Extensions for Using Data Elements from FHIR DSTU2 in FHIR R5 - Downloaded Version null See the Directory of published versions

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Resource Profile: Profile_R2_DocumentReference_R5

This cross-version profile allows DSTU2 DocumentReference content to be represented via FHIR R5 DocumentReference resources.

Usages:

• Refer to this Profile: DSTU2: Binding Contract (new) and DSTU2: Additional clinical information additional types

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference(5.0.0)	A reference to a document Constraints: docRef-1, docRef-2
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:created		0..1	dateTime	DSTU2: Document creation time (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.created Constraints: ext-1
extension:indexed		1..1	instant	DSTU2: When this document reference created (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.indexed Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:encounter		0..1	Reference(Cross-version Profile for DSTU2.Encounter for use in FHIR R5(0.1.0) | Encounter)	DSTU2: Context of the document content (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.encounter Constraints: ext-1
extension:event		0..*	CodeableConcept	DSTU2: Main Clinical Acts Documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.event Binding: R2V3ActCodeForR5 (0.1.0) (example): This list of codes represents the main clinical acts being documented. Constraints: ext-1
extension:period		0..1	Period	DSTU2: Time of service that is being documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.period Constraints: ext-1
extension:facilityType		0..1	CodeableConcept	DSTU2: Kind of facility where patient was seen (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.facilityType Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. Constraints: ext-1
extension:practiceSetting		0..1	CodeableConcept	DSTU2: Additional details about where the content was created (e.g. clinical specialty) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.practiceSetting Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty). Constraints: ext-1
extension:sourcePatientInfo		0..1	Reference(Cross-version Profile for DSTU2.Patient for use in FHIR R5(0.1.0) | Patient)	DSTU2: Patient demographics from source (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo Constraints: ext-1
extension:related		0..*	(Complex)	DSTU2: Related identifiers or resources (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.related Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
content	Σ	1..*	BackboneElement	Document referenced
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:format		0..*	Coding	DSTU2: Format/content rules for the document (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.format Binding: R2FormatcodesForR5 (0.1.0) (preferred): Document Format Codes. Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
attachment	Σ	1..1	Attachment	Where to access the document
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:attachment		1..1	Attachment	DSTU2: attachment additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.attachment Constraints: ext-1
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.status	Base	required	DocumentReferenceStatus	📍5.0.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	DocumentReference	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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management	text.`div`.exists()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter	facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present	practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1	error	DocumentReference.implicitRules, DocumentReference.extension, DocumentReference.extension:created, DocumentReference.extension:indexed, DocumentReference.modifierExtension, DocumentReference.status, DocumentReference.context, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.context.reference, DocumentReference.content, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment, DocumentReference.content.attachment.extension, DocumentReference.content.attachment.extension:attachment	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	DocumentReference.extension, DocumentReference.extension:created, DocumentReference.extension:indexed, DocumentReference.modifierExtension, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment.extension, DocumentReference.content.attachment.extension:attachment	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference(5.0.0)	A reference to a document
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	Meta	DSTU2: meta additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.meta
text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	(Complex)	DSTU2: text additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.text
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:created		0..1	dateTime	DSTU2: Document creation time (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.created
extension:indexed		1..1	instant	DSTU2: When this document reference created (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.indexed
identifier
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:masterIdentifier		0..1	Identifier	DSTU2: Master Version Specific Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.masterIdentifier
extension:identifier		0..*	Identifier	DSTU2: Other identifiers for the document additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.identifier
docStatus
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:docStatus		0..1	CodeableConcept	DSTU2: preliminary | final | appended | amended | entered-in-error additional types additional codes URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.docStatus Binding: CompositionStatus (required): Status of the underlying document.
subject
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:subject		0..1	Reference(Resource)	DSTU2: subject URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
context
