CH EPR FHIR (R4)
4.0.1-ballot - ballot Switzerland flag

This page is part of the CH EPR FHIR (R4) (v4.0.1-ballot: DSTU 4 Ballot 2) 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: CHMhdDocumentReferenceComprehensive - Detailed Descriptions

Draft as of 2020-07-10

Definitions for the ch-mhd-documentreference-comprehensive resource profile.

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

0. DocumentReference
ShortCH MHD DocumentReference Comprehensive
Invariantsch-mhd: The DocumentReference needs to conform to IHE.MHD.Comprehensive.DocumentReference (conformsTo('https://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.Comprehensive.DocumentReference'))
2. DocumentReference.extension
Control1..?
Must Supporttrue
SlicingThis element introduces a set of slices on DocumentReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. DocumentReference.extension:deletionStatus
    Slice NamedeletionStatus
    ShortDeletion status of the document
    Control0..1
    TypeExtension(CH Extension Deletion Status) (Extension Type: Coding)
    Must Supporttrue
    6. DocumentReference.extension:originalProviderRole
    Slice NameoriginalProviderRole
    ShortOriginal ProviderRole: This extra metadata attribute SHALL be set by the Document Source actor to the role value of the current user and SHALL NOT be updated by Update Initiator or Document Administrator actors.
    Control1..1
    TypeExtension(CH Extension Author AuthorRole) (Extension Type: Coding)
    Must Supporttrue
    8. DocumentReference.masterIdentifier
    Comments

    See ITI TF-2: Z.9.1.1 Identifier and CDA root plus extension.

    Control1..?
    TypeIdentifier(Oid Identifier)
    Must Supporttrue
    10. DocumentReference.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Must Supporttrue
    12. DocumentReference.status
    Shortcurrent | superseded
    Comments

    approved -> status=current, deprecated -> status=superseded

    Must Supporttrue
    14. DocumentReference.docStatus
    Comments

    These HL7 FHIR elements are not used in XDS, therefore would not be present. Document Consumers should be robust to these elements holding values.

    Control0..0
    16. DocumentReference.type
    Control1..?
    Must Supporttrue
    18. DocumentReference.category
    Control1..1
    Must Supporttrue
    20. DocumentReference.subject
    Comments

    Not a contained resource. URL Points to an existing Patient Resource representing the XDS Affinity Domain Patient.

    Control1..?
    TypeReference(CH Core Patient)referenced
    Must Supporttrue
    22. DocumentReference.date
    Control1..?
    Must Supporttrue
    24. DocumentReference.author
    Comments

    Contained resource.

    TypeReferencecontained
    Must Supporttrue
    26. DocumentReference.authenticator
    TypeReferencecontained
    28. DocumentReference.custodian
    Control0..0
    30. DocumentReference.relatesTo
    Comments

    See ITI TF-2c: 3.65.4.1.2.3

    Must Supporttrue
    32. DocumentReference.description
    Must Supporttrue
    34. DocumentReference.securityLabel
    Comments

    Note: This is NOT the DocumentReference.meta, as that holds the meta tags for the DocumentReference itself.

    Control1..?
    Must Supporttrue
    36. DocumentReference.content
    Control0..1
    38. DocumentReference.content.attachment
    Must Supporttrue
    40. DocumentReference.content.attachment.contentType
    Control1..?
    BindingThe codes SHALL be taken from DocumentEntry.mimeType
    (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.mimeType)
    Must Supporttrue
    42. DocumentReference.content.attachment.language
    Control1..?
    BindingThe codes SHALL be taken from DocumentEntry.languageCode
    (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.languageCode)
    Must Supporttrue
    44. DocumentReference.content.attachment.data
    Comments

    These HL7 FHIR elements are not used in XDS, therefore would not be present. Document Consumers should be robust to these elements holding values.

    Control0..0
    46. DocumentReference.content.attachment.url
    Control1..1
    Must Supporttrue
    48. DocumentReference.content.attachment.size
    Must Supporttrue
    50. DocumentReference.content.attachment.hash
    Must Supporttrue
    52. DocumentReference.content.attachment.title
    Must Supporttrue
    54. DocumentReference.content.attachment.creation
    Control1..?
    Must Supporttrue
    56. DocumentReference.content.format
    Control1..?
    BindingThe codes SHALL be taken from DocumentEntry.formatCode
    (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.formatCode)

    Document Format Codes.

