Extensions for Using Data Elements from FHIR STU3 in FHIR R4B
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Extensions for Using Data Elements from FHIR STU3 in FHIR R4B - Downloaded Version null See the Directory of published versions

Resource Profile: Profile_R3_DocumentReference_R4B - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 0

Definitions for the profile-DocumentReference resource profile.

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

0. DocumentReference
Definition

A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.

ShortA reference to a document
Comments

Usually, this is used for documents other than those defined by FHIR.

Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. DocumentReference.implicitRules
Definition

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

ShortA set of rules under which this content was created
Comments

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

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

An Extension


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

ShortExtensionAdditional content defined by implementations
Comments

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

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

    STU3: DocumentReference.created (new:dateTime)

    ShortSTU3: Document creation time (new)
    Comments

    Element DocumentReference.created has a context of DocumentReference based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.created has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). Creation time is used for tracking, organizing versions and searching. This is the creation time of the document, not the source material on which it is based.

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(STU3: Document creation time (new)) (Extension Type: dateTime)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. DocumentReference.extension:indexed
    Slice Nameindexed
    Definition

    STU3: DocumentReference.indexed (new:instant)

    ShortSTU3: When this document reference was created (new)
    Comments

    Element DocumentReference.indexed has a context of DocumentReference based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.indexed has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). Referencing/indexing time is used for tracking, organizing versions and searching.

    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(STU3: When this document reference was created (new)) (Extension Type: instant)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. DocumentReference.modifierExtension
    Definition

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

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

    ShortExtensions that cannot be ignored
    Comments

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

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

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

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

    The status of this document reference.

    Shortcurrent | superseded | entered-in-error
    Comments

    This is the status of the DocumentReference object, which might be independent from the docStatus element.

    This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

    Control1..1
    BindingThe codes SHALL be taken from DocumentReferenceStatushttp://hl7.org/fhir/ValueSet/document-reference-status|4.3.0
    (required to http://hl7.org/fhir/ValueSet/document-reference-status|4.3.0)

    The status of the document reference.

    Typecode
    Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. DocumentReference.content
    Definition

    The document and format referenced. There may be multiple content element repetitions, each with a different format.

    ShortDocument referenced
    Control1..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    16. DocumentReference.content.modifierExtension
    Definition

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

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

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

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

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

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

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

    The document or URL of the document along with critical metadata to prove content has integrity.

    ShortWhere to access the document
    Control1..1
    TypeAttachment
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. DocumentReference.content.attachment.extension
    Definition

    An Extension


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

    ShortExtensionAdditional content defined by implementations
    Comments

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

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

      STU3: DocumentReference.content.attachment additional types (Attachment) additional types from child elements (contentType, creation, data, hash, language, size, title, url)

      ShortSTU3: attachment additional types
      Comments

      Element DocumentReference.content.attachment is mapped to FHIR R4B element DocumentReference.content.attachment as SourceIsBroaderThanTarget. The mappings for DocumentReference.content.attachment do not cover the following types: Attachment. The mappings for DocumentReference.content.attachment do not cover the following types based on type expansion: contentType, creation, data, hash, language, size, title, url.

      Control1..1
      TypeExtension(STU3: attachment additional types) (Extension Type: Attachment)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())

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

      0. DocumentReference
      2. DocumentReference.meta
      4. DocumentReference.meta.extension
      Control0..*
      SlicingThis element introduces a set of slices on DocumentReference.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 6. DocumentReference.meta.extension:meta
        Slice Namemeta
        Definition

        STU3: DocumentReference.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

        ShortSTU3: meta additional types
        Comments

        Element DocumentReference.meta is mapped to FHIR R4B element DocumentReference.meta as SourceIsBroaderThanTarget. The mappings for DocumentReference.meta do not cover the following types: Meta. The mappings for DocumentReference.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

        Control0..1
        TypeExtension(STU3: meta additional types) (Complex Extension)
        8. DocumentReference.text
        10. DocumentReference.text.extension
        Control0..*
        SlicingThis element introduces a set of slices on DocumentReference.text.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 12. DocumentReference.text.extension:text
          Slice Nametext
          Definition

          STU3: DocumentReference.text additional types (Narrative) additional types from child elements (div, status)

          ShortSTU3: text additional types
          Comments

          Element DocumentReference.text is mapped to FHIR R4B element DocumentReference.text as SourceIsBroaderThanTarget. The mappings for DocumentReference.text do not cover the following types: Narrative. The mappings for DocumentReference.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

          Control0..1
          TypeExtension(STU3: text additional types) (Complex Extension)
          14. DocumentReference.extension
          Control1..*
          SlicingThis element introduces a set of slices on DocumentReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 16. DocumentReference.extension:created
            Slice Namecreated
            Definition

            STU3: DocumentReference.created (new:dateTime)

            ShortSTU3: Document creation time (new)
            Comments

            Element DocumentReference.created has a context of DocumentReference based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.created has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). Creation time is used for tracking, organizing versions and searching. This is the creation time of the document, not the source material on which it is based.

            Control0..1
            TypeExtension(STU3: Document creation time (new)) (Extension Type: dateTime)
            18. DocumentReference.extension:indexed
            Slice Nameindexed
            Definition

            STU3: DocumentReference.indexed (new:instant)

            ShortSTU3: When this document reference was created (new)
            Comments

            Element DocumentReference.indexed has a context of DocumentReference based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.indexed has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). Referencing/indexing time is used for tracking, organizing versions and searching.

            Control1..1
            TypeExtension(STU3: When this document reference was created (new)) (Extension Type: instant)
            20. DocumentReference.masterIdentifier
            22. DocumentReference.masterIdentifier.extension
            Control0..*
            SlicingThis element introduces a set of slices on DocumentReference.masterIdentifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 24. DocumentReference.masterIdentifier.extension:masterIdentifier
              Slice NamemasterIdentifier
              Definition

              STU3: DocumentReference.masterIdentifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

              ShortSTU3: masterIdentifier additional types
              Comments

              Element DocumentReference.masterIdentifier is mapped to FHIR R4B element DocumentReference.masterIdentifier as SourceIsBroaderThanTarget. The mappings for DocumentReference.masterIdentifier do not cover the following types: Identifier. The mappings for DocumentReference.masterIdentifier do not cover the following types based on type expansion: assigner, period, system, type, use, value. CDA Document Id extension and root.

              Control0..1
              TypeExtension(STU3: masterIdentifier additional types) (Extension Type: Identifier)
              26. DocumentReference.identifier
              NoteThis is a business identifier, not a resource identifier (see discussion)
              28. DocumentReference.identifier.extension
              Control0..*
              SlicingThis element introduces a set of slices on DocumentReference.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 30. DocumentReference.identifier.extension:identifier
                Slice Nameidentifier
                Definition

                STU3: DocumentReference.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

                ShortSTU3: identifier additional types
                Comments

                Element DocumentReference.identifier is mapped to FHIR R4B element DocumentReference.identifier as SourceIsBroaderThanTarget. The mappings for DocumentReference.identifier do not cover the following types: Identifier. The mappings for DocumentReference.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

                Control0..*
                TypeExtension(STU3: identifier additional types) (Extension Type: Identifier)
                32. DocumentReference.subject
                34. DocumentReference.subject.extension
                Control0..*
                SlicingThis element introduces a set of slices on DocumentReference.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 36. DocumentReference.subject.extension:subject
                  Slice Namesubject
                  Definition

                  STU3: DocumentReference.subject

                  ShortSTU3: subject
                  Comments

                  Element DocumentReference.subject is mapped to FHIR R4B element DocumentReference.subject as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.subject with unmapped reference targets: Device, Group, Patient, Practitioner.

                  Control0..1
                  TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                  38. DocumentReference.author
                  40. DocumentReference.author.extension
                  Control0..*
                  SlicingThis element introduces a set of slices on DocumentReference.author.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 42. DocumentReference.author.extension:author
                    Slice Nameauthor
                    Definition

                    STU3: DocumentReference.author

                    ShortSTU3: author
                    Comments

                    Element DocumentReference.author is mapped to FHIR R4B element DocumentReference.author as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.author with unmapped reference targets: Device, Organization, Patient, Practitioner, RelatedPerson. Not necessarily who did the actual data entry (i.e. typist) it in or who was the source (informant).

