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US Core DiagnosticReport for Laboratory Results Reporting

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Where a Health Plan has access to Laboratory Results and other diagnostic information, they SHALL make the information available using the US Core DiagnosticReport for Laboratory Results Reporting resource.

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the US Core DiagnosticReport for Laboratory Results Reporting resource are:

R4 Element Name Cardinality Type
DiagnosticReport.status status 1..1 code
DiagnosticReport.category category 1..* (Slice Definition)
DiagnosticReport.category:LaboratorySlice category:LaboratorySlice 1..1 CodeableConcept
DiagnosticReport.category:LaboratorySlice.coding coding 1..* Coding
DiagnosticReport.category:LaboratorySlice.coding.system system 1..1 uri
DiagnosticReport.category:LaboratorySlice.coding.code code 1..1 code
DiagnosticReport.code code 1..1 CodeableConcept
DiagnosticReport.subject subject 1..1 Reference(US Core Patient Profile)
DiagnosticReport.effective[x] effective[x] 1..1  
DiagnosticReport.issued issued 1..1 instant
DiagnosticReport.performer performer 0..* Reference(US Core Practitioner Profile | US Core Organization Profile)
DiagnosticReport.result result 0..* Reference(US Core Laboratory Result Observation Profile)

Table Definition

HL7 V2 Mapping to Diagnostic Report

R4 Hierarchical Name R4 Name Cardinality Type HL7 V2 Source
DiagnosticReport.basedOn basedOn 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder| ServiceRequest) ORC
DiagnosticReport.status status 1..1 code OBX-11
DiagnosticReport.code code 1..1 CodeableConcept OBX-3
DiagnosticReport.subject subject 1..1 Reference(US Core Patient Profile) PID-3
DiagnosticReport.focus focus 0..* Reference(Resource) OBX-3
DiagnosticReport.encounter encounter 0..1 Reference(Encounter) PV1
DiagnosticReport.effective[x] effective[x] 0..1 dateTime, Period OBX-14
DiagnosticReport.issued issued 0..1 instant OBR-22
DiagnosticReport.performer performer 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) OBX-15
DiagnosticReport.value[x] value[x] 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period OBX-5
DiagnosticReport.dataAbsentReason dataAbsentReason 0..1 CodeableConcept N/A
DiagnosticReport.interpretation interpretation 0..* CodeableConcept OBX-8
DiagnosticReport.note note 0..* Annotation NTE
DiagnosticReport.bodySite bodySite 0..1 CodeableConcept OBX-20
DiagnosticReport.method method 0..1 CodeableConcept OBX-17
DiagnosticReport.specimen specimen 0..1 Reference(Specimen) SPM
DiagnosticReport.device device 0..1 Reference(Device | DeviceMetric) OBX-17
DiagnosticReport.referenceRange referenceRange 0..* BackboneElement OBX-7
DiagnosticReport.referenceRange.extension extension 0..* Extension OBX-7
DiagnosticReport.referenceRange.low low 0..1 SimpleQuantity OBX-7
DiagnosticReport.referenceRange.high high 0..1 SimpleQuantity OBX-7
DiagnosticReport.referenceRange.type type 0..1 CodeableConcept OBX-10
DiagnosticReport.referenceRange.appliesTo appliesTo 0..* CodeableConcept OBX-10
DiagnosticReport.referenceRange.text text 0..1 string OBX-7

