Release 5 Preview #1

This page is part of the FHIR Specification (v4.2.0: R5 Preview #1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Reference.profile.xml

Modeling and Methodology Work GroupMaturity Level: N/AStandards Status: Informative

Raw XML (canonical form + also see XML Format Specification)

StructureDefinition for Reference

<?xml version="1.0" encoding="UTF-8"?>

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="Reference"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;">
        <tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;">
          <th class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="formats.html#table" title="The logical name of the element">Name</a> 
          </th> 
          <th class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="formats.html#table" title="Information about the use of the element">Flags</a> 
          </th> 
          <th class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="formats.html#table" title="Minimum and Maximum # of times the the element can appear in the instance">Card.</a> 
          </th> 
          <th class="hierarchy" style="width: 100px">
            <a href="formats.html#table" title="Reference to the type of the element">Type</a> 
          </th> 
          <th class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="formats.html#table" title="Additional information about the element">Description &amp; Constraints</a> 
            <span style="float: right">
              <a href="formats.html#table" title="Legend for this format">
                <img alt="doco" src="help16.png" style="background-color: inherit"/> 
              </a> 
            </span> 
          </th> 
        </tr> 
        <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;">
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data: image/png;base64,iVBORw0KG
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          AAAABJRU5ErkJggg==)">
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAAWCAYAAAABxvaqAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB
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            NdCABMPwMo2ctnoQAAAABJRU5ErkJggg==" style="background-color: inherit"/> 
            <img alt="." class="hierarchy" src="data: image/png;base64,R0lGODlhEAAQAPQfAOvGUf7ztuvPMf/78/fkl/Pbg+u8Rvjqteu2Pf3zxPz36Pz0z+vTmPzurPvuw
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            5exg8Shl1ckRUQVaMVkQ2kCstKCEAOw==" style="background-color: white; background-color: inherit" title="Element"/>  
            <a href="references-definitions.html#Reference" title="Reference : A reference from one resource to another.">Reference</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="elementdefinition-definitions.html#ElementDefinition.isSummary" style="padding-left: 3px; padding-right: 3px; color: black; null" title="This element is included in summaries">Σ</a> 
            <a href="versions.html#std-process" style="padding-left: 3px; padding-right: 3px; border: 1px grey solid; font-weight: bold; color:
             black; background-color: #e6ffe6" title="Standards Status = Normative">N</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px"/> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="types.html#Element">Element</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">A reference from one resource to another
            <br/>  
            <span style="font-style: italic" title="ref-1">+ Rule: SHALL have a contained resource if a local reference is provided</span> 
            <br/>  Elements defined in Ancestors: 
            <a href="types.html#Element" title="Unique id for the element within a resource (for internal references). This may be any
             string value that does not contain spaces.">id</a> , 
            <a href="types.html#Element" title="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.">extension</a> 
          </td> 
        </tr> 

        <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7;">
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data: image/png;base64,iV
          BORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgE
          AADClAVWFQIBRHMicAAAAAElFTkSuQmCC)">
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAAWCAYAAAABxvaqAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB
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            NdCABMPwMo2ctnoQAAAABJRU5ErkJggg==" style="background-color: inherit"/> 
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAWCAYAAADJqhx8AAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB
            3RJTUUH3wYeFzI3XJ6V3QAAAB1pVFh0Q29tbWVudAAAAAAAQ3JlYXRlZCB3aXRoIEdJTVBkLmUHAAAANklEQVQ4y+2RsQ0AIAzDav
            7/2VzQwoCY4iWbZSmo1QGoUgNMghvWaIejPQW/CrrNCylIwcOCDYfLNRcNer4SAAAAAElFTkSuQmCC" style="background-color: inherit"/> 
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAR
            klEQVQ4y2P8//8/AyWAhYFCMAgMuHjx4n+KXaCv+I0szW8WpCG8kFO1lGFKW/SIjAUYgxz/MzAwMDC+nqhDUTQyjuYFBgCNmhP4Ov
            TRgwAAAABJRU5ErkJggg==" style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type"/>  
            <a href="references-definitions.html#Reference.reference" title="Reference.reference : 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.">reference</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px">
            <a href="elementdefinition-definitions.html#ElementDefinition.isSummary" style="padding-left: 3px; padding-right: 3px; color: black; null" title="This element is included in summaries">Σ</a> 
            <a href="conformance-rules.html#constraints" style="padding-left: 3px; padding-right: 3px; color: black; null" title="This element has or is affected by some invariants">I</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px">0..1</td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px">
            <a href="datatypes.html#string">string</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px">Literal reference, Relative, internal or absolute URL</td> 
        </tr> 