                    Control0..*
                    TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                    44. DocumentReference.authenticator
                    46. DocumentReference.authenticator.extension
                    Control0..*
                    SlicingThis element introduces a set of slices on DocumentReference.authenticator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 48. DocumentReference.authenticator.extension:authenticator
                      Slice Nameauthenticator
                      Definition

                      STU3: DocumentReference.authenticator additional types from child elements (display, identifier, reference)

                      ShortSTU3: authenticator additional types
                      Comments

                      Element DocumentReference.authenticator is mapped to FHIR R4B element DocumentReference.authenticator as SourceIsBroaderThanTarget. The mappings for DocumentReference.authenticator do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.authenticator with unmapped reference targets: Organization, Practitioner. Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

                      Control0..1
                      TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                      50. DocumentReference.custodian
                      52. DocumentReference.custodian.extension
                      Control0..*
                      SlicingThis element introduces a set of slices on DocumentReference.custodian.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 54. DocumentReference.custodian.extension:custodian
                        Slice Namecustodian
                        Definition

                        STU3: DocumentReference.custodian additional types from child elements (display, identifier, reference)

                        ShortSTU3: custodian additional types
                        Comments

                        Element DocumentReference.custodian is mapped to FHIR R4B element DocumentReference.custodian as SourceIsBroaderThanTarget. The mappings for DocumentReference.custodian do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.custodian with unmapped reference targets: Organization. Identifies the logical organization to go to find the current version, where to report issues, etc. This is different from the physical location of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

                        Control0..1
                        TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                        56. DocumentReference.relatesTo
                        58. DocumentReference.relatesTo.target
                        60. DocumentReference.relatesTo.target.extension
                        Control0..*
                        SlicingThis element introduces a set of slices on DocumentReference.relatesTo.target.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 62. DocumentReference.relatesTo.target.extension:target
                          Slice Nametarget
                          Definition

                          STU3: DocumentReference.relatesTo.target additional types from child elements (display, identifier, reference)

                          ShortSTU3: target additional types
                          Comments

                          Element DocumentReference.relatesTo.target is mapped to FHIR R4B element DocumentReference.relatesTo.target as SourceIsBroaderThanTarget. The mappings for DocumentReference.relatesTo.target do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.relatesTo.target with unmapped reference targets: DocumentReference.

                          Control0..1
                          TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                          64. DocumentReference.content
                          66. DocumentReference.content.attachment
                          68. DocumentReference.content.attachment.extension
                          Control0..*
                          SlicingThis element introduces a set of slices on DocumentReference.content.attachment.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 70. DocumentReference.content.attachment.extension:attachment
                            Slice Nameattachment
                            Definition

                            STU3: DocumentReference.content.attachment additional types (Attachment) additional types from child elements (contentType, creation, data, hash, language, size, title, url)

                            ShortSTU3: attachment additional types
                            Comments

                            Element DocumentReference.content.attachment is mapped to FHIR R4B element DocumentReference.content.attachment as SourceIsBroaderThanTarget. The mappings for DocumentReference.content.attachment do not cover the following types: Attachment. The mappings for DocumentReference.content.attachment do not cover the following types based on type expansion: contentType, creation, data, hash, language, size, title, url.

                            Control0..1
                            TypeExtension(STU3: attachment additional types) (Extension Type: Attachment)
                            72. DocumentReference.context
                            74. DocumentReference.context.encounter
                            76. DocumentReference.context.encounter.extension
                            Control0..*
                            SlicingThis element introduces a set of slices on DocumentReference.context.encounter.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 78. DocumentReference.context.encounter.extension:encounter
                              Slice Nameencounter
                              Definition

                              STU3: DocumentReference.context.encounter additional types from child elements (display, identifier, reference)

                              ShortSTU3: encounter additional types
                              Comments

                              Element DocumentReference.context.encounter is mapped to FHIR R4B element DocumentReference.context.encounter as RelatedTo. The mappings for DocumentReference.context.encounter do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.context.encounter with unmapped reference targets: Encounter.