    Must Supporttrue
    58. DocumentReference.context
    Control1..?
    60. DocumentReference.context.period
    Must Supporttrue
    62. DocumentReference.context.facilityType
    Control1..?
    BindingThe codes SHALL be taken from DocumentEntry.healthcareFacilityTypeCode
    (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.healthcareFacilityTypeCode)

    XDS Facility Type.

    Must Supporttrue
    64. DocumentReference.context.practiceSetting
    Control1..?
    BindingThe codes SHALL be taken from DocumentEntry.practiceSettingCode
    (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.practiceSettingCode)

    Additional details about where the content was created (e.g. clinical specialty).

    Must Supporttrue
    66. DocumentReference.context.sourcePatientInfo
    Comments

    Contained Patient resource with Patient.identifier.use element set to ‘usual’.

    Indicates that the data within the XDS document entry be represented as a contained resource. See Section 4.5.4.4.7

    Control1..?
    TypeReference(CH Core Patient)contained
    Must Supporttrue
    68. DocumentReference.context.related
    Comments

    May be filled with URL pointers to Resources or Identifiers found in referenceIdList

    Must Supporttrue
    70. DocumentReference.context.related.identifier
    ShortRequirements on XDS-I.b (Swiss context): When a Imaging Document Source provides a document to the Document Repository, it must provide the StudyInstanceUID, found in the to be registered KOS object, in the referenceIdList (urn:ihe:iti:xds:2013:referenceIdList) attribute of the documentEntry metadata.
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Must Supporttrue

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

    0. DocumentReference
    Definition

    A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.

    ShortCH MHD DocumentReference ComprehensiveA reference to a document
    Comments

    Usually, this is used for documents other than those defined by FHIR.

    Control0..*
    Is Modifierfalse
    Summaryfalse
    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-mhd: The DocumentReference needs to conform to IHE.MHD.Comprehensive.DocumentReference (conformsTo('https://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.Comprehensive.DocumentReference'))
    2. DocumentReference.implicitRules
    Definition

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

    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. DocumentReference.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
    Must Supporttrue
    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 DocumentReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 6. DocumentReference.extension:deletionStatus
      Slice NamedeletionStatus
      Definition

      Extension

      ShortDeletion status of the document
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(CH Extension Deletion Status) (Extension Type: Coding)
      Is Modifierfalse
      Must Supporttrue
      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. DocumentReference.extension:originalProviderRole
      Slice NameoriginalProviderRole
      Definition

      Extension

      ShortOriginal ProviderRole: This extra metadata attribute SHALL be set by the Document Source actor to the role value of the current user and SHALL NOT be updated by Update Initiator or Document Administrator actors.
      Control1..1
      This element is affected by the following invariants: ele-1
      TypeExtension(CH Extension Author AuthorRole) (Extension Type: Coding)
      Is Modifierfalse
      Must Supporttrue
      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())
      10. DocumentReference.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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())
      12. DocumentReference.masterIdentifier
      Definition

      An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.


      Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document.

      ShortAn identifier intended for computationMaster Version Specific Identifier
      Comments

      See ITI TF-2: Z.9.1.1 Identifier and CDA root plus extension.


      CDA Document Id extension and root.

      Control10..1
      This element is affected by the following invariants: ele-1
      TypeIdentifier(Oid Identifier)
      Is Modifierfalse
      Must Supporttrue
      Requirements

      The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).

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

      Other identifiers associated with the document, including version independent identifiers.

      ShortOther identifiers for the document
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. DocumentReference.status
      Definition

      The status of this document reference.

      Shortcurrent | supersededcurrent | superseded | entered-in-error
      Comments

      approved -> status=current, deprecated -> status=superseded


      This is the status of the DocumentReference object, which might be independent from the docStatus element.

      This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

      Control1..1
      BindingThe codes SHALL be taken from DocumentReferenceStatushttp://hl7.org/fhir/ValueSet/document-reference-status|4.0.1
      (required to http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1)

      The status of the document reference.

      Typecode
      Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. DocumentReference.docStatus
      Definition

      The status of the underlying document.

      Shortpreliminary | final | amended | entered-in-error
      Comments

      These HL7 FHIR elements are not used in XDS, therefore would not be present. Document Consumers should be robust to these elements holding values.


      The document that is pointed to might be in various lifecycle states.

      Control0..01
      BindingThe codes SHALL be taken from CompositionStatushttp://hl7.org/fhir/ValueSet/composition-status|4.0.1
      (required to http://hl7.org/fhir/ValueSet/composition-status|4.0.1)

      Status of the underlying document.

      Typecode
      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()))
      20. DocumentReference.type
      Definition

      Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

      ShortKind of document (LOINC if possible)
      Comments

      Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.

      Control10..1
      BindingThe codes SHALL be taken from The codes SHOULD be taken from DocumentEntry.typeCodehttp://hl7.org/fhir/ValueSet/c80-doc-typecodes
      (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.typeCode)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. DocumentReference.category
      Definition

      A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

      ShortCategorization of document
      Comments

      Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

      Control10..1*
      BindingThe codes SHALL be taken from For example codes, see DocumentEntry.classCodehttp://hl7.org/fhir/ValueSet/document-classcodes
      (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.classCode)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Alternate Namesclaxs
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. DocumentReference.subject
      Definition

      Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

      ShortWho/what is the subject of the document
      Comments

      Not a contained resource. URL Points to an existing Patient Resource representing the XDS Affinity Domain Patient.

      Control10..1
      TypeReference(CH Core Patient, Patient, Practitioner, Group, Device)referenced
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. DocumentReference.date
      Definition

      When the document reference was created.

      ShortWhen this document reference was created
      Comments

      Referencing/indexing time is used for tracking, organizing versions and searching.

      Control10..1
      Typeinstant
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Alternate Namesindexed
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. DocumentReference.author
      Definition

      Identifies who is responsible for adding the information to the document.

      ShortWho and/or what authored the document
      Comments

      Contained resource.


      Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

      Control0..*
      TypeReference(Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson)contained
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. DocumentReference.authenticator
      Definition

      Which person or organization authenticates that this document is valid.

      ShortWho/what authenticated the document
      Comments

      Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

      Control0..1
      TypeReference(Practitioner, PractitionerRole, Organization)contained
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. DocumentReference.custodian
      Definition

      Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

      ShortOrganization which maintains the document
      Comments

      Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

      Control0..01
      TypeReference(CH Core Organization, Organization)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. DocumentReference.relatesTo
      Definition

      Relationships that this document has with other document references that already exist.

      ShortRelationships to other documents
      Comments

      See ITI TF-2c: 3.65.4.1.2.3


      This element is labeled as a modifier because documents that append to other documents are incomplete on their own.

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. DocumentReference.relatesTo.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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())
      38. DocumentReference.relatesTo.code
      Definition

      The type of relationship that this document has with anther document.

      Shortreplaces | transforms | signs | appends
      Comments

      If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

      Control1..1
      BindingThe codes SHALL be taken from DocumentRelationshipTypehttp://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1
      (required to http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1)

      The type of relationship between documents.

      Typecode
      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()))
      40. DocumentReference.relatesTo.target
      Definition

      The target document of this relationship.

      ShortTarget of the relationship
      Control1..1
      TypeReference(CH Core DocumentReference, DocumentReference)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. DocumentReference.description
      Definition

      Human-readable description of the source document.

      ShortHuman-readable description
      Comments

      What the document is about, a terse summary of the document.

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

      Helps humans to assess whether the document is of interest.

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

      A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.

      ShortDocument security-tags
      Comments

      Note: This is NOT the DocumentReference.meta, as that holds the meta tags for the DocumentReference itself.


      The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce.

      In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.

      Control10..*
      BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from DocumentEntry.confidentialityCodehttp://hl7.org/fhir/ValueSet/security-labels
      (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.confidentialityCode)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

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

      The document and format referenced. There may be multiple content element repetitions, each with a different format.

      ShortDocument referenced
      Control1..1*
      TypeBackboneElement
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. DocumentReference.content.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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())
      50. DocumentReference.content.attachment
      Definition

      The document or URL of the document along with critical metadata to prove content has integrity.

      ShortWhere to access the document
      Control1..1
      TypeAttachment
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. DocumentReference.content.attachment.contentType
      Definition

      Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

      ShortMime type of the content, with charset etc.
      Control10..1
      BindingThe codes SHALL be taken from DocumentEntry.mimeTypehttp://hl7.org/fhir/ValueSet/mimetypes|4.0.1
      (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.mimeType)
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Processors of the data need to be able to know how to interpret the data.

      Example<br/><b>General</b>:text/plain; charset=UTF-8, image/png
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ch-docref-1: The codes from the following ValueSet are 'preferred': http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.mimeType (memberOf('http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.mimeType'))
      54. DocumentReference.content.attachment.language
      Definition

      The human language of the content. The value can be any valid value according to BCP 47.

      ShortHuman language of the content (BCP-47)
      Control10..1
      BindingThe codes SHALL be taken from The codes SHOULD be taken from DocumentEntry.languageCodehttp://hl7.org/fhir/ValueSet/languages
      (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.languageCode)
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Users need to be able to choose between the languages in a set of attachments.

      Example<br/><b>General</b>:en-AU
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      56. DocumentReference.content.attachment.data
      Definition

      The actual data of the attachment - a sequence of bytes, base64 encoded.

      ShortData inline, base64ed
      Comments

      These HL7 FHIR elements are not used in XDS, therefore would not be present. Document Consumers should be robust to these elements holding values.


      The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

      Control0..01
      Typebase64Binary
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Requirements

      The data needs to able to be transmitted inline.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. DocumentReference.content.attachment.url
      Definition

      A location where the data can be accessed.

      ShortUri where the data can be found
      Comments

      If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

      The data needs to be transmitted by reference.

      Example<br/><b>General</b>:http://www.acme.com/logo-small.png
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      60. DocumentReference.content.attachment.size
      Definition

      The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

      ShortNumber of bytes of content (if url provided)
      Comments

      The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.

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

      Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      62. DocumentReference.content.attachment.hash
      Definition

      The calculated hash of the data using SHA-1. Represented using base64.

      ShortHash of the data (sha-1, base64ed)
      Comments

      The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.


      The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.

      Control0..1
      Typebase64Binary
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      64. DocumentReference.content.attachment.title
      Definition

      A label or set of text to display in place of the data.

      ShortLabel to display in place of the data
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

      Example<br/><b>General</b>:Official Corporate Logo
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. DocumentReference.content.attachment.creation
      Definition

      The date that the attachment was first created.

      ShortDate attachment was first created
      Control10..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      This is often tracked as an integrity issue for use of the attachment.

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

      An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

      ShortFormat/content rules for the document
      Comments

      Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

      Control10..1
      BindingThe codes SHALL be taken from The codes SHOULD be taken from DocumentEntry.formatCodehttp://hl7.org/fhir/ValueSet/formatcodes
      (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.formatCode)

      Document Format Codes.

      TypeCoding
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      70. DocumentReference.context
      Definition

      The clinical context in which the document was prepared.

      ShortClinical context of document
      Comments

      These values are primarily added to help with searching for interesting/relevant documents.

      Control10..1
      TypeBackboneElement
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      72. DocumentReference.context.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())
      74. DocumentReference.context.period
      Definition

      The time period over which the service that is described by the document was provided.

      ShortTime of service that is being documented
      Control0..1
      TypePeriod
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      76. DocumentReference.context.facilityType
      Definition

      The kind of facility where the patient was seen.

      ShortKind of facility where patient was seen
      Control10..1
      BindingThe codes SHALL be taken from For example codes, see DocumentEntry.healthcareFacilityTypeCodehttp://hl7.org/fhir/ValueSet/c80-facilitycodes
      (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.healthcareFacilityTypeCode)

      XDS Facility Type.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      78. DocumentReference.context.practiceSetting
      Definition

      This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.

      ShortAdditional details about where the content was created (e.g. clinical specialty)
      Comments

      This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.

      Control10..1
      BindingThe codes SHALL be taken from For example codes, see DocumentEntry.practiceSettingCodehttp://hl7.org/fhir/ValueSet/c80-practice-codes
      (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.practiceSettingCode)

      Additional details about where the content was created (e.g. clinical specialty).

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

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

      The Patient Information as known when the document was published. May be a reference to a version specific, or contained.

      ShortPatient demographics from source
      Comments

      Contained Patient resource with Patient.identifier.use element set to ‘usual’.

      Indicates that the data within the XDS document entry be represented as a contained resource. See Section 4.5.4.4.7

      Control10..1
      TypeReference(CH Core Patient, Patient)contained
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      82. DocumentReference.context.related
      Definition

      Related identifiers or resources associated with the DocumentReference.

      ShortRelated identifiers or resources
      Comments

      May be filled with URL pointers to Resources or Identifiers found in referenceIdList


      May be identifiers or resources that caused the DocumentReference or referenced Document to be created.