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:encounter		0..1	Reference(Cross-version Profile for DSTU2.Encounter for use in FHIR R5(0.1.0) | Encounter)	DSTU2: Context of the document content (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.encounter
extension:event		0..*	CodeableConcept	DSTU2: Main Clinical Acts Documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.event Binding: R2V3ActCodeForR5 (0.1.0) (example): This list of codes represents the main clinical acts being documented.
extension:period		0..1	Period	DSTU2: Time of service that is being documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.period
extension:facilityType		0..1	CodeableConcept	DSTU2: Kind of facility where patient was seen (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.facilityType Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
extension:practiceSetting		0..1	CodeableConcept	DSTU2: Additional details about where the content was created (e.g. clinical specialty) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.practiceSetting Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
extension:sourcePatientInfo		0..1	Reference(Cross-version Profile for DSTU2.Patient for use in FHIR R5(0.1.0) | Patient)	DSTU2: Patient demographics from source (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo
extension:related		0..*	(Complex)	DSTU2: Related identifiers or resources (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.related
author
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:author		0..*	Reference(Resource)	DSTU2: author URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
attester
mode
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:authenticator		0..1	Reference(Cross-version Profile for DSTU2.Practitioner for use in FHIR R5(0.1.0) | PractitionerRole | Cross-version Profile for DSTU2.Organization for use in FHIR R5(0.1.0) | Organization)	DSTU2: Who/what authenticated the document additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.authenticator
custodian
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:custodian		0..1	Reference(Resource)	DSTU2: custodian additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
relatesTo
code
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:code		0..1	code	DSTU2: replaces | transforms | signs | appends additional codes URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.relatesTo.code Binding: DocumentRelationshipType (required): The type of relationship between documents.
target
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:target		0..1	Reference(Resource)	DSTU2: target additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
content
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:format		0..*	Coding	DSTU2: Format/content rules for the document (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.format Binding: R2FormatcodesForR5 (0.1.0) (preferred): Document Format Codes.
attachment
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:attachment		0..1	Attachment	DSTU2: attachment additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.attachment
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference(5.0.0)	A reference to a document Constraints: docRef-1, docRef-2
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:meta		0..1	Meta	DSTU2: meta additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.meta Constraints: ext-1
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:text		0..1	(Complex)	DSTU2: text additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.text Constraints: ext-1
status		1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:created		0..1	dateTime	DSTU2: Document creation time (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.created Constraints: ext-1
extension:indexed		1..1	instant	DSTU2: When this document reference created (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.indexed Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier	Σ	0..*	Identifier	Business identifiers for the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:masterIdentifier		0..1	Identifier	DSTU2: Master Version Specific Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.masterIdentifier Constraints: ext-1
extension:identifier		0..*	Identifier	DSTU2: Other identifiers for the document additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.identifier Constraints: ext-1
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	ΣC	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
version	Σ	0..1	string	An explicitly assigned identifer of a variation of the content in the DocumentReference
basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:docStatus		0..1	CodeableConcept	DSTU2: preliminary | final | appended | amended | entered-in-error additional types additional codes URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.docStatus Binding: CompositionStatus (required): Status of the underlying document. Constraints: ext-1
value		0..1	code	Primitive value for code
modality	Σ	0..*	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type	Σ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
category	Σ	0..*	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
subject	Σ	0..1	Reference(Resource)	Who/what is the subject of the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:subject		0..1	Reference(Resource)	DSTU2: subject URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:encounter		0..1	Reference(Cross-version Profile for DSTU2.Encounter for use in FHIR R5(0.1.0) | Encounter)	DSTU2: Context of the document content (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.encounter Constraints: ext-1
extension:event		0..*	CodeableConcept	DSTU2: Main Clinical Acts Documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.event Binding: R2V3ActCodeForR5 (0.1.0) (example): This list of codes represents the main clinical acts being documented. Constraints: ext-1
extension:period		0..1	Period	DSTU2: Time of service that is being documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.period Constraints: ext-1