                              Control0..1
                              TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                              80. DocumentReference.context.period
                              82. DocumentReference.context.period.extension
                              Control0..*
                              SlicingThis element introduces a set of slices on DocumentReference.context.period.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 84. DocumentReference.context.period.extension:period
                                Slice Nameperiod
                                Definition

                                STU3: DocumentReference.context.period additional types (Period) additional types from child elements (end, start)

                                ShortSTU3: period additional types
                                Comments

                                Element DocumentReference.context.period is mapped to FHIR R4B element DocumentReference.context.period as SourceIsBroaderThanTarget. The mappings for DocumentReference.context.period do not cover the following types: Period. The mappings for DocumentReference.context.period do not cover the following types based on type expansion: end, start.

                                Control0..1
                                TypeExtension(STU3: period additional types) (Extension Type: Period)
                                86. DocumentReference.context.sourcePatientInfo
                                88. DocumentReference.context.sourcePatientInfo.extension
                                Control0..*
                                SlicingThis element introduces a set of slices on DocumentReference.context.sourcePatientInfo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 90. DocumentReference.context.sourcePatientInfo.extension:sourcePatientInfo
                                  Slice NamesourcePatientInfo
                                  Definition

                                  STU3: DocumentReference.context.sourcePatientInfo additional types from child elements (display, identifier, reference)

                                  ShortSTU3: sourcePatientInfo additional types
                                  Comments

                                  Element DocumentReference.context.sourcePatientInfo is mapped to FHIR R4B element DocumentReference.context.sourcePatientInfo as SourceIsBroaderThanTarget. The mappings for DocumentReference.context.sourcePatientInfo do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.context.sourcePatientInfo with unmapped reference targets: Patient.

                                  Control0..1
                                  TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                                  92. DocumentReference.context.related
                                  94. DocumentReference.context.related.extension
                                  Control0..*
                                  SlicingThis element introduces a set of slices on DocumentReference.context.related.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 96. DocumentReference.context.related.extension:identifier
                                    Slice Nameidentifier
                                    Definition

                                    STU3: DocumentReference.context.related.identifier (new:Identifier)

                                    ShortSTU3: Identifier of related objects or events (new)
                                    Comments

                                    Element DocumentReference.context.related.identifier has a context of DocumentReference.context.related based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.related.identifier has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). Order numbers, accession numbers, XDW workflow numbers.

                                    Control0..1
                                    TypeExtension(STU3: Identifier of related objects or events (new)) (Extension Type: Identifier)
                                    98. DocumentReference.context.related.extension:ref
                                    Slice Nameref
                                    Definition

                                    STU3: DocumentReference.context.related.ref additional types from child elements (display, identifier, reference)

                                    ShortSTU3: Related Resource additional types
                                    Comments

                                    Element DocumentReference.context.related.ref is mapped to FHIR R4B element DocumentReference.context.related as RelatedTo. The mappings for DocumentReference.context.related.ref do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.context.related.ref with unmapped reference targets: Resource. Order, ProcedureRequest, Procedure, EligibilityRequest, etc.

                                    Control0..1
                                    TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))

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

                                    0. DocumentReference
                                    Definition

                                    A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.

                                    ShortA reference to a document
                                    Comments

                                    Usually, this is used for documents other than those defined by FHIR.

                                    Control0..*
                                    Is Modifierfalse
                                    Must Supportfalse
                                    Summaryfalse
                                    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                                    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
                                    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                                    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                                    dom-6: A resource should have narrative for robust management (text.`div`.exists())
                                    2. DocumentReference.id
                                    Definition

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

                                    ShortLogical id of this artifact
                                    Comments

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

                                    Control0..1
                                    Typeid
                                    Is Modifierfalse
                                    Must Supportfalse
                                    Summarytrue
                                    4. DocumentReference.meta
                                    Definition

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

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

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

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typeid
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    8. DocumentReference.meta.extension
                                    Definition

                                    An Extension

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

                                      STU3: DocumentReference.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

                                      ShortSTU3: meta additional types
                                      Comments

                                      Element DocumentReference.meta is mapped to FHIR R4B element DocumentReference.meta as SourceIsBroaderThanTarget. The mappings for DocumentReference.meta do not cover the following types: Meta. The mappings for DocumentReference.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

                                      Control0..1
                                      TypeExtension(STU3: meta additional types) (Complex Extension)
                                      Is Modifierfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      12. DocumentReference.meta.versionId
                                      Definition

                                      The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                                      ShortVersion specific identifier
                                      Comments

                                      The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

                                      Control0..1
                                      Typeid
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      14. DocumentReference.meta.lastUpdated
                                      Definition

                                      When the resource last changed - e.g. when the version changed.