      Control0..*
      TypeReference(Resource)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      84. DocumentReference.context.related.identifier
      Definition

      An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

      ShortRequirements on XDS-I.b (Swiss context): When a Imaging Document Source provides a document to the Document Repository, it must provide the StudyInstanceUID, found in the to be registered KOS object, in the referenceIdList (urn:ihe:iti:xds:2013:referenceIdList) attribute of the documentEntry metadata.Logical reference, when literal reference is not known
      Comments

      When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

      When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

      Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

      Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      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. DocumentReference
      Definition

      A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.

      ShortCH MHD DocumentReference Comprehensive
      Comments

      Usually, this is used for documents other than those defined by FHIR.

      Control0..*
      Is Modifierfalse
      Summaryfalse
      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-mhd: The DocumentReference needs to conform to IHE.MHD.Comprehensive.DocumentReference (conformsTo('https://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.Comprehensive.DocumentReference'))
      2. DocumentReference.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. DocumentReference.meta
      Definition

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

      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. DocumentReference.implicitRules
      Definition

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

      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. DocumentReference.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. DocumentReference.text
      Definition

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

      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. DocumentReference.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. DocumentReference.extension
      Definition

      An Extension

      ShortExtension
      Control1..*
      TypeExtension
      Is Modifierfalse
      Must Supporttrue
      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 DocumentReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. DocumentReference.extension:deletionStatus
        Slice NamedeletionStatus
        Definition

        Extension

        ShortDeletion status of the document
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(CH Extension Deletion Status) (Extension Type: Coding)
        Is Modifierfalse
        Must Supporttrue
        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. DocumentReference.extension:originalProviderRole
        Slice NameoriginalProviderRole
        Definition

        Extension

        ShortOriginal ProviderRole: This extra metadata attribute SHALL be set by the Document Source actor to the role value of the current user and SHALL NOT be updated by Update Initiator or Document Administrator actors.
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(CH Extension Author AuthorRole) (Extension Type: Coding)
        Is Modifierfalse
        Must Supporttrue
        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())
        20. DocumentReference.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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())
        22. DocumentReference.masterIdentifier
        Definition

        An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.

        ShortAn identifier intended for computation
        Comments

        See ITI TF-2: Z.9.1.1 Identifier and CDA root plus extension.

        Control1..1
        This element is affected by the following invariants: ele-1
        TypeIdentifier(Oid Identifier)
        Is Modifierfalse
        Must Supporttrue
        Requirements

        The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).

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

        Other identifiers associated with the document, including version independent identifiers.

        ShortOther identifiers for the document
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        TypeIdentifier
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. DocumentReference.status
        Definition

        The status of this document reference.

        Shortcurrent | superseded
        Comments

        approved -> status=current, deprecated -> status=superseded

        Control1..1
        BindingThe codes SHALL be taken from DocumentReferenceStatus
        (required to http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1)

        The status of the document reference.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. DocumentReference.docStatus
        Definition

        The status of the underlying document.

        Shortpreliminary | final | amended | entered-in-error
        Comments

        These HL7 FHIR elements are not used in XDS, therefore would not be present. Document Consumers should be robust to these elements holding values.

        Control0..0
        BindingThe codes SHALL be taken from CompositionStatus
        (required to http://hl7.org/fhir/ValueSet/composition-status|4.0.1)

        Status of the underlying document.

        Typecode
        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()))
        30. DocumentReference.type
        Definition

        Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

        ShortKind of document (LOINC if possible)
        Comments

        Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.

        Control1..1
        BindingThe codes SHALL be taken from DocumentEntry.typeCode
        (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.typeCode)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. DocumentReference.category
        Definition

        A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

        ShortCategorization of document
        Comments

        Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

        Control1..1
        BindingThe codes SHALL be taken from DocumentEntry.classCode
        (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.classCode)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Alternate Namesclaxs
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. DocumentReference.subject
        Definition

        Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

        ShortWho/what is the subject of the document
        Comments

        Not a contained resource. URL Points to an existing Patient Resource representing the XDS Affinity Domain Patient.

        Control1..1
        TypeReference(CH Core Patient)referenced
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. DocumentReference.date
        Definition

        When the document reference was created.

        ShortWhen this document reference was created
        Comments

        Referencing/indexing time is used for tracking, organizing versions and searching.

        Control1..1
        Typeinstant
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Alternate Namesindexed
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. DocumentReference.author
        Definition

        Identifies who is responsible for adding the information to the document.

