ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.

                        Control0..*
                        TypeReference(ImagingStudy)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        100. DiagnosticReport.media
                        Definition

                        A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).

                        ShortKey images associated with this report
                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Many diagnostic services include images in the report as part of their service.

                        Alternate NamesDICOM, Slides, Scans
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        102. DiagnosticReport.media.id
                        Definition

                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        ShortUnique id for inter-element referencing
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        104. DiagnosticReport.media.extension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                        ShortAdditional content defined by implementations
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        106. DiagnosticReport.media.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        108. DiagnosticReport.media.comment
                        Definition

                        A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.

                        ShortComment about the image (e.g. explanation)
                        Comments

                        The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.

                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        The provider of the report should make a comment about each image included in the report.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        110. DiagnosticReport.media.link
                        Definition

                        Reference to the image source.

                        ShortReference to the image source
                        Control1..1
                        TypeReference(Media)
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        112. DiagnosticReport.conclusion
                        Definition

                        Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.

                        ShortClinical conclusion (interpretation) of test results
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Need to be able to provide a conclusion that is not lost among the basic result data.

                        Alternate NamesReport
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        114. DiagnosticReport.conclusionCode
                        Definition

                        One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.

                        ShortCodes for the clinical conclusion of test results
                        Control0..*
                        BindingFor example codes, see SNOMEDCTClinicalFindings
                        (example to http://hl7.org/fhir/ValueSet/clinical-findings)

                        Diagnosis codes provided as adjuncts to the report.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        116. DiagnosticReport.presentedForm
                        Definition

                        Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.

                        ShortEntire report as issued
                        Comments

                        "application/pdf" is recommended as the most reliable and interoperable in this context.

                        Control0..*
                        TypeAttachment
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))