                                      ShortWhen the resource version last changed
                                      Comments

                                      This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

                                      Control0..1
                                      Typeinstant
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      16. DocumentReference.meta.source
                                      Definition

                                      A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                                      ShortIdentifies where the resource comes from
                                      Comments

                                      In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

                                      This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

                                      Control0..1
                                      Typeuri
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      18. DocumentReference.meta.profile
                                      Definition

                                      A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                                      ShortProfiles this resource claims to conform to
                                      Comments

                                      It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

                                      Control0..*
                                      Typecanonical(StructureDefinition)
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      20. DocumentReference.meta.security
                                      Definition

                                      Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                                      ShortSecurity Labels applied to this resource
                                      Comments

                                      The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                                      Control0..*
                                      BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                      (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.3.0)
                                      TypeCoding
                                      Is Modifierfalse
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      22. DocumentReference.meta.tag
                                      Definition

                                      Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                                      ShortTags applied to this resource
                                      Comments

                                      The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

                                      Control0..*
                                      BindingFor example codes, see CommonTags
                                      (example to http://hl7.org/fhir/ValueSet/common-tags|4.3.0)
                                      TypeCoding
                                      Is Modifierfalse
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      24. DocumentReference.implicitRules
                                      Definition

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

                                      ShortA set of rules under which this content was created
                                      Comments

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

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

                                      The base language in which the resource is written.

                                      ShortLanguage of the resource content
                                      Comments

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

                                      Control0..1
                                      BindingThe codes SHOULD be taken from CommonLanguages
                                      (preferred to http://hl7.org/fhir/ValueSet/languages|4.3.0)

                                      IETF language tag

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

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

                                      ShortText summary of the resource, for human interpretation
                                      Comments

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

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

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

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typeid
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      32. DocumentReference.text.extension
                                      Definition

                                      An Extension

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

                                        STU3: DocumentReference.text additional types (Narrative) additional types from child elements (div, status)

                                        ShortSTU3: text additional types
                                        Comments

                                        Element DocumentReference.text is mapped to FHIR R4B element DocumentReference.text as SourceIsBroaderThanTarget. The mappings for DocumentReference.text do not cover the following types: Narrative. The mappings for DocumentReference.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

                                        Control0..1
                                        TypeExtension(STU3: text additional types) (Complex Extension)
                                        Is Modifierfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        36. DocumentReference.text.status
                                        Definition

                                        The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

                                        Shortgenerated | extensions | additional | empty
                                        Control1..1
                                        BindingThe codes SHALL be taken from NarrativeStatus
                                        (required to http://hl7.org/fhir/ValueSet/narrative-status|4.3.0)
                                        Typecode
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        38. DocumentReference.text.div
                                        Definition

                                        The actual narrative content, a stripped down version of XHTML.

                                        ShortLimited xhtml content
                                        Comments

                                        The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

                                        Control1..1
                                        Typexhtml
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        txt-1: 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: The narrative SHALL have some non-whitespace content (htmlChecks())
                                        40. DocumentReference.contained
                                        Definition

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

                                        ShortContained, inline Resources
                                        Comments

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

                                        Control0..*
                                        TypeResource
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Alternate Namesinline resources, anonymous resources, contained resources
                                        Invariantsdom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems (($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic))
                                        42. DocumentReference.extension
                                        Definition

                                        An Extension

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

                                          STU3: DocumentReference.created (new:dateTime)

                                          ShortSTU3: Document creation time (new)
                                          Comments

                                          Element DocumentReference.created has a context of DocumentReference based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.created has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). Creation time is used for tracking, organizing versions and searching. This is the creation time of the document, not the source material on which it is based.