        ShortWho and/or what authored the document
        Comments

        Contained resource.

        Control0..*
        TypeReference
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. DocumentReference.authenticator
        Definition

        Which person or organization authenticates that this document is valid.

        ShortWho/what authenticated the document
        Comments

        Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

        Control0..1
        TypeReference
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. DocumentReference.custodian
        Definition

        Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

        ShortOrganization which maintains the document
        Comments

        Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

        Control0..0
        TypeReference(CH Core Organization)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. DocumentReference.relatesTo
        Definition

        Relationships that this document has with other document references that already exist.

        ShortRelationships to other documents
        Comments

        See ITI TF-2c: 3.65.4.1.2.3

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. DocumentReference.relatesTo.id
        Definition

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

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

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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())
        50. DocumentReference.relatesTo.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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())
        52. DocumentReference.relatesTo.code
        Definition

        The type of relationship that this document has with anther document.

        Shortreplaces | transforms | signs | appends
        Comments

        If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

        Control1..1
        BindingThe codes SHALL be taken from DocumentRelationshipType
        (required to http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1)

        The type of relationship between documents.

        Typecode
        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()))
        54. DocumentReference.relatesTo.target
        Definition

        The target document of this relationship.

        ShortTarget of the relationship
        Control1..1
        TypeReference(CH Core DocumentReference)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. DocumentReference.description
        Definition

        Human-readable description of the source document.

        ShortHuman-readable description
        Comments

        What the document is about, a terse summary of the document.

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

        Helps humans to assess whether the document is of interest.

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

        A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.

        ShortDocument security-tags
        Comments

        Note: This is NOT the DocumentReference.meta, as that holds the meta tags for the DocumentReference itself.

        Control1..*
        BindingThe codes SHALL be taken from DocumentEntry.confidentialityCode
        (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.confidentialityCode)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

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

        The document and format referenced. There may be multiple content element repetitions, each with a different format.

        ShortDocument referenced
        Control1..1
        TypeBackboneElement
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. DocumentReference.content.id
        Definition

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

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

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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())
        66. DocumentReference.content.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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())
        68. DocumentReference.content.attachment
        Definition

        The document or URL of the document along with critical metadata to prove content has integrity.

        ShortWhere to access the document
        Control1..1
        TypeAttachment
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. DocumentReference.content.attachment.id
        Definition

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

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

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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 DocumentReference.content.attachment.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 74. DocumentReference.content.attachment.contentType
          Definition

          Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

          ShortMime type of the content, with charset etc.
          Control1..1
          BindingThe codes SHALL be taken from DocumentEntry.mimeType
          (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.mimeType)
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Processors of the data need to be able to know how to interpret the data.

          Example<br/><b>General</b>:text/plain; charset=UTF-8, image/png
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ch-docref-1: The codes from the following ValueSet are 'preferred': http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.mimeType (memberOf('http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.mimeType'))
          76. DocumentReference.content.attachment.language
          Definition

          The human language of the content. The value can be any valid value according to BCP 47.

          ShortHuman language of the content (BCP-47)
          Control1..1
          BindingThe codes SHALL be taken from DocumentEntry.languageCode
          (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.languageCode)
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Users need to be able to choose between the languages in a set of attachments.

          Example<br/><b>General</b>:en-AU
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          78. DocumentReference.content.attachment.data
          Definition

          The actual data of the attachment - a sequence of bytes, base64 encoded.

          ShortData inline, base64ed
          Comments

          These HL7 FHIR elements are not used in XDS, therefore would not be present. Document Consumers should be robust to these elements holding values.

          Control0..0
          Typebase64Binary
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Requirements

          The data needs to able to be transmitted inline.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          80. DocumentReference.content.attachment.url
          Definition

          A location where the data can be accessed.

          ShortUri where the data can be found
          Comments

          If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

          The data needs to be transmitted by reference.

          Example<br/><b>General</b>:http://www.acme.com/logo-small.png
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          82. DocumentReference.content.attachment.size
          Definition

          The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

          ShortNumber of bytes of content (if url provided)
          Comments

          The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.

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

          Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          84. DocumentReference.content.attachment.hash
          Definition

          The calculated hash of the data using SHA-1. Represented using base64.

          ShortHash of the data (sha-1, base64ed)
          Comments

          The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.

          Control0..1
          Typebase64Binary
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          86. DocumentReference.content.attachment.title
          Definition

          A label or set of text to display in place of the data.