extension:facilityType		0..1	CodeableConcept	DSTU2: Kind of facility where patient was seen (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.facilityType Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. Constraints: ext-1
extension:practiceSetting		0..1	CodeableConcept	DSTU2: Additional details about where the content was created (e.g. clinical specialty) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.practiceSetting Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty). Constraints: ext-1
extension:sourcePatientInfo		0..1	Reference(Cross-version Profile for DSTU2.Patient for use in FHIR R5(0.1.0) | Patient)	DSTU2: Patient demographics from source (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo Constraints: ext-1
extension:related		0..*	(Complex)	DSTU2: Related identifiers or resources (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.related Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
event		0..*	CodeableReference()	Main clinical acts documented Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented.
bodySite	Σ	0..*	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	C	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
period	Σ	0..1	Period	Time of service that is being documented
date	Σ	0..1	instant	When this document reference was created
author	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:author		0..1	Reference(Resource)	DSTU2: author URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
attester		0..*	BackboneElement	Attests to accuracy of the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
mode		1..1	CodeableConcept	personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:authenticator		0..1	Reference(Cross-version Profile for DSTU2.Practitioner for use in FHIR R5(0.1.0) | PractitionerRole | Cross-version Profile for DSTU2.Organization for use in FHIR R5(0.1.0) | Organization)	DSTU2: Who/what authenticated the document additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.authenticator Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
time		0..1	dateTime	When the document was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:custodian		0..1	Reference(Resource)	DSTU2: custodian additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
code	Σ	1..1	CodeableConcept	The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:code		1..1	code	DSTU2: replaces | transforms | signs | appends additional codes URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.relatesTo.code Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:target		0..1	Reference(Resource)	DSTU2: target additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
description	Σ	0..1	markdown	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:format		0..*	Coding	DSTU2: Format/content rules for the document (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.format Binding: R2FormatcodesForR5 (0.1.0) (preferred): Document Format Codes. Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:attachment		1..1	Attachment	DSTU2: attachment additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.attachment Constraints: ext-1
contentType	ΣC	0..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language. Additional Bindings Purpose CommonLanguages Starter Example General: en-AU
data	C	0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	integer64	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	Σ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	Σ	0..1	dateTime	Date attachment was first created
height		0..1	positiveInt	Height of the image in pixels (photo/video)
width		0..1	positiveInt	Width of the image in pixels (photo/video)
frames		0..1	positiveInt	Number of frames if > 1 (photo)
duration		0..1	decimal	Length in seconds (audio / video)
pages		0..1	positiveInt	Number of printed pages
profile	Σ	0..*	BackboneElement	Content profile rules for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7FormatCodes (2.1.0) (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	All Security Labels	📍5.0.0	tx.fhir.org
DocumentReference.meta.​tag	Base	example	Common Tags	📍5.0.0	FHIR Std.
DocumentReference.language	Base	required	All Languages	📍5.0.0	FHIR Std.
DocumentReference.text.​status	Base	required	NarrativeStatus	📍5.0.0	FHIR Std.
DocumentReference.identifier.​use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
DocumentReference.identifier.​type	Base	extensible	Identifier Type Codes	📍5.0.0	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📍5.0.0	FHIR Std.
DocumentReference.docStatus	Base	required	Composition Status	📍5.0.0	FHIR Std.
DocumentReference.modality	Base	extensible	Modality	⏿2025.3.20250714	tx.fhir.org
DocumentReference.type	Base	preferred	FHIR Document Type Codes	📍5.0.0	FHIR Std.
DocumentReference.category	Base	example	Referenced Item Category Value Set	📍5.0.0	FHIR Std.
DocumentReference.subject.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.context.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.event	Base	example	v3 Code System ActCode	📍3.0.0	tx.fhir.org
DocumentReference.bodySite	Base	example	SNOMED CT Body Structures	📍5.0.0	FHIR Std.
DocumentReference.facilityType	Base	example	Facility Type Code Value Set	📍5.0.0	FHIR Std.
DocumentReference.practiceSetting	Base	example	Practice Setting Code Value Set	📍5.0.0	FHIR Std.
DocumentReference.author.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.attester.​mode	Base	preferred	Composition Attestation Mode	📍5.0.0	FHIR Std.
DocumentReference.custodian.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.relatesTo.​code	Base	extensible	Document Relationship Type	📍5.0.0	FHIR Std.
DocumentReference.relatesTo.​target.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.securityLabel	Base	example	Example set of Security Labels	📍5.0.0	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	Mime Types	📍5.0.0	FHIR Std.
DocumentReference.content.​attachment.language	Base	required	All Languages	📍5.0.0	FHIR Std.
DocumentReference.content.​profile.value[x]	Base	preferred	HL7 ValueSet of Format Codes for use with Document Sharing	📍2.1.0	THO v7.1