C-CDA Mapping to Diagnostic Report

R4 Hierarchical Name R4 Name Cardinality Type CCDA
DiagnosticReport.text text 0..1 Narrative Act.text (?)
DiagnosticReport.contained contained 0..* Resource N/A
DiagnosticReport.extension extension 0..* Extension N/A
DiagnosticReport.modifierExtension modifierExtension 0..* Extension N/A
DiagnosticReport.identifier identifier 0..* Identifier id
DiagnosticReport.basedOn basedOn 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder| ServiceRequest) .outboundRelationship[typeCode=FLFS].target
DiagnosticReport.category category 1..* CodeableConcept .outboundRelationship[typeCode=”COMP].target[classCode=”LIST”, moodCode=”EVN”].code
DiagnosticReport.code code 1..1 CodeableConcept code
DiagnosticReport.subject subject 1..1 Reference(US Core Patient Profile) participation[typeCode=SBJ]
DiagnosticReport.performer performer 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) participation[typeCode=PRF]
DiagnosticReport.value[x] value[x] 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period value
DiagnosticReport.dataAbsentReason dataAbsentReason 0..1 CodeableConcept value.nullFlavor
DiagnosticReport.interpretation interpretation 0..* CodeableConcept interpretationCode
DiagnosticReport.method method 0..1 CodeableConcept methodCode
DiagnosticReport.specimen specimen 0..1 Reference(Specimen) participation[typparticipation[typeCode=DEV]eCode=SPC].specimen
DiagnosticReport.device device 0..1 Reference(Device | DeviceMetric) participation[typeCode=DEV]
DiagnosticReport.referenceRange referenceRange 0..* BackboneElement outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
DiagnosticReport.referenceRange.low low 0..1 SimpleQuantity value:IVL_PQ.low
DiagnosticReport.referenceRange.high high 0..1 SimpleQuantity value:IVL_PQ.high
DiagnosticReport.referenceRange.type type 0..1 CodeableConcept interpretationCode
DiagnosticReport.referenceRange.appliesTo appliesTo 0..* CodeableConcept N/A (?)
DiagnosticReport.referenceRange.age age 0..1 Range outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=”age”].value
DiagnosticReport.referenceRange.text text 0..1 string value:ST
DiagnosticReport.hasMember hasMember 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) outBoundRelationship
DiagnosticReport.derivedFrom derivedFrom 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) N/A (?)

Claim (837) to Diagnostic Report

R4 Hierarchical Name R4 Name Cardinality Type Claim(837) / Note
DiagnosticReport.implicitRules implicitRules 0..1 uri x
DiagnosticReport.language language 0..1 code x
DiagnosticReport.text text 0..1 Narrative x
DiagnosticReport.contained contained 0..* Resource x
DiagnosticReport.extension extension 0..* Extension x
DiagnosticReport.modifierExtension modifierExtension 0..* Extension x
DiagnosticReport.identifier identifier 0..* Identifier x
DiagnosticReport.partOf partOf 0..* Reference(MedicationAdministration| MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) x
DiagnosticReport.status status 1..1 code Default to “unknown”
DiagnosticReport.category category 1..* CodeableConcept x
DiagnosticReport.code code 1..1 CodeableConcept Procedure Code
DiagnosticReport.subject subject 1..1 Reference(US Core Patient Profile) Patient Demographics
DiagnosticReport.focus focus 0..* Reference(Resource) x
DiagnosticReport.effective[x] effective[x] 0..1 dateTime, Period Date of Service
DiagnosticReport.issued issued 0..1 instant Interchange Date/Time
DiagnosticReport.performer performer 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) Billing/Rendering Provider
DiagnosticReport.value[x] value[x] 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period x
DiagnosticReport.dataAbsentReason dataAbsentReason 0..1 CodeableConcept x
DiagnosticReport.interpretation interpretation 0..* CodeableConcept x
DiagnosticReport.note note 0..* Annotation Note Segment
DiagnosticReport.bodySite bodySite 0..1 CodeableConcept x
DiagnosticReport.method method 0..1 CodeableConcept x
DiagnosticReport.specimen specimen 0..1 Reference(Specimen) x
DiagnosticReport.device device 0..1 Reference(Device | DeviceMetric) x
DiagnosticReport.referenceRange referenceRange 0..* BackboneElement x
DiagnosticReport.referenceRange.id id 0..1 string x
DiagnosticReport.referenceRange.extension extension 0..* Extension x
DiagnosticReport.referenceRange.modifierExtension modifierExtension 0..* Extension x
DiagnosticReport.referenceRange.low low 0..1 SimpleQuantity x
DiagnosticReport.referenceRange.high high 0..1 SimpleQuantity x
DiagnosticReport.referenceRange.type type 0..1 CodeableConcept x
DiagnosticReport.referenceRange.appliesTo appliesTo 0..* CodeableConcept x
DiagnosticReport.referenceRange.age age 0..1 Range x
DiagnosticReport.referenceRange.text text 0..1 string x
DiagnosticReport.hasMember hasMember 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) x
DiagnosticReport.derivedFrom derivedFrom 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) x

Example DiagnosticReport for Laboratory Results Reporting Resource

An example mapping of a DiagnosticReport for urinalysis is shown below:

{
  "resourceType" : "DiagnosticReport",
  "id" : "urinalysis",
  "meta" : {
    "versionId" : "209563",
    "lastUpdated" : "2016-04-19T17:28:11.308+00:00",
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">
Generated Narrative with Details
id: urinalysis
meta: 
status: final
category: Laboratory <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/v2-0074 code 'LAB' = 'Laboratory', given as 'Laboratory'})</span>
code: Complete Urinalysis <span style=\"background: LightGoldenRodYellow\">(Details : {LOINC code '24356-8' = 'Urinalysis complete panel - Urine', given as 'Urinalysis complete panel - Urine'})</span>
subject: <a href=\"Patient-example.html\">Amy Shaw. Generated Summary: id: example; Medical Record Number = 1032702 (USUAL); active; Amy V. Shaw ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: Feb 20, 2007</a>
effective: Jul 5, 2005, 12:00:00 AM
issued: Jul 6, 2005, 12:45:33 AM
performer: <a href=\"Organization-acme-lab.html\">Acme Laboratory, Inc. Generated Summary: id: acme-lab; 1144221847, 2523423456; active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span>; name: Acme Labs; ph: (+1) 734-677-7777, hq@acme.org</a>
result: 
  • <a href=\"Observation-urine-color.html\">COLOR=Yellow. Generated Summary: id: urine-color; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 5778-6}\">COLOR</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.inbnm,fo/sct 371244009}\">Yellow</span></a>
  • <a href=\"Observation-urine-clarity.html\">APPEARANCE=Hazy. Generated Summary: id: urine-clarity; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 32167-9}\">APPEARANCE</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 81858005}\">Hazy</span></a>
  • <a href=\"Observation-urine-glucose.html\">GLUCOSE=Negative. Generated Summary: id: urine-glucose; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 25428-4}\">GLUCOSE</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 260385009}\">Negative</span></a>
  • <a href=\"Observation-urine-bilirubin.html\">BILIRUBIN=Negative. Generated Summary: id: urine-bilirubin; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 5770-3}\">BILIRUBIN</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 260385009}\">Negative</span></a>
  • <a href=\"Observation-urine-ketone.html\">KETONE=Negative. Generated Summary: id: urine-ketone; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 2514-8}\">KETONE</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 260385009}\">Negative</span></a>
  • <a href=\"Observation-usg.html\">SPEC GRAV=1.017. Generated Summary: id: usg; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 5811-5}\">SPEC GRAV</span>; effective: Jul 5, 2005, 12:00:00 AM; 1.017 {urine specific gravity}</a>
  • <a href=\"Observation-urine-ph.html\">PH=6 (pH). Generated Summary: id: urine-ph; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 5803-2}\">PH</span>; effective: Jul 5, 2005, 12:00:00 AM; 6.0 (pH)</a>
  • <a href=\"Observation-urine-protein.html\">PROTEIN=Negative. Generated Summary: id: urine-protein; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 20454-5}\">PROTEIN</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 260385009}\">Negative</span></a>
  • <a href=\"Observation-urobilinogen.html\">UROBILINOGEN=0.3 mg/dL. Generated Summary: id: urobilinogen; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 20405-7}\">UROBILINOGEN</span>; effective: Jul 5, 2005, 12:00:00 AM; 0.3 mg/dL</a>
  • <a href=\"Observation-urine-nitrite.html\">NITRITE=Positive. Generated Summary: id: urine-nitrite; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 5802-4}\">NITRITE</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 10828004}\">Positive</span></a>
  • <a href=\"Observation-urine-hemoglobin.html\">BLOOD=Trace. Generated Summary: id: urine-hemoglobin; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 5794-3}\">BLOOD</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 260405006}\">Trace</span></a>