                                          Control0..1
                                          This element is affected by the following invariants: ele-1
                                          TypeExtension(STU3: Document creation time (new)) (Extension Type: dateTime)
                                          Is Modifierfalse
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          46. DocumentReference.extension:indexed
                                          Slice Nameindexed
                                          Definition

                                          STU3: DocumentReference.indexed (new:instant)

                                          ShortSTU3: When this document reference was created (new)
                                          Comments

                                          Element DocumentReference.indexed has a context of DocumentReference based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.indexed has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). Referencing/indexing time is used for tracking, organizing versions and searching.

                                          Control1..1
                                          This element is affected by the following invariants: ele-1
                                          TypeExtension(STU3: When this document reference was created (new)) (Extension Type: instant)
                                          Is Modifierfalse
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          48. DocumentReference.modifierExtension
                                          Definition

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

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

                                          ShortExtensions that cannot be ignored
                                          Comments

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

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

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

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

                                          Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document.

                                          ShortMaster Version Specific Identifier
                                          Comments

                                          CDA Document Id extension and root.

                                          Control0..1
                                          TypeIdentifier
                                          Is Modifierfalse
                                          Must Supportfalse
                                          Summarytrue
                                          Requirements

                                          The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).

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

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

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typeid
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          54. DocumentReference.masterIdentifier.extension
                                          Definition

                                          An Extension

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

                                            STU3: DocumentReference.masterIdentifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

                                            ShortSTU3: masterIdentifier additional types
                                            Comments

                                            Element DocumentReference.masterIdentifier is mapped to FHIR R4B element DocumentReference.masterIdentifier as SourceIsBroaderThanTarget. The mappings for DocumentReference.masterIdentifier do not cover the following types: Identifier. The mappings for DocumentReference.masterIdentifier do not cover the following types based on type expansion: assigner, period, system, type, use, value. CDA Document Id extension and root.

                                            Control0..1
                                            TypeExtension(STU3: masterIdentifier additional types) (Extension Type: Identifier)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            58. DocumentReference.masterIdentifier.use
                                            Definition

                                            The purpose of this identifier.

                                            Shortusual | official | temp | secondary | old (If known)
                                            Comments

                                            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                            Control0..1
                                            BindingThe codes SHALL be taken from IdentifierUse
                                            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.3.0)
                                            Typecode
                                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Requirements

                                            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

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

                                            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                            ShortDescription of identifier
                                            Comments

                                            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                            Control0..1
                                            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                            (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.3.0)
                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summarytrue
                                            Requirements

                                            Allows users to make use of identifiers when the identifier system is not known.

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

                                            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                            ShortThe namespace for the identifier value
                                            Comments

                                            Identifier.system is always case sensitive.

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

                                            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                            ExampleGeneral: http://www.acme.com/identifiers/patient
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            64. DocumentReference.masterIdentifier.value
                                            Definition

                                            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                            ShortThe value that is unique
                                            Comments

                                            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            ExampleGeneral: 123456
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            66. DocumentReference.masterIdentifier.period
                                            Definition

                                            Time period during which identifier is/was valid for use.

                                            ShortTime period when id is/was valid for use
                                            Control0..1
                                            TypePeriod
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            68. DocumentReference.masterIdentifier.assigner
                                            Definition

                                            Organization that issued/manages the identifier.

                                            ShortOrganization that issued id (may be just text)
                                            Comments

                                            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                            Control0..1
                                            TypeReference(Organization)
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            70. DocumentReference.identifier
                                            Definition

                                            Other identifiers associated with the document, including version independent identifiers.

                                            ShortOther identifiers for the document
                                            NoteThis is a business identifier, not a resource identifier (see discussion)
                                            Control0..*
                                            TypeIdentifier
                                            Is Modifierfalse
                                            Must Supportfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            72. DocumentReference.identifier.id
                                            Definition

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

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typeid
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            74. DocumentReference.identifier.extension
                                            Definition

                                            An Extension

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

                                              STU3: DocumentReference.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

                                              ShortSTU3: identifier additional types
                                              Comments

                                              Element DocumentReference.identifier is mapped to FHIR R4B element DocumentReference.identifier as SourceIsBroaderThanTarget. The mappings for DocumentReference.identifier do not cover the following types: Identifier. The mappings for DocumentReference.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

                                              Control0..*
                                              TypeExtension(STU3: identifier additional types) (Extension Type: Identifier)
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              78. DocumentReference.identifier.use
                                              Definition

                                              The purpose of this identifier.

                                              Shortusual | official | temp | secondary | old (If known)
                                              Comments

                                              Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                              Control0..1
                                              BindingThe codes SHALL be taken from IdentifierUse
                                              (required to http://hl7.org/fhir/ValueSet/identifier-use|4.3.0)
                                              Typecode
                                              Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

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

                                              A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                              ShortDescription of identifier
                                              Comments

                                              This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                              Control0..1
                                              BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                              (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.3.0)
                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summarytrue
                                              Requirements

                                              Allows users to make use of identifiers when the identifier system is not known.

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

                                              Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                              ShortThe namespace for the identifier value
                                              Comments

                                              Identifier.system is always case sensitive.

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

                                              There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                              ExampleGeneral: http://www.acme.com/identifiers/patient
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              84. DocumentReference.identifier.value
                                              Definition

                                              The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                              ShortThe value that is unique
                                              Comments

                                              If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              ExampleGeneral: 123456
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              86. DocumentReference.identifier.period
                                              Definition

                                              Time period during which identifier is/was valid for use.

                                              ShortTime period when id is/was valid for use
                                              Control0..1
                                              TypePeriod
                                              Is Modifierfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              88. DocumentReference.identifier.assigner
                                              Definition

                                              Organization that issued/manages the identifier.

                                              ShortOrganization that issued id (may be just text)
                                              Comments

                                              The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                              Control0..1
                                              TypeReference(Organization)
                                              Is Modifierfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              90. DocumentReference.status
                                              Definition

                                              The status of this document reference.

                                              Shortcurrent | superseded | entered-in-error
                                              Comments

                                              This is the status of the DocumentReference object, which might be independent from the docStatus element.

                                              This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

                                              Control1..1
                                              BindingThe codes SHALL be taken from DocumentReferenceStatus
                                              (required to http://hl7.org/fhir/ValueSet/document-reference-status|4.3.0)

                                              The status of the document reference.

                                              Typecode
                                              Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              92. DocumentReference.docStatus
                                              Definition

                                              The status of the underlying document.

                                              Shortpreliminary | final | amended | entered-in-error
                                              Comments

                                              The document that is pointed to might be in various lifecycle states.

                                              Control0..1
                                              BindingThe codes SHALL be taken from CompositionStatus
                                              (required to http://hl7.org/fhir/ValueSet/composition-status|4.3.0)

                                              Status of the underlying document.

                                              Typecode
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              94. DocumentReference.type
                                              Definition

                                              Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

                                              ShortKind of document (LOINC if possible)
                                              Comments

                                              Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.

                                              Control0..1
                                              BindingThe codes SHOULD be taken from FHIRDocumentTypeCodes
                                              (preferred to http://hl7.org/fhir/ValueSet/doc-typecodes|4.3.0)

                                              Precise type of clinical document.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              96. DocumentReference.category
                                              Definition

                                              A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

                                              ShortCategorization of document
                                              Comments

                                              Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

                                              Control0..*
                                              BindingFor example codes, see DocumentClassValueSet
                                              (example to http://hl7.org/fhir/ValueSet/doc-classcodes|4.3.0)

                                              High-level kind of a clinical document at a macro level.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Alternate Namesclaxs
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              98. DocumentReference.subject
                                              Definition

                                              Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

                                              ShortWho/what is the subject of the document
                                              Control0..1
                                              TypeReference(Patient, Practitioner, Group, Device)
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              100. DocumentReference.subject.id
                                              Definition

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

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typeid
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              102. DocumentReference.subject.extension
                                              Definition

                                              An Extension

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

                                                STU3: DocumentReference.subject

                                                ShortSTU3: subject
                                                Comments

                                                Element DocumentReference.subject is mapped to FHIR R4B element DocumentReference.subject as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.subject with unmapped reference targets: Device, Group, Patient, Practitioner.

                                                Control0..1
                                                TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                106. DocumentReference.subject.reference
                                                Definition

                                                A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                ShortLiteral reference, Relative, internal or absolute URL
                                                Comments

                                                Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                Control0..1
                                                This element is affected by the following invariants: ref-1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                108. DocumentReference.subject.type
                                                Definition

                                                The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                ShortType the reference refers to (e.g. "Patient")
                                                Comments

                                                This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                Control0..1
                                                BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                110. DocumentReference.subject.identifier
                                                Definition

                                                An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                ShortLogical reference, when literal reference is not known
                                                Comments

                                                When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                                Control0..1
                                                TypeIdentifier
                                                Is Modifierfalse
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                112. DocumentReference.subject.display
                                                Definition

                                                Plain text narrative that identifies the resource in addition to the resource reference.

                                                ShortText alternative for the resource
                                                Comments

                                                This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                114. DocumentReference.date
                                                Definition

                                                When the document reference was created.

                                                ShortWhen this document reference was created
                                                Comments

                                                Referencing/indexing time is used for tracking, organizing versions and searching.

                                                Control0..1
                                                Typeinstant
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supportfalse
                                                Summarytrue
                                                Alternate Namesindexed
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                116. DocumentReference.author
                                                Definition

                                                Identifies who is responsible for adding the information to the document.

                                                ShortWho and/or what authored the document
                                                Comments

                                                Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

                                                Control0..*
                                                TypeReference(Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson)
                                                Is Modifierfalse
                                                Must Supportfalse
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                118. DocumentReference.author.id
                                                Definition

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

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typeid
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                120. DocumentReference.author.extension
                                                Definition

                                                An Extension

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

                                                  STU3: DocumentReference.author

                                                  ShortSTU3: author
                                                  Comments

                                                  Element DocumentReference.author is mapped to FHIR R4B element DocumentReference.author as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.author with unmapped reference targets: Device, Organization, Patient, Practitioner, RelatedPerson. Not necessarily who did the actual data entry (i.e. typist) it in or who was the source (informant).

                                                  Control0..1
                                                  TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  124. DocumentReference.author.reference
                                                  Definition

                                                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                  ShortLiteral reference, Relative, internal or absolute URL
                                                  Comments

                                                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                  Control0..1
                                                  This element is affected by the following invariants: ref-1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  126. DocumentReference.author.type
                                                  Definition

                                                  The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                  The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                  ShortType the reference refers to (e.g. "Patient")
                                                  Comments

                                                  This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                  Control0..1
                                                  BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                  (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  128. DocumentReference.author.identifier
                                                  Definition

                                                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                  ShortLogical reference, when literal reference is not known
                                                  Comments

                                                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                  Control0..1
                                                  TypeIdentifier
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  130. DocumentReference.author.display
                                                  Definition

                                                  Plain text narrative that identifies the resource in addition to the resource reference.

                                                  ShortText alternative for the resource
                                                  Comments

                                                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  132. DocumentReference.authenticator
                                                  Definition

                                                  Which person or organization authenticates that this document is valid.

                                                  ShortWho/what authenticated the document
                                                  Comments

                                                  Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

                                                  Control0..1
                                                  TypeReference(Practitioner, PractitionerRole, Organization)
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  134. DocumentReference.authenticator.id
                                                  Definition

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

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typeid
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  136. DocumentReference.authenticator.extension
                                                  Definition

                                                  An Extension

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

                                                    STU3: DocumentReference.authenticator additional types from child elements (display, identifier, reference)

                                                    ShortSTU3: authenticator additional types
                                                    Comments

                                                    Element DocumentReference.authenticator is mapped to FHIR R4B element DocumentReference.authenticator as SourceIsBroaderThanTarget. The mappings for DocumentReference.authenticator do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.authenticator with unmapped reference targets: Organization, Practitioner. Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

                                                    Control0..1
                                                    TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    140. DocumentReference.authenticator.reference
                                                    Definition

                                                    A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                    ShortLiteral reference, Relative, internal or absolute URL
                                                    Comments

                                                    Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                    Control0..1
                                                    This element is affected by the following invariants: ref-1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    142. DocumentReference.authenticator.type
                                                    Definition

                                                    The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                    The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                    ShortType the reference refers to (e.g. "Patient")
                                                    Comments

                                                    This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                    Control0..1
                                                    BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                    (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)
                                                    Typeuri
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    144. DocumentReference.authenticator.identifier
                                                    Definition

                                                    An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                    ShortLogical reference