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	DocumentReference	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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management	text.`div`.exists()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter	facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present	practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1	error	DocumentReference.meta, DocumentReference.meta.extension, DocumentReference.meta.extension:meta, DocumentReference.meta.versionId, DocumentReference.meta.lastUpdated, DocumentReference.meta.source, DocumentReference.meta.profile, DocumentReference.meta.security, DocumentReference.meta.tag, DocumentReference.implicitRules, DocumentReference.language, DocumentReference.text, DocumentReference.text.extension, DocumentReference.text.extension:text, DocumentReference.text.status, DocumentReference.text.div, DocumentReference.extension, DocumentReference.extension:created, DocumentReference.extension:indexed, DocumentReference.modifierExtension, DocumentReference.identifier, DocumentReference.identifier.extension, DocumentReference.identifier.extension:masterIdentifier, DocumentReference.identifier.extension:identifier, DocumentReference.identifier.use, DocumentReference.identifier.type, DocumentReference.identifier.system, DocumentReference.identifier.value, DocumentReference.identifier.period, DocumentReference.identifier.assigner, DocumentReference.version, DocumentReference.basedOn, DocumentReference.status, DocumentReference.docStatus, DocumentReference.docStatus.extension, DocumentReference.docStatus.extension:docStatus, DocumentReference.modality, DocumentReference.type, DocumentReference.category, DocumentReference.subject, DocumentReference.subject.extension, DocumentReference.subject.extension:subject, DocumentReference.subject.reference, DocumentReference.subject.type, DocumentReference.subject.identifier, DocumentReference.subject.display, DocumentReference.context, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.context.reference, DocumentReference.context.type, DocumentReference.context.identifier, DocumentReference.context.display, DocumentReference.event, DocumentReference.bodySite, DocumentReference.facilityType, DocumentReference.practiceSetting, DocumentReference.period, DocumentReference.date, DocumentReference.author, DocumentReference.author.extension, DocumentReference.author.extension:author, DocumentReference.author.reference, DocumentReference.author.type, DocumentReference.author.identifier, DocumentReference.author.display, DocumentReference.attester, DocumentReference.attester.extension, DocumentReference.attester.modifierExtension, DocumentReference.attester.mode, DocumentReference.attester.mode.extension, DocumentReference.attester.mode.extension:authenticator, DocumentReference.attester.mode.coding, DocumentReference.attester.mode.text, DocumentReference.attester.time, DocumentReference.attester.party, DocumentReference.custodian, DocumentReference.custodian.extension, DocumentReference.custodian.extension:custodian, DocumentReference.custodian.reference, DocumentReference.custodian.type, DocumentReference.custodian.identifier, DocumentReference.custodian.display, DocumentReference.relatesTo, DocumentReference.relatesTo.extension, DocumentReference.relatesTo.modifierExtension, DocumentReference.relatesTo.code, DocumentReference.relatesTo.code.extension, DocumentReference.relatesTo.code.extension:code, DocumentReference.relatesTo.code.coding, DocumentReference.relatesTo.code.text, DocumentReference.relatesTo.target, DocumentReference.relatesTo.target.extension, DocumentReference.relatesTo.target.extension:target, DocumentReference.relatesTo.target.reference, DocumentReference.relatesTo.target.type, DocumentReference.relatesTo.target.identifier, DocumentReference.relatesTo.target.display, DocumentReference.description, DocumentReference.securityLabel, DocumentReference.content, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment, DocumentReference.content.attachment.extension, DocumentReference.content.attachment.extension:attachment, DocumentReference.content.attachment.contentType, DocumentReference.content.attachment.language, DocumentReference.content.attachment.data, DocumentReference.content.attachment.url, DocumentReference.content.attachment.size, DocumentReference.content.attachment.hash, DocumentReference.content.attachment.title, DocumentReference.content.attachment.creation, DocumentReference.content.attachment.height, DocumentReference.content.attachment.width, DocumentReference.content.attachment.frames, DocumentReference.content.attachment.duration, DocumentReference.content.attachment.pages, DocumentReference.content.profile, DocumentReference.content.profile.extension, DocumentReference.content.profile.modifierExtension, DocumentReference.content.profile.value[x]	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	DocumentReference.meta.extension, DocumentReference.meta.extension:meta, DocumentReference.text.extension, DocumentReference.text.extension:text, DocumentReference.extension, DocumentReference.extension:created, DocumentReference.extension:indexed, DocumentReference.modifierExtension, DocumentReference.identifier.extension, DocumentReference.identifier.extension:masterIdentifier, DocumentReference.identifier.extension:identifier, DocumentReference.docStatus.extension, DocumentReference.docStatus.extension:docStatus, DocumentReference.subject.extension, DocumentReference.subject.extension:subject, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.author.extension, DocumentReference.author.extension:author, DocumentReference.attester.extension, DocumentReference.attester.modifierExtension, DocumentReference.attester.mode.extension, DocumentReference.attester.mode.extension:authenticator, DocumentReference.custodian.extension, DocumentReference.custodian.extension:custodian, DocumentReference.relatesTo.extension, DocumentReference.relatesTo.modifierExtension, DocumentReference.relatesTo.code.extension, DocumentReference.relatesTo.code.extension:code, DocumentReference.relatesTo.target.extension, DocumentReference.relatesTo.target.extension:target, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment.extension, DocumentReference.content.attachment.extension:attachment, DocumentReference.content.profile.extension, DocumentReference.content.profile.modifierExtension	Must have either extensions or value[x], not both	extension.exists() != value.exists()
txt-1	error	DocumentReference.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	DocumentReference.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