  • <a href=\"Observation-urine-leukocyte-esterase.html\">LEUK ESTERASE=2+e. Generated Summary: id: urine-leukocyte-esterase; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 5799-2}\">LEUK ESTERASE</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 260348001}\">2+</span></a>
  • <a href=\"Observation-urine-sediment.html\">COMMENT=Recommend Urine Culture. Generated Summary: id: urine-sediment; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 11279-7}\">COMMENT</span>; effective: Jul 5, 2005, 12:00:00 AM; value: Recommend Urine Culture</a>
  • <a href=\"Observation-urine-bacteria.html\">BACTERIA=4+. Generated Summary: id: urine-bacteria; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 25145-4}\">BACTERIA</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 260350009}\">4+</span></a>
  • <a href=\"Observation-urine-epi-cells.html\">EPITHELIAL CELLS=1-5 cells/HPF. Generated Summary: id: urine-epi-cells; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 5787-7}\">EPITHELIAL CELLS</span>; effective: Jul 5, 2005, 12:00:00 AM; </a>
  • <a href=\"Observation-urine-wbcs.html\">WBC=20-30 cells/HPF. Generated Summary: id: urine-wbcs; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 5821-4}\">WBC</span>; effective: Jul 5, 2005, 12:00:00 AM; </a>
  • <a href=\"Observation-urine-rbcs.html\">RBC=Occasional cells/HPF. Generated Summary: id: urine-rbcs; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/observation-category laboratory}\">Laboratory</span>; <span title=\"Codes: {http://loinc.org 13945-1}\">RBC</span>; effective: Jul 5, 2005, 12:00:00 AM; <span title=\"Codes: {http://snomed.info/sct 84638005}\">Occasional</span></a>
</div>"
  },
  "status" : "final",
  "category" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
          "code" : "LAB",
          "display" : "Laboratory"
        }
      ]
    }
  ],
  "code" : {
    "coding" : [
      {
        "system" : "http://loinc.org",
        "code" : "24356-8",
        "display" : "Urinalysis complete panel - Urine"
      }
    ],
    "text" : "Complete Urinalysis"
  },
  "subject" : {
    "reference" : "Patient/example",
    "display" : "Amy Shaw"
  },
  "effectiveDateTime" : "2005-07-05",
  "issued" : "2005-07-06T11:45:33+11:00",
  "performer" : [
    {
      "reference" : "Organization/acme-lab",
      "display" : "Acme Laboratory, Inc"
    }
  ],
  "result" : [
    {
      "reference" : "Observation/urine-color",
      "display" : "COLOR=Yellow"
    },
    {
      "reference" : "Observation/urine-clarity",
      "display" : "APPEARANCE=Hazy"
    },
    {
      "reference" : "Observation/urine-glucose",
      "display" : "GLUCOSE=Negative"
    },
    {
      "reference" : "Observation/urine-bilirubin",
      "display" : "BILIRUBIN=Negative"
    },
    {
      "reference" : "Observation/urine-ketone",
      "display" : "KETONE=Negative"
    },
    {
      "reference" : "Observation/usg",
      "display" : "SPEC GRAV=1.017"
    },
    {
      "reference" : "Observation/urine-ph",
      "display" : "PH=6 (pH)"
    },
    {
      "reference" : "Observation/urine-protein",
      "display" : "PROTEIN=Negative"
    },
    {
      "reference" : "Observation/urobilinogen",
      "display" : "UROBILINOGEN=0.3 mg/dL"
    },
    {
      "reference" : "Observation/urine-nitrite",
      "display" : "NITRITE=Positive"
    },
    {
      "reference" : "Observation/urine-hemoglobin",
      "display" : "BLOOD=Trace"
    },
    {
      "reference" : "Observation/urine-leukocyte-esterase",
      "display" : "LEUK ESTERASE=2+e"
    },
    {
      "reference" : "Observation/urine-sediment",
      "display" : "COMMENT=Recommend Urine Culture"
    },
    {
      "reference" : "Observation/urine-bacteria",
      "display" : "BACTERIA=4+"
    },
    {
      "reference" : "Observation/urine-epi-cells",
      "display" : "EPITHELIAL CELLS=1-5 cells/HPF"
    },
    {
      "reference" : "Observation/urine-wbcs",
      "display" : "WBC=20-30 cells/HPF"
    },
    {
      "reference" : "Observation/urine-rbcs",
      "display" : "RBC=Occasional cells/HPF"
    }
  ]
}

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