CH LAB-Report (R4)
1.0.0-ballot - ballot Switzerland flag

This page is part of the CH LAB-Report (R4) (v1.0.0-ballot: STU 1 Ballot 1) 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: ChLabDiagnosticReport - Detailed Descriptions

Active as of 2024-05-17

Definitions for the ch-lab-diagnosticreport resource profile.

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

0. DiagnosticReport
Definition

Laboratory Report DiagnosticReport

ShortCH LAB DiagnosticReport: Laboratory Report
Impose ProfileThis profile also requires that the instance also conform this additional profile:
2. DiagnosticReport.extension
Control1..?
SlicingThis element introduces a set of slices on DiagnosticReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. DiagnosticReport.extension:DiagnosticReportCompositionR5
    Slice NameDiagnosticReportCompositionR5
    Definition

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

    ShortAssociated Lab Report Composition
    Control1..1
    TypeExtension(Extension Definition for DiagnosticReport.composition for Version 5.0) (Extension Type: Reference(Composition))
    6. DiagnosticReport.extension:DiagnosticReportCompositionR5.value[x]
    Control1..?
    TypeReference(CH LAB Composition: Laboratory Report)
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    8. DiagnosticReport.identifier
    Definition

    Identifiers assigned to this Laboratory Report by the performer or other systems. It shall be common to several report versions

    ShortReport identifier
    Comments

    Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists

    NoteThis is a business identifier, not a resource identifier (see discussion)
    10. DiagnosticReport.basedOn
    TypeReference(CH LAB ServiceRequest: Laboratory Order)
    12. DiagnosticReport.status
    ShortStatus of the Report
    Comments

    DiagnosticReport.status and Composition.status shall be aligned, based on the http://hl7.eu/fhir/laboratory/ConceptMap/ConceptMap-eu-diagRptStatus2CompStatus mapping

    14. DiagnosticReport.category
    Definition

    A code that classifies this laboratory report. Two basic categories has been selected in this guide: laboratory specialty and Study type. Laboratory specialty is characteristic of the laboratory that produced the test result while Study type is an arbitrary classificion of the test type.

    ShortReport Category
    Comments

    DiagnosticReport.category and Composition.category shall be aligned

    SlicingThis element introduces a set of slices on DiagnosticReport.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ $this
    • 16. DiagnosticReport.category:studyType
      Slice NamestudyType
      Definition

      Laboratory services, i.e., results of tests performed, could be characterized using typology of services, commonly called study types. Study type could be seen as an attribute or grouping mechanism that assigns a common clinical sense to certain types of laboratory test results., e.g., Hemoglobin, Platelet count, etc. belongs to 'Hematology study'.

      ShortThe way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)
      Comments

      In comparison to the laboratory specialty which is an attribute of laboratory, study type is a categorization of laboratory service. It needs to be mentioned that classification of test to study types in not standardized.

      Control0..*
      BindingThe codes SHALL be taken from Laboratory Study Types
      (required to http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab)
      18. DiagnosticReport.category:specialty
      Slice Namespecialty
      Definition

      Laboratory specialty is an attribute of any laboratory setting representing professional qualification of the laboratory to execute certain kind of laboratory tests.

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

      Specialty could be used as parameter for searching/querying of laboratory test results.

      Control0..*
      BindingThe codes SHALL be taken from Laboratory Specialty
      (required to http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab)
      20. DiagnosticReport.code
      Definition

      Specifies that it refers to a Laboratory Report

      ShortType of (Laboratory) Report
      Comments

      At least one DiagnosticReport.code.coding and Composition.type.coding SHALL be equal

      BindingThe codes SHOULD be taken from Laboratory Report Types
      (preferred to http://hl7.eu/fhir/laboratory/ValueSet/lab-reportType-eu-lab)
      22. DiagnosticReport.subject
      Definition

      Who or what this report is about. The report can be about a human patient, a living subject, a device (e.g. a machine), a location or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).

      ShortWho and/or what this report is about
      Comments

      DiagnosticReport and Composition SHALL have the same subject

      Control1..?
      TypeReference(CH LAB Patient, Patient: Animal, Group, Location, Device)
      24. DiagnosticReport.encounter
      Definition

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

      ShortThe healthcare event which this Laboratory Report is about (when test ordered).
      Comments

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

      DiagnosticReport and Composition SHALL have the same encounter.

      26. DiagnosticReport.effective[x]
      ShortClinically relevant time/time-period for report.
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      28. DiagnosticReport.performer
      ShortResponsible Diagnostic Service.
      Comments

      If a DiagnosticReport.resultsInterpreter exists this is expected to be a Composition.author; otherwise a DiagnosticReport.performer should be an author.

      30. DiagnosticReport.resultsInterpreter
      Comments

      If a DiagnosticReport.resultsInterpreter exists this is expected to be a Composition.author; otherwise a DiagnosticReport.performer should be an author.

      32. DiagnosticReport.specimen
      ShortSpecimens this report is based on.
      TypeReference(CH LAB Specimen)
      34. DiagnosticReport.result
      Shortresults
      TypeReference(CH LAB Observation Results: Laboratory Report)
      36. DiagnosticReport.imagingStudy
      Control0..0
      38. DiagnosticReport.presentedForm
      ShortEntire report as issued (pdf recommended)

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

      0. DiagnosticReport
      Definition

      Laboratory Report DiagnosticReport


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

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

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

      Control0..*
      Is Modifierfalse
      Impose ProfileThis profile also requires that the instance also conform this additional profile:
      Summaryfalse
      Alternate NamesReport, Test, Result, Results, Labs, Laboratory
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      2. DiagnosticReport.implicitRules
      Definition

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

      ShortA set of rules under which this content was created
      Comments

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

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

      An Extension


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

      ShortExtensionAdditional content defined by implementations
      Comments

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

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

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

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

        An Extension


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

        ShortExtensionAdditional content defined by implementations
        Comments

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

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

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

          Shortidentifies the meaning of the extension
          Comments

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

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

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

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

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

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

          ShortExtensions that cannot be ignored
          Comments

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

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

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

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

          Identifiers assigned to this Laboratory Report by the performer or other systems. It shall be common to several report versions


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

          ShortReport identifierBusiness identifier for report
          Comments

          Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists


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

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          Requirements

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

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

          Details concerning a service requested.

          ShortWhat was requested
          Comments

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

          Control0..*
          TypeReference(CH LAB ServiceRequest: Laboratory Order, CarePlan, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
          Is Modifierfalse
          Summaryfalse
          Requirements

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

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

          The status of the diagnostic report.

          ShortStatus of the Reportregistered | partial | preliminary | final +
          Comments

          DiagnosticReport.status and Composition.status shall be aligned, based on the http://hl7.eu/fhir/laboratory/ConceptMap/ConceptMap-eu-diagRptStatus2CompStatus mapping

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

          The status of the diagnostic report.

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

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

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

          A code that classifies this laboratory report. Two basic categories has been selected in this guide: laboratory specialty and Study type. Laboratory specialty is characteristic of the laboratory that produced the test result while Study type is an arbitrary classificion of the test type.


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

          ShortReport CategoryService category
          Comments

          DiagnosticReport.category and Composition.category shall be aligned


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

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

          Codes for diagnostic service sections.

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

            Laboratory services, i.e., results of tests performed, could be characterized using typology of services, commonly called study types. Study type could be seen as an attribute or grouping mechanism that assigns a common clinical sense to certain types of laboratory test results., e.g., Hemoglobin, Platelet count, etc. belongs to 'Hematology study'.


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

            ShortThe way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)Service category
            Comments

            In comparison to the laboratory specialty which is an attribute of laboratory, study type is a categorization of laboratory service. It needs to be mentioned that classification of test to study types in not standardized.


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

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

            Laboratory specialty is an attribute of any laboratory setting representing professional qualification of the laboratory to execute certain kind of laboratory tests.


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

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

            Specialty could be used as parameter for searching/querying of laboratory test results.


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

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

            Specifies that it refers to a Laboratory Report


            A code or name that describes this diagnostic report.