This structure is derived from DocumentReference

Summary

Mandatory: 2 elements

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.meta|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.text|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.created|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.indexed|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.masterIdentifier|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.identifier|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.docStatus|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.encounter|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.event|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.period|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.facilityType|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.practiceSetting|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.related|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.authenticator|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.relatesTo.code|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.format|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.attachment|0.1.0

Maturity: 0

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference(5.0.0)	A reference to a document Constraints: docRef-1, docRef-2
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:created		0..1	dateTime	DSTU2: Document creation time (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.created Constraints: ext-1
extension:indexed		1..1	instant	DSTU2: When this document reference created (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.indexed Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:encounter		0..1	Reference(Cross-version Profile for DSTU2.Encounter for use in FHIR R5(0.1.0) | Encounter)	DSTU2: Context of the document content (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.encounter Constraints: ext-1
extension:event		0..*	CodeableConcept	DSTU2: Main Clinical Acts Documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.event Binding: R2V3ActCodeForR5 (0.1.0) (example): This list of codes represents the main clinical acts being documented. Constraints: ext-1
extension:period		0..1	Period	DSTU2: Time of service that is being documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.period Constraints: ext-1
extension:facilityType		0..1	CodeableConcept	DSTU2: Kind of facility where patient was seen (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.facilityType Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. Constraints: ext-1
extension:practiceSetting		0..1	CodeableConcept	DSTU2: Additional details about where the content was created (e.g. clinical specialty) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.practiceSetting Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty). Constraints: ext-1
extension:sourcePatientInfo		0..1	Reference(Cross-version Profile for DSTU2.Patient for use in FHIR R5(0.1.0) | Patient)	DSTU2: Patient demographics from source (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo Constraints: ext-1
extension:related		0..*	(Complex)	DSTU2: Related identifiers or resources (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.related Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
content	Σ	1..*	BackboneElement	Document referenced
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:format		0..*	Coding	DSTU2: Format/content rules for the document (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.format Binding: R2FormatcodesForR5 (0.1.0) (preferred): Document Format Codes. Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
attachment	Σ	1..1	Attachment	Where to access the document
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:attachment		1..1	Attachment	DSTU2: attachment additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.attachment Constraints: ext-1
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.status	Base	required	DocumentReferenceStatus	📍5.0.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	DocumentReference	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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management	text.`div`.exists()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter	facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present	practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1	error	DocumentReference.implicitRules, DocumentReference.extension, DocumentReference.extension:created, DocumentReference.extension:indexed, DocumentReference.modifierExtension, DocumentReference.status, DocumentReference.context, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.context.reference, DocumentReference.content, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment, DocumentReference.content.attachment.extension, DocumentReference.content.attachment.extension:attachment	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	DocumentReference.extension, DocumentReference.extension:created, DocumentReference.extension:indexed, DocumentReference.modifierExtension, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment.extension, DocumentReference.content.attachment.extension:attachment	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	DocumentReference(5.0.0)	A reference to a document
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	Meta	DSTU2: meta additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.meta
text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	(Complex)	DSTU2: text additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.text
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:created		0..1	dateTime	DSTU2: Document creation time (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.created
extension:indexed		1..1	instant	DSTU2: When this document reference created (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.indexed
identifier
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:masterIdentifier		0..1	Identifier	DSTU2: Master Version Specific Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.masterIdentifier
extension:identifier		0..*	Identifier	DSTU2: Other identifiers for the document additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.identifier
docStatus