        <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;">
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data: image/png;base64,iVBORw0KG
          goAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAV
          WFQIBRHMicAAAAAElFTkSuQmCC)">
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAAWCAYAAAABxvaqAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB
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            NdCABMPwMo2ctnoQAAAABJRU5ErkJggg==" style="background-color: inherit"/> 
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAWCAYAAADJqhx8AAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB
            3RJTUUH3wYeFzI3XJ6V3QAAAB1pVFh0Q29tbWVudAAAAAAAQ3JlYXRlZCB3aXRoIEdJTVBkLmUHAAAANklEQVQ4y+2RsQ0AIAzDav
            7/2VzQwoCY4iWbZSmo1QGoUgNMghvWaIejPQW/CrrNCylIwcOCDYfLNRcNer4SAAAAAElFTkSuQmCC" style="background-color: inherit"/> 
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAR
            klEQVQ4y2P8//8/AyWAhYFCMAgMuHjx4n+KXaCv+I0szW8WpCG8kFO1lGFKW/SIjAUYgxz/MzAwMDC+nqhDUTQyjuYFBgCNmhP4Ov
            TRgwAAAABJRU5ErkJggg==" style="background-color: white; background-color: inherit" title="Primitive Data Type"/>  
            <a href="references-definitions.html#Reference.type" title="Reference.type : 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. &quot;Patient&quot; 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).">type</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="elementdefinition-definitions.html#ElementDefinition.isSummary" style="padding-left: 3px; padding-right: 3px; color: black; null" title="This element is included in summaries">Σ</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">0..1</td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="datatypes.html#uri">uri</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">Type the reference refers to (e.g. &quot;Patient&quot;)
            <br/>  
            <a href="valueset-resource-types.html" title="Aa resource (or, for logical models, the URI of the logical model).">ResourceType</a>  (
            <a href="terminologies.html#extensible" title="To be conformant, the concept in this element SHALL be from the specified value set if
             any of the codes within the value set can apply to the concept being communicated.  If
             the value set does not cover the concept (based on human review), alternate codings (or,
             data type allowing, text) may be included instead.">Extensible</a> )
          </td> 
        </tr> 

        <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7;">
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data: image/png;base64,iV
          BORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgE
          AADClAVWFQIBRHMicAAAAAElFTkSuQmCC)">
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAAWCAYAAAABxvaqAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB
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            NdCABMPwMo2ctnoQAAAABJRU5ErkJggg==" style="background-color: inherit"/> 
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAWCAYAAADJqhx8AAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB
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            7/2VzQwoCY4iWbZSmo1QGoUgNMghvWaIejPQW/CrrNCylIwcOCDYfLNRcNer4SAAAAAElFTkSuQmCC" style="background-color: inherit"/> 
            <img alt="." class="hierarchy" src="data: image/png;base64,R0lGODlhEAAQAPZ/APrkusOiYvvfqbiXWaV2G+jGhdq1b8GgYf3v1frw3vTUlsWkZNewbcSjY/DQk
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            szv3rye3LiPvnv+3MjPDasKiIS/789/3x2f747eXDg+7Mifvu0tu7f+/QkfDTnPXWmPrjsvrjtPbPgrqZW+/QlPz48K2EMv36866O
            UPvowat8Ivvgq/Pbrvzgq/PguvrgrqN0Gda2evfYm9+7d/rpw9q6e/LSku/Rl/XVl/LSlfrkt+zVqe7Wqv3x1/bNffbOf59wFdS6i
            f3u0vrqyP3owPvepfXQivDQkO/PkKh9K7STVf779P///wD/ACH5BAEKAH8ALAAAAAAQABAAAAemgH+CgxeFF4OIhBdKGwFChYl/hY
            wbdkoBPnaQkosbG3d3VEpSUlonUoY1Gzo6QkI8SrGxWBOFG4uySgY5ZWR3PFy2hnaWZXC/PHcPwkpJk1ShoHcxhQEXSUmtFy6+0iS
            FVResrjoTPDzdcoU+F65CduVU6KAhhQa3F8Tx8nchBoYuqoTLZoAKFRIhqGwqJAULFx0GYpBQeChRIR4TJm6KJMhQRUSBAAA7" style="background-color: #F7F7F7; background-color: inherit" title="Data Type"/>  
            <a href="references-definitions.html#Reference.identifier" title="Reference.identifier : 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.">identifier</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px">
            <a href="elementdefinition-definitions.html#ElementDefinition.isSummary" style="padding-left: 3px; padding-right: 3px; color: black; null" title="This element is included in summaries">Σ</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px">0..1</td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px">
            <a href="datatypes.html#Identifier">Identifier</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0
           solid; padding:0px 4px 0px 4px">Logical reference, when literal reference is not known</td> 
        </tr> 

