This profile sets additional expectations for the US Core Diagnostic Report and Note Profile to search and fetch Diagnostic Reports and Notes using the DiagnosticReport resource. Diagnostic Reports are typically used for Cardiology, Radiology, and Pathology reports. In addition to the requirements set forth in US Core Diagnostic Report and Note, this derived profile is designed to add requirements to the following elements:

• DiagnosticReport.extension:resource-pertainsToGoal (Must Support)
• DiagnosticReport.basedOn (Must Support) to encourage linking back Care Plan activities.

Comments are welcome with respect to the pragmatic use of the “Must Support” rules defined on these elements.

No additional value sets were defined for use in this profile beyond the US Core Diagnostic Report profile.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from USCoreDiagnosticReportProfileNoteExchange

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	USCoreDiagnosticReportProfileNoteExchange	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainesToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
basedOn	S	0..*	Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	What was requested
code		1..1	CodeableConcept	Please see the Diagnostic Report and Note Value Set Library for value sets that are derived from LOINC that can be used at DiagnosticReport.code element
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport	C	0..*	USCoreDiagnosticReportProfileNoteExchange	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainesToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	S	0..*	Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	What was requested
status	?!SΣC	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category	SΣ	1..*	CodeableConcept	Service category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:us-core	SΣ	0..*	CodeableConcept	Service category Binding: US Core Diagnostic Report Category Codes (required)
code	SΣ	1..1	CodeableConcept	Please see the Diagnostic Report and Note Value Set Library for value sets that are derived from LOINC that can be used at DiagnosticReport.code element Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject	SΣ	1..1	Reference(US Core Patient Profile)	The subject of the report - usually, but not always, the patient
encounter	SΣ	0..1	Reference(US Core Encounter Profile)	Health care event when test ordered
effective[x]	SΣC	0..1		Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime			dateTime
issued	SΣ	0..1	instant	DateTime this version was made
performer	SΣ	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile)	Responsible Diagnostic Service
result	S	0..*	Reference(US Core Laboratory Result Observation Profile | US Core Observation Clinical Test Result Profile | US Core Observation Imaging Result Profile)	Observations
media	SΣ	0..*	BackboneElement	Key images associated with this report
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
link	SΣ	1..1	Reference(Media)	Reference to the image source
presentedForm	S	0..*	Attachment	Entire report as issued
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DiagnosticReport.status	required	DiagnosticReportStatus
DiagnosticReport.category	example	DiagnosticServiceSectionCodes
DiagnosticReport.category:us-core	required	USCoreDiagnosticReportCategory
DiagnosticReport.code	extensible	USCoreNonLaboratoryCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DiagnosticReport	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	error	DiagnosticReport	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	error	DiagnosticReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DiagnosticReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-10	error	DiagnosticReport	effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' : (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport	C	0..*	USCoreDiagnosticReportProfileNoteExchange	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainesToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier for report
basedOn	S	0..*	Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	What was requested
status	?!SΣC	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category	SΣ	1..*	CodeableConcept	Service category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:us-core	SΣ	0..*	CodeableConcept	Service category Binding: US Core Diagnostic Report Category Codes (required)
code	SΣ	1..1	CodeableConcept	Please see the Diagnostic Report and Note Value Set Library for value sets that are derived from LOINC that can be used at DiagnosticReport.code element Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject	SΣ	1..1	Reference(US Core Patient Profile)	The subject of the report - usually, but not always, the patient
encounter	SΣ	0..1	Reference(US Core Encounter Profile)	Health care event when test ordered
effective[x]	SΣC	0..1		Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime			dateTime S
effectivePeriod			Period
issued	SΣ	0..1	instant	DateTime this version was made
performer	SΣ	0..*	Reference(US Core Practitioner Profile S | US Core Organization Profile S | US Core PractitionerRole Profile | US Core CareTeam Profile)	Responsible Diagnostic Service
resultsInterpreter	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam)	Primary result interpreter
specimen		0..*	Reference(Specimen)	Specimens this report is based on
result	S	0..*	Reference(US Core Laboratory Result Observation Profile S | US Core Observation Clinical Test Result Profile S | US Core Observation Imaging Result Profile S)	Observations
imagingStudy		0..*	Reference(ImagingStudy)	Reference to full details of imaging associated with the diagnostic report
media	SΣ	0..*	BackboneElement	Key images associated with this report
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
comment		0..1	string	Comment about the image (e.g. explanation)
link	SΣ	1..1	Reference(Media)	Reference to the image source
conclusion		0..1	string	Clinical conclusion (interpretation) of test results
conclusionCode		0..*	CodeableConcept	Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm	S	0..*	Attachment	Entire report as issued
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DiagnosticReport.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
DiagnosticReport.status	required	DiagnosticReportStatus
DiagnosticReport.category	example	DiagnosticServiceSectionCodes
DiagnosticReport.category:us-core	required	USCoreDiagnosticReportCategory
DiagnosticReport.code	extensible	USCoreNonLaboratoryCodes
DiagnosticReport.conclusionCode	example	SNOMEDCTClinicalFindings