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:docStatus		0..1	CodeableConcept	DSTU2: preliminary | final | appended | amended | entered-in-error additional types additional codes URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.docStatus Binding: CompositionStatus (required): Status of the underlying document.
subject
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:subject		0..1	Reference(Resource)	DSTU2: subject URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
context
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:encounter		0..1	Reference(Cross-version Profile for DSTU2.Encounter for use in FHIR R5(0.1.0) | Encounter)	DSTU2: Context of the document content (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.encounter
extension:event		0..*	CodeableConcept	DSTU2: Main Clinical Acts Documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.event Binding: R2V3ActCodeForR5 (0.1.0) (example): This list of codes represents the main clinical acts being documented.
extension:period		0..1	Period	DSTU2: Time of service that is being documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.period
extension:facilityType		0..1	CodeableConcept	DSTU2: Kind of facility where patient was seen (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.facilityType Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
extension:practiceSetting		0..1	CodeableConcept	DSTU2: Additional details about where the content was created (e.g. clinical specialty) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.practiceSetting Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
extension:sourcePatientInfo		0..1	Reference(Cross-version Profile for DSTU2.Patient for use in FHIR R5(0.1.0) | Patient)	DSTU2: Patient demographics from source (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo
extension:related		0..*	(Complex)	DSTU2: Related identifiers or resources (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.related
author
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:author		0..*	Reference(Resource)	DSTU2: author URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
attester
mode
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:authenticator		0..1	Reference(Cross-version Profile for DSTU2.Practitioner for use in FHIR R5(0.1.0) | PractitionerRole | Cross-version Profile for DSTU2.Organization for use in FHIR R5(0.1.0) | Organization)	DSTU2: Who/what authenticated the document additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.authenticator
custodian
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:custodian		0..1	Reference(Resource)	DSTU2: custodian additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
relatesTo
code
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:code		0..1	code	DSTU2: replaces | transforms | signs | appends additional codes URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.relatesTo.code Binding: DocumentRelationshipType (required): The type of relationship between documents.
target
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:target		0..1	Reference(Resource)	DSTU2: target additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
content
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:format		0..*	Coding	DSTU2: Format/content rules for the document (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.format Binding: R2FormatcodesForR5 (0.1.0) (preferred): Document Format Codes.
attachment
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:attachment		0..1	Attachment	DSTU2: attachment additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.attachment
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference(5.0.0)	A reference to a document Constraints: docRef-1, docRef-2
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:meta		0..1	Meta	DSTU2: meta additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.meta Constraints: ext-1
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:text		0..1	(Complex)	DSTU2: text additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.text Constraints: ext-1
status		1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:created		0..1	dateTime	DSTU2: Document creation time (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.created Constraints: ext-1
extension:indexed		1..1	instant	DSTU2: When this document reference created (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.indexed Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier	Σ	0..*	Identifier	Business identifiers for the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:masterIdentifier		0..1	Identifier	DSTU2: Master Version Specific Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.masterIdentifier Constraints: ext-1
extension:identifier		0..*	Identifier	DSTU2: Other identifiers for the document additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.identifier Constraints: ext-1
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	ΣC	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
version	Σ	0..1	string	An explicitly assigned identifer of a variation of the content in the DocumentReference
basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:docStatus		0..1	CodeableConcept	DSTU2: preliminary | final | appended | amended | entered-in-error additional types additional codes URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.docStatus Binding: CompositionStatus (required): Status of the underlying document. Constraints: ext-1
value		0..1	code	Primitive value for code
modality	Σ	0..*	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type	Σ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document.
category	Σ	0..*	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
subject	Σ	0..1	Reference(Resource)	Who/what is the subject of the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:subject		0..1	Reference(Resource)	DSTU2: subject URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:encounter		0..1	Reference(Cross-version Profile for DSTU2.Encounter for use in FHIR R5(0.1.0) | Encounter)	DSTU2: Context of the document content (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.encounter Constraints: ext-1
extension:event		0..*	CodeableConcept	DSTU2: Main Clinical Acts Documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.event Binding: R2V3ActCodeForR5 (0.1.0) (example): This list of codes represents the main clinical acts being documented. Constraints: ext-1
extension:period		0..1	Period	DSTU2: Time of service that is being documented (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.period Constraints: ext-1
extension:facilityType		0..1	CodeableConcept	DSTU2: Kind of facility where patient was seen (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.facilityType Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. Constraints: ext-1
extension:practiceSetting		0..1	CodeableConcept	DSTU2: Additional details about where the content was created (e.g. clinical specialty) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.practiceSetting Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty). Constraints: ext-1
extension:sourcePatientInfo		0..1	Reference(Cross-version Profile for DSTU2.Patient for use in FHIR R5(0.1.0) | Patient)	DSTU2: Patient demographics from source (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo Constraints: ext-1
extension:related		0..*	(Complex)	DSTU2: Related identifiers or resources (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.related Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
event		0..*	CodeableReference()	Main clinical acts documented Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented.
bodySite	Σ	0..*	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	C	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
period	Σ	0..1	Period	Time of service that is being documented
date	Σ	0..1	instant	When this document reference was created
author	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:author		0..1	Reference(Resource)	DSTU2: author URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
attester		0..*	BackboneElement	Attests to accuracy of the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
mode		1..1	CodeableConcept	personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:authenticator		0..1	Reference(Cross-version Profile for DSTU2.Practitioner for use in FHIR R5(0.1.0) | PractitionerRole | Cross-version Profile for DSTU2.Organization for use in FHIR R5(0.1.0) | Organization)	DSTU2: Who/what authenticated the document additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.authenticator Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
time		0..1	dateTime	When the document was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:custodian		0..1	Reference(Resource)	DSTU2: custodian additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
code	Σ	1..1	CodeableConcept	The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:code		1..1	code	DSTU2: replaces | transforms | signs | appends additional codes URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.relatesTo.code Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:target		0..1	Reference(Resource)	DSTU2: target additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
description	Σ	0..1	markdown	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:format		0..*	Coding	DSTU2: Format/content rules for the document (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.format Binding: R2FormatcodesForR5 (0.1.0) (preferred): Document Format Codes. Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:attachment		1..1	Attachment	DSTU2: attachment additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.attachment Constraints: ext-1
contentType	ΣC	0..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language. Additional Bindings Purpose CommonLanguages Starter Example General: en-AU
data	C	0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	integer64	Number of bytes of content (if url provided)
hash	Σ	0..1	base64Binary	Hash of the data (sha-1, base64ed)
title	Σ	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	Σ	0..1	dateTime	Date attachment was first created
height		0..1	positiveInt	Height of the image in pixels (photo/video)
width		0..1	positiveInt	Width of the image in pixels (photo/video)
frames		0..1	positiveInt	Number of frames if > 1 (photo)
duration		0..1	decimal	Length in seconds (audio / video)
pages		0..1	positiveInt	Number of printed pages
profile	Σ	0..*	BackboneElement	Content profile rules for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7FormatCodes (2.1.0) (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	All Security Labels	📍5.0.0	tx.fhir.org
DocumentReference.meta.​tag	Base	example	Common Tags	📍5.0.0	FHIR Std.
DocumentReference.language	Base	required	All Languages	📍5.0.0	FHIR Std.
DocumentReference.text.​status	Base	required	NarrativeStatus	📍5.0.0	FHIR Std.
DocumentReference.identifier.​use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
DocumentReference.identifier.​type	Base	extensible	Identifier Type Codes	📍5.0.0	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📍5.0.0	FHIR Std.
DocumentReference.docStatus	Base	required	Composition Status	📍5.0.0	FHIR Std.
DocumentReference.modality	Base	extensible	Modality	⏿2025.3.20250714	tx.fhir.org
DocumentReference.type	Base	preferred	FHIR Document Type Codes	📍5.0.0	FHIR Std.
DocumentReference.category	Base	example	Referenced Item Category Value Set	📍5.0.0	FHIR Std.
DocumentReference.subject.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.context.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.event	Base	example	v3 Code System ActCode	📍3.0.0	tx.fhir.org
DocumentReference.bodySite	Base	example	SNOMED CT Body Structures	📍5.0.0	FHIR Std.
DocumentReference.facilityType	Base	example	Facility Type Code Value Set	📍5.0.0	FHIR Std.
DocumentReference.practiceSetting	Base	example	Practice Setting Code Value Set	📍5.0.0	FHIR Std.
DocumentReference.author.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.attester.​mode	Base	preferred	Composition Attestation Mode	📍5.0.0	FHIR Std.
DocumentReference.custodian.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.relatesTo.​code	Base	extensible	Document Relationship Type	📍5.0.0	FHIR Std.
DocumentReference.relatesTo.​target.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
DocumentReference.securityLabel	Base	example	Example set of Security Labels	📍5.0.0	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	Mime Types	📍5.0.0	FHIR Std.
DocumentReference.content.​attachment.language	Base	required	All Languages	📍5.0.0	FHIR Std.
DocumentReference.content.​profile.value[x]	Base	preferred	HL7 ValueSet of Format Codes for use with Document Sharing	📍2.1.0	THO v7.1