          ShortLabel to display in place of the data
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

          Example<br/><b>General</b>:Official Corporate Logo
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          88. DocumentReference.content.attachment.creation
          Definition

          The date that the attachment was first created.

          ShortDate attachment was first created
          Control1..1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          This is often tracked as an integrity issue for use of the attachment.

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

          An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

          ShortFormat/content rules for the document
          Comments

          Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

          Control1..1
          BindingThe codes SHALL be taken from DocumentEntry.formatCode
          (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.formatCode)

          Document Format Codes.

          TypeCoding
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          92. DocumentReference.context
          Definition

          The clinical context in which the document was prepared.

          ShortClinical context of document
          Comments

          These values are primarily added to help with searching for interesting/relevant documents.

          Control1..1
          TypeBackboneElement
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          94. DocumentReference.context.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
          96. DocumentReference.context.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())
          98. DocumentReference.context.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())
          100. DocumentReference.context.encounter
          Definition

          Describes the clinical encounter or type of care that the document content is associated with.

          ShortContext of the document content
          Control0..*
          TypeReference(CH Core Encounter, EpisodeOfCare)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          102. DocumentReference.context.event
          Definition

          This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.

          ShortMain clinical acts documented
          Comments

          An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation.

          Control0..*
          BindingFor example codes, see v3 Code System ActCode
          (example to http://terminology.hl7.org/ValueSet/v3-ActCode)

          This list of codes represents the main clinical acts being documented.

          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          104. DocumentReference.context.period
          Definition

          The time period over which the service that is described by the document was provided.

          ShortTime of service that is being documented
          Control0..1
          TypePeriod
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          106. DocumentReference.context.facilityType
          Definition

          The kind of facility where the patient was seen.

          ShortKind of facility where patient was seen
          Control1..1
          BindingThe codes SHALL be taken from DocumentEntry.healthcareFacilityTypeCode
          (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.healthcareFacilityTypeCode)

          XDS Facility Type.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          108. DocumentReference.context.practiceSetting
          Definition

          This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.

          ShortAdditional details about where the content was created (e.g. clinical specialty)
          Comments

          This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.

          Control1..1
          BindingThe codes SHALL be taken from DocumentEntry.practiceSettingCode
          (required to http://fhir.ch/ig/ch-term/ValueSet/DocumentEntry.practiceSettingCode)

          Additional details about where the content was created (e.g. clinical specialty).

          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Requirements

          This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

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

          The Patient Information as known when the document was published. May be a reference to a version specific, or contained.

          ShortPatient demographics from source
          Comments

          Contained Patient resource with Patient.identifier.use element set to ‘usual’.

          Indicates that the data within the XDS document entry be represented as a contained resource. See Section 4.5.4.4.7

          Control1..1
          TypeReference(CH Core Patient)contained
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          112. DocumentReference.context.related
          Definition

          Related identifiers or resources associated with the DocumentReference.

          ShortRelated identifiers or resources
          Comments

          May be filled with URL pointers to Resources or Identifiers found in referenceIdList

          Control0..*
          TypeReference(Resource)
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          114. DocumentReference.context.related.id
          Definition

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

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

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and 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 DocumentReference.context.related.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 118. DocumentReference.context.related.reference
            Definition

            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

            ShortLiteral reference, Relative, internal or absolute URL
            Comments

            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

            Control0..1
            This element is affected by the following invariants: ref-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()))
            120. DocumentReference.context.related.type
            Definition

            The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

            The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

            ShortType the reference refers to (e.g. "Patient")
            Comments

            This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from ResourceType
            (extensible to http://hl7.org/fhir/ValueSet/resource-types)

            Aa resource (or, for logical models, the URI of the logical model).

            Typeuri
            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()))
            122. DocumentReference.context.related.identifier
            Definition

            An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

            ShortRequirements on XDS-I.b (Swiss context): When a Imaging Document Source provides a document to the Document Repository, it must provide the StudyInstanceUID, found in the to be registered KOS object, in the referenceIdList (urn:ihe:iti:xds:2013:referenceIdList) attribute of the documentEntry metadata.
            Comments

            When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

            When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

            Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

            Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1
            TypeIdentifier
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            124. DocumentReference.context.related.display
            Definition

            Plain text narrative that identifies the resource in addition to the resource reference.

            ShortText alternative for the resource
            Comments

            This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

            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()))