        <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;">
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data: image/png;base64,iVBORw0KG
          goAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAAJUlEQVR4Xu3IIQEAAAgDsHd9/w4EQIOamFnaBgAA4MMKAACAKwNp30CqZFfFmw
          AAAABJRU5ErkJggg==)">
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAAWCAYAAAABxvaqAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB
            3RJTUUH3wYeFzIs1vtcMQAAAB1pVFh0Q29tbWVudAAAAAAAQ3JlYXRlZCB3aXRoIEdJTVBkLmUHAAAAE0lEQVQI12P4//8/AxMDAw
            NdCABMPwMo2ctnoQAAAABJRU5ErkJggg==" style="background-color: inherit"/> 
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAWCAYAAADJqhx8AAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB
            3RJTUUH3wYeFzME+lXFigAAAB1pVFh0Q29tbWVudAAAAAAAQ3JlYXRlZCB3aXRoIEdJTVBkLmUHAAAANklEQVQ4y+3OsRUAIAjEUO
            L+O8cJABttJM11/x1qZAGqRBEVcNIqdWj1efDqQbb3HwwwwEfABmQUHSPM9dtDAAAAAElFTkSuQmCC" style="background-color: inherit"/> 
            <img alt="." class="hierarchy" src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAR
            klEQVQ4y2P8//8/AyWAhYFCMAgMuHjx4n+KXaCv+I0szW8WpCG8kFO1lGFKW/SIjAUYgxz/MzAwMDC+nqhDUTQyjuYFBgCNmhP4Ov
            TRgwAAAABJRU5ErkJggg==" style="background-color: white; background-color: inherit" title="Primitive Data Type"/>  
            <a href="references-definitions.html#Reference.display" title="Reference.display : Plain text narrative that identifies the resource in addition to the
             resource reference.">display</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="elementdefinition-definitions.html#ElementDefinition.isSummary" style="padding-left: 3px; padding-right: 3px; color: black; null" title="This element is included in summaries">Σ</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">0..1</td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">
            <a href="datatypes.html#string">string</a> 
          </td> 
          <td class="hierarchy" style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid;
           padding:0px 4px 0px 4px">Text alternative for the resource</td> 
        </tr> 

        <tr> 
          <td class="hierarchy" colspan="5">
            <br/>  
            <a href="formats.html#table" title="Legend for this format">
              <img alt="doco" src="help16.png" style="background-color: inherit"/>  Documentation for this format
            </a> 
          </td> 
        </tr> 
      </table> 
    </div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="normative"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version">
    <valueCode value="4.0.0"/> 
  </extension> 
  <url value="http://hl7.org/fhir/StructureDefinition/Reference"/> 
  <version value="4.2.0"/> 
  <name value="Reference"/> 
  <status value="active"/> 
  <date value="2019-12-31T21:03:40+11:00"/> 
  <publisher value="HL7 FHIR Standard"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/fhir"/> 
    </telecom> 
  </contact> 
  <description value="Base StructureDefinition for Reference Type: A reference from one resource to another."/> 
  <fhirVersion value="4.2.0"/> 
  <mapping> 
    <identity value="rim"/> 
    <uri value="http://hl7.org/v3"/> 
    <name value="RIM Mapping"/> 
  </mapping> 
  <kind value="complex-type"/> 
  <abstract value="false"/> 
  <type value="Reference"/> 
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DataType"/> 
  <derivation value="specialization"/> 
  <snapshot> 
    <element id="Reference">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
        <valueCode value="normative"/> 
      </extension> 
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version">
        <valueCode value="4.0.0"/> 
      </extension> 
      <path value="Reference"/> 
      <short value="A reference from one resource to another"/> 
      <definition value="A reference from one resource to another."/> 
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing
       for access control, temporary unavailability, etc.). Resolution can be either by retrieval
       from the URL, or, where applicable by resource type, by treating an absolute reference
       as a canonical URL and looking it up in a local registry/repository."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Reference"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <constraint> 
        <key value="ref-1"/> 
        <severity value="error"/> 
        <human value="SHALL have a contained resource if a local reference is provided"/> 
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.i
        d.trace('ids'))"/> 
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/
        f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value,
         '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])"/> 
      </constraint> 
      <isModifier value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)"/> 
      </mapping> 
    </element> 
    <element id="Reference.id">
      <path value="Reference.id"/> 
      <representation value="xmlAttr"/> 
      <short value="Unique id for inter-element referencing"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
    <!--  Note: special primitive values have a FHIRPath system type. e.g. this is compiler magic
       (j)  -->
      <type> 
        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUri value="string"/> 
        </extension> 
        <code value="http://hl7.org/fhirpath/System.String"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Reference.extension">
      <path value="Reference.extension"/> 
      <slicing> 
        <discriminator> 
          <type value="value"/> 
          <path value="url"/> 
        </discriminator> 
        <description value="Extensions are always sliced by (at least) url"/> 
        <rules value="open"/> 
      </slicing> 
      <short value="Additional content defined by implementations"/> 
      <definition value="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."/> 
      <comment value="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."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <constraint> 
        <key value="ext-1"/> 
        <severity value="error"/> 
        <human value="Must have either extensions or value[x], not both"/> 
        <expression value="extension.exists() != value.exists()"/> 
        <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/> 
        <source value="Extension"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Reference.reference">
      <path value="Reference.reference"/> 
      <short value="Literal reference, Relative, internal or absolute URL"/> 
      <definition value="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."/> 
      <comment value="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 &quot;/[type]/[id]&quot; then it should be assumed that the reference is
       to a FHIR RESTful server."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Reference.reference"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <condition value="ref-1"/> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Reference.type">
      <path value="Reference.type"/> 
      <short value="Type the reference refers to (e.g. &quot;Patient&quot;)"/> 
      <definition value="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. &quot;Patient&quot; 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)."/> 
      <comment value="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."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Reference.type"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="uri"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="FHIRResourceTypeExt"/> 
        </extension> 
        <strength value="extensible"/> 
        <description value="Aa resource (or, for logical models, the URI of the logical model)."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/resource-types"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Reference.identifier">
      <path value="Reference.identifier"/> 
      <short value="Logical reference, when literal reference is not known"/> 
      <definition value="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."/> 
      <comment value="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)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Reference.identifier"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Identifier"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".identifier"/> 
      </mapping> 
    </element> 
    <element id="Reference.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/> 
      </extension> 
      <path value="Reference.display"/> 
      <short value="Text alternative for the resource"/> 
      <definition value="Plain text narrative that identifies the resource in addition to the resource reference."/> 
      <comment value="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."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Reference.display"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
  </snapshot> 
  <differential> 
    <element id="Reference">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
        <valueCode value="normative"/> 
      </extension> 
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version">
        <valueCode value="4.0.0"/> 
      </extension> 
      <path value="Reference"/> 
      <short value="A reference from one resource to another"/> 
      <definition value="A reference from one resource to another."/> 
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing
       for access control, temporary unavailability, etc.). Resolution can be either by retrieval
       from the URL, or, where applicable by resource type, by treating an absolute reference
       as a canonical URL and looking it up in a local registry/repository."/> 
      <min value="0"/> 
      <max value="*"/> 
      <constraint> 
        <key value="ref-1"/> 
        <severity value="error"/> 
        <human value="SHALL have a contained resource if a local reference is provided"/> 
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.i
        d.trace('ids'))"/> 
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/
        f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value,
         '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])"/> 
      </constraint> 
      <mapping> 
        <identity value="rim"/> 
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)"/> 
      </mapping> 
    </element> 
    <element id="Reference.reference">
      <path value="Reference.reference"/> 
      <short value="Literal reference, Relative, internal or absolute URL"/> 
      <definition value="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."/> 
      <comment value="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 &quot;/[type]/[id]&quot; then it should be assumed that the reference is
       to a FHIR RESTful server."/> 
      <min value="0"/> 
      <max value="1"/> 
      <type> 
        <code value="string"/> 
      </type> 
      <condition value="ref-1"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Reference.type">
      <path value="Reference.type"/> 
      <short value="Type the reference refers to (e.g. &quot;Patient&quot;)"/> 
      <definition value="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. &quot;Patient&quot; 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)."/> 
      <comment value="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."/> 
      <min value="0"/> 
      <max value="1"/> 
      <type> 
        <code value="uri"/> 
      </type> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="FHIRResourceTypeExt"/> 
        </extension> 
        <strength value="extensible"/> 
        <description value="Aa resource (or, for logical models, the URI of the logical model)."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/resource-types"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Reference.identifier">
      <path value="Reference.identifier"/> 
      <short value="Logical reference, when literal reference is not known"/> 
      <definition value="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."/> 
      <comment value="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)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <type> 
        <code value="Identifier"/> 
      </type> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".identifier"/> 
      </mapping> 
    </element> 
    <element id="Reference.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/> 
      </extension> 
      <path value="Reference.display"/> 
      <short value="Text alternative for the resource"/> 
      <definition value="Plain text narrative that identifies the resource in addition to the resource reference."/> 
      <comment value="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."/> 
      <min value="0"/> 
      <max value="1"/> 
      <type> 
        <code value="string"/> 
      </type> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
  </differential> 
</StructureDefinition> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.