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	DocumentReference	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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management	text.`div`.exists()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter	facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present	practiceSetting.empty() or context.where(resolve() is Encounter).empty()
ele-1	error	DocumentReference.meta, DocumentReference.meta.extension, DocumentReference.meta.extension:meta, DocumentReference.meta.versionId, DocumentReference.meta.lastUpdated, DocumentReference.meta.source, DocumentReference.meta.profile, DocumentReference.meta.security, DocumentReference.meta.tag, DocumentReference.implicitRules, DocumentReference.language, DocumentReference.text, DocumentReference.text.extension, DocumentReference.text.extension:text, DocumentReference.text.status, DocumentReference.text.div, DocumentReference.extension, DocumentReference.extension:created, DocumentReference.extension:indexed, DocumentReference.modifierExtension, DocumentReference.identifier, DocumentReference.identifier.extension, DocumentReference.identifier.extension:masterIdentifier, DocumentReference.identifier.extension:identifier, DocumentReference.identifier.use, DocumentReference.identifier.type, DocumentReference.identifier.system, DocumentReference.identifier.value, DocumentReference.identifier.period, DocumentReference.identifier.assigner, DocumentReference.version, DocumentReference.basedOn, DocumentReference.status, DocumentReference.docStatus, DocumentReference.docStatus.extension, DocumentReference.docStatus.extension:docStatus, DocumentReference.modality, DocumentReference.type, DocumentReference.category, DocumentReference.subject, DocumentReference.subject.extension, DocumentReference.subject.extension:subject, DocumentReference.subject.reference, DocumentReference.subject.type, DocumentReference.subject.identifier, DocumentReference.subject.display, DocumentReference.context, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.context.reference, DocumentReference.context.type, DocumentReference.context.identifier, DocumentReference.context.display, DocumentReference.event, DocumentReference.bodySite, DocumentReference.facilityType, DocumentReference.practiceSetting, DocumentReference.period, DocumentReference.date, DocumentReference.author, DocumentReference.author.extension, DocumentReference.author.extension:author, DocumentReference.author.reference, DocumentReference.author.type, DocumentReference.author.identifier, DocumentReference.author.display, DocumentReference.attester, DocumentReference.attester.extension, DocumentReference.attester.modifierExtension, DocumentReference.attester.mode, DocumentReference.attester.mode.extension, DocumentReference.attester.mode.extension:authenticator, DocumentReference.attester.mode.coding, DocumentReference.attester.mode.text, DocumentReference.attester.time, DocumentReference.attester.party, DocumentReference.custodian, DocumentReference.custodian.extension, DocumentReference.custodian.extension:custodian, DocumentReference.custodian.reference, DocumentReference.custodian.type, DocumentReference.custodian.identifier, DocumentReference.custodian.display, DocumentReference.relatesTo, DocumentReference.relatesTo.extension, DocumentReference.relatesTo.modifierExtension, DocumentReference.relatesTo.code, DocumentReference.relatesTo.code.extension, DocumentReference.relatesTo.code.extension:code, DocumentReference.relatesTo.code.coding, DocumentReference.relatesTo.code.text, DocumentReference.relatesTo.target, DocumentReference.relatesTo.target.extension, DocumentReference.relatesTo.target.extension:target, DocumentReference.relatesTo.target.reference, DocumentReference.relatesTo.target.type, DocumentReference.relatesTo.target.identifier, DocumentReference.relatesTo.target.display, DocumentReference.description, DocumentReference.securityLabel, DocumentReference.content, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment, DocumentReference.content.attachment.extension, DocumentReference.content.attachment.extension:attachment, DocumentReference.content.attachment.contentType, DocumentReference.content.attachment.language, DocumentReference.content.attachment.data, DocumentReference.content.attachment.url, DocumentReference.content.attachment.size, DocumentReference.content.attachment.hash, DocumentReference.content.attachment.title, DocumentReference.content.attachment.creation, DocumentReference.content.attachment.height, DocumentReference.content.attachment.width, DocumentReference.content.attachment.frames, DocumentReference.content.attachment.duration, DocumentReference.content.attachment.pages, DocumentReference.content.profile, DocumentReference.content.profile.extension, DocumentReference.content.profile.modifierExtension, DocumentReference.content.profile.value[x]	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	DocumentReference.meta.extension, DocumentReference.meta.extension:meta, DocumentReference.text.extension, DocumentReference.text.extension:text, DocumentReference.extension, DocumentReference.extension:created, DocumentReference.extension:indexed, DocumentReference.modifierExtension, DocumentReference.identifier.extension, DocumentReference.identifier.extension:masterIdentifier, DocumentReference.identifier.extension:identifier, DocumentReference.docStatus.extension, DocumentReference.docStatus.extension:docStatus, DocumentReference.subject.extension, DocumentReference.subject.extension:subject, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.author.extension, DocumentReference.author.extension:author, DocumentReference.attester.extension, DocumentReference.attester.modifierExtension, DocumentReference.attester.mode.extension, DocumentReference.attester.mode.extension:authenticator, DocumentReference.custodian.extension, DocumentReference.custodian.extension:custodian, DocumentReference.relatesTo.extension, DocumentReference.relatesTo.modifierExtension, DocumentReference.relatesTo.code.extension, DocumentReference.relatesTo.code.extension:code, DocumentReference.relatesTo.target.extension, DocumentReference.relatesTo.target.extension:target, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment.extension, DocumentReference.content.attachment.extension:attachment, DocumentReference.content.profile.extension, DocumentReference.content.profile.modifierExtension	Must have either extensions or value[x], not both	extension.exists() != value.exists()
txt-1	error	DocumentReference.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	DocumentReference.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

This structure is derived from DocumentReference

Summary

Mandatory: 2 elements

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.meta|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.text|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.created|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.indexed|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.masterIdentifier|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.identifier|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.docStatus|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.encounter|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.event|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.period|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.facilityType|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.practiceSetting|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.context.related|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.authenticator|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.relatesTo.code|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.format|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-DocumentReference.content.attachment|0.1.0

Maturity: 0