            ShortType of (Laboratory) ReportName/Code for this diagnostic report
            Comments

            At least one DiagnosticReport.code.coding and Composition.type.coding SHALL be equal

            Control1..1
            BindingThe codes SHOULD be taken from Laboratory Report Typeshttp://hl7.org/fhir/ValueSet/report-codes
            (preferred to http://hl7.eu/fhir/laboratory/ValueSet/lab-reportType-eu-lab)
            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Alternate NamesType
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. DiagnosticReport.subject
            Definition

            Who or what this report is about. The report can be about a human patient, a living subject, a device (e.g. a machine), a location or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).


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

            ShortWho and/or what this report is aboutThe subject of the report - usually, but not always, the patient
            Comments

            DiagnosticReport and Composition SHALL have the same subject

            Control10..1
            TypeReference(CH LAB Patient, Patient: Animal, Group, Location, Device, Patient)
            Is Modifierfalse
            Summarytrue
            Requirements

            SHALL know the subject context.

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

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


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

            ShortThe healthcare event which this Laboratory Report is about (when test ordered).Health care event when test ordered
            Comments

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

            DiagnosticReport and Composition SHALL have the same encounter.


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

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

            Links the request to the Encounter context.

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

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

            ShortClinically relevant time/time-period for report.
            Comments

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

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

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

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

            The diagnostic service that is responsible for issuing the report.

            ShortResponsible Diagnostic Service.
            Comments

            If a DiagnosticReport.resultsInterpreter exists this is expected to be a Composition.author; otherwise a DiagnosticReport.performer should be an author.


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

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

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

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

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

            ShortPrimary result interpreter
            Comments

            If a DiagnosticReport.resultsInterpreter exists this is expected to be a Composition.author; otherwise a DiagnosticReport.performer should be an author.


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

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

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

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

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

            ShortSpecimens this report is based on.
            Comments

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

            Control0..*
            TypeReference(CH LAB Specimen, Specimen)
            Is Modifierfalse
            Summaryfalse
            Requirements

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

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

            Observations that are part of this diagnostic report.

            ShortresultsObservations
            Comments

            Observations can contain observations.

            Control0..*
            TypeReference(CH LAB Observation Results: Laboratory Report, Observation)
            Is Modifierfalse
            Summaryfalse
            Requirements

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

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

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

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

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

            Control0..0*
            TypeReference(ImagingStudy)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. DiagnosticReport.presentedForm
            Definition

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

            ShortEntire report as issued (pdf recommended)
            Comments

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

            Control0..*
            TypeAttachment
            Is Modifierfalse
            Summaryfalse
            Requirements

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

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

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

            0. DiagnosticReport
            Definition

            Laboratory Report DiagnosticReport

            ShortCH LAB DiagnosticReport: Laboratory Report
            Comments

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

            Control0..*
            Is Modifierfalse
            Impose ProfileThis profile also requires that the instance also conform this additional profile:
            Summaryfalse
            Alternate NamesReport, Test, Result, Results, Labs, Laboratory
            Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
            dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
            dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
            dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
            dom-6: A resource should have narrative for robust management (text.`div`.exists())
            2. DiagnosticReport.id
            Definition

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

            ShortLogical id of this artifact
            Comments

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

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

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

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

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

            ShortA set of rules under which this content was created
            Comments

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

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

            The base language in which the resource is written.

            ShortLanguage of the resource content
            Comments

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

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

            A human language.

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

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

            ShortText summary of the resource, for human interpretation
            Comments

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

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

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

            ShortContained, inline Resources
            Comments

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

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

            An Extension

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

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

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

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

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

              An Extension

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

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

                Shortidentifies the meaning of the extension
                Comments

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

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

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

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

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

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

                ShortExtensions that cannot be ignored
                Comments

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

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

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

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

                Identifiers assigned to this Laboratory Report by the performer or other systems. It shall be common to several report versions

                ShortReport identifier
                Comments

                Composition.identifier SHALL be equal to one of the DiagnosticReport.identifier, if at least one exists

                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..*
                TypeIdentifier
                Is Modifierfalse
                Summarytrue
                Requirements

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

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

                Details concerning a service requested.

                ShortWhat was requested
                Comments

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

                Control0..*
                TypeReference(CH LAB ServiceRequest: Laboratory Order)
                Is Modifierfalse
                Summaryfalse
                Requirements

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

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

                The status of the diagnostic report.

                ShortStatus of the Report
                Comments

                DiagnosticReport.status and Composition.status shall be aligned, based on the http://hl7.eu/fhir/laboratory/ConceptMap/ConceptMap-eu-diagRptStatus2CompStatus mapping

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

                The status of the diagnostic report.

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

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

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

                A code that classifies this laboratory report. Two basic categories has been selected in this guide: laboratory specialty and Study type. Laboratory specialty is characteristic of the laboratory that produced the test result while Study type is an arbitrary classificion of the test type.

                ShortReport Category
                Comments

                DiagnosticReport.category and Composition.category shall be aligned

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

                Codes for diagnostic service sections.

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

                  Laboratory services, i.e., results of tests performed, could be characterized using typology of services, commonly called study types. Study type could be seen as an attribute or grouping mechanism that assigns a common clinical sense to certain types of laboratory test results., e.g., Hemoglobin, Platelet count, etc. belongs to 'Hematology study'.

                  ShortThe way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)
                  Comments

                  In comparison to the laboratory specialty which is an attribute of laboratory, study type is a categorization of laboratory service. It needs to be mentioned that classification of test to study types in not standardized.

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

                  Laboratory specialty is an attribute of any laboratory setting representing professional qualification of the laboratory to execute certain kind of laboratory tests.

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

                  Specialty could be used as parameter for searching/querying of laboratory test results.

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

                  Specifies that it refers to a Laboratory Report

                  ShortType of (Laboratory) Report
                  Comments

                  At least one DiagnosticReport.code.coding and Composition.type.coding SHALL be equal

                  Control1..1
                  BindingThe codes SHOULD be taken from Laboratory Report Types
                  (preferred to http://hl7.eu/fhir/laboratory/ValueSet/lab-reportType-eu-lab)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Alternate NamesType
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  42. DiagnosticReport.subject
                  Definition

                  Who or what this report is about. The report can be about a human patient, a living subject, a device (e.g. a machine), a location or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).

                  ShortWho and/or what this report is about
                  Comments

                  DiagnosticReport and Composition SHALL have the same subject

                  Control1..1
                  TypeReference(CH LAB Patient, Patient: Animal, Group, Location, Device)
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  SHALL know the subject context.

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

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

                  ShortThe healthcare event which this Laboratory Report is about (when test ordered).
                  Comments

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

                  DiagnosticReport and Composition SHALL have the same encounter.

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

                  Links the request to the Encounter context.

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

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

                  ShortClinically relevant time/time-period for report.
                  Comments

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

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

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

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

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

                  ShortDateTime this version was made
                  Comments

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

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

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

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

                  The diagnostic service that is responsible for issuing the report.

                  ShortResponsible Diagnostic Service.
                  Comments

                  If a DiagnosticReport.resultsInterpreter exists this is expected to be a Composition.author; otherwise a DiagnosticReport.performer should be an author.

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

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

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

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

                  ShortPrimary result interpreter
                  Comments

                  If a DiagnosticReport.resultsInterpreter exists this is expected to be a Composition.author; otherwise a DiagnosticReport.performer should be an author.

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

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

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

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

                  ShortSpecimens this report is based on.
                  Comments

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

                  Control0..*
                  TypeReference(CH LAB Specimen)
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

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

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

                  Observations that are part of this diagnostic report.

                  Shortresults
                  Comments

                  Observations can contain observations.

                  Control0..*
                  TypeReference(CH LAB Observation Results: Laboratory Report)
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

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

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

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

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

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

                  Control0..0
                  TypeReference(ImagingStudy)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  60. DiagnosticReport.media
                  Definition

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

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

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

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

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

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

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

                  ShortAdditional content defined by implementations
                  Comments

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

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

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

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

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

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

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

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

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

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

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

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

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

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

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

                  Reference to the image source.

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

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

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

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

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

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

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

                  Diagnosis codes provided as adjuncts to the report.

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

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

                  ShortEntire report as issued (pdf recommended)
                  Comments

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

                  Control0..*
                  TypeAttachment
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

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

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