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from USCoreDiagnosticReportProfileNoteExchange

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport		0..*	USCoreDiagnosticReportProfileNoteExchange	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainesToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
basedOn	S	0..*	Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	What was requested
code		1..1	CodeableConcept	Please see the Diagnostic Report and Note Value Set Library for value sets that are derived from LOINC that can be used at DiagnosticReport.code element
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport	C	0..*	USCoreDiagnosticReportProfileNoteExchange	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainesToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	S	0..*	Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	What was requested
status	?!SΣC	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category	SΣ	1..*	CodeableConcept	Service category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:us-core	SΣ	0..*	CodeableConcept	Service category Binding: US Core Diagnostic Report Category Codes (required)
code	SΣ	1..1	CodeableConcept	Please see the Diagnostic Report and Note Value Set Library for value sets that are derived from LOINC that can be used at DiagnosticReport.code element Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject	SΣ	1..1	Reference(US Core Patient Profile)	The subject of the report - usually, but not always, the patient
encounter	SΣ	0..1	Reference(US Core Encounter Profile)	Health care event when test ordered
effective[x]	SΣC	0..1		Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime			dateTime
issued	SΣ	0..1	instant	DateTime this version was made
performer	SΣ	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile)	Responsible Diagnostic Service
result	S	0..*	Reference(US Core Laboratory Result Observation Profile | US Core Observation Clinical Test Result Profile | US Core Observation Imaging Result Profile)	Observations
media	SΣ	0..*	BackboneElement	Key images associated with this report
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
link	SΣ	1..1	Reference(Media)	Reference to the image source
presentedForm	S	0..*	Attachment	Entire report as issued
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DiagnosticReport.status	required	DiagnosticReportStatus
DiagnosticReport.category	example	DiagnosticServiceSectionCodes
DiagnosticReport.category:us-core	required	USCoreDiagnosticReportCategory
DiagnosticReport.code	extensible	USCoreNonLaboratoryCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DiagnosticReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DiagnosticReport	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	error	DiagnosticReport	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	error	DiagnosticReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DiagnosticReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-10	error	DiagnosticReport	effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' : (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
DiagnosticReport	C	0..*	USCoreDiagnosticReportProfileNoteExchange	A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainesToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier for report
basedOn	S	0..*	Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	What was requested
status	?!SΣC	1..1	code	registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required)
Slices for category	SΣ	1..*	CodeableConcept	Service category Slice: Unordered, Open by pattern:$this Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
category:us-core	SΣ	0..*	CodeableConcept	Service category Binding: US Core Diagnostic Report Category Codes (required)
code	SΣ	1..1	CodeableConcept	Please see the Diagnostic Report and Note Value Set Library for value sets that are derived from LOINC that can be used at DiagnosticReport.code element Binding: US Core Non Laboratory Codes (extensible): LOINC codes
subject	SΣ	1..1	Reference(US Core Patient Profile)	The subject of the report - usually, but not always, the patient
encounter	SΣ	0..1	Reference(US Core Encounter Profile)	Health care event when test ordered
effective[x]	SΣC	0..1		Diagnostically relevant time (typically the time of the procedure)
effectiveDateTime			dateTime S
effectivePeriod			Period
issued	SΣ	0..1	instant	DateTime this version was made
performer	SΣ	0..*	Reference(US Core Practitioner Profile S | US Core Organization Profile S | US Core PractitionerRole Profile | US Core CareTeam Profile)	Responsible Diagnostic Service
resultsInterpreter	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam)	Primary result interpreter
specimen		0..*	Reference(Specimen)	Specimens this report is based on
result	S	0..*	Reference(US Core Laboratory Result Observation Profile S | US Core Observation Clinical Test Result Profile S | US Core Observation Imaging Result Profile S)	Observations
imagingStudy		0..*	Reference(ImagingStudy)	Reference to full details of imaging associated with the diagnostic report
media	SΣ	0..*	BackboneElement	Key images associated with this report
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
comment		0..1	string	Comment about the image (e.g. explanation)
link	SΣ	1..1	Reference(Media)	Reference to the image source
conclusion		0..1	string	Clinical conclusion (interpretation) of test results
conclusionCode		0..*	CodeableConcept	Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm	S	0..*	Attachment	Entire report as issued
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DiagnosticReport.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
DiagnosticReport.status	required	DiagnosticReportStatus
DiagnosticReport.category	example	DiagnosticServiceSectionCodes
DiagnosticReport.category:us-core	required	USCoreDiagnosticReportCategory
DiagnosticReport.code	extensible	USCoreNonLaboratoryCodes
DiagnosticReport.conclusionCode	example	SNOMEDCTClinicalFindings

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from USCoreDiagnosticReportProfileNoteExchange

Summary

Must-Support: 2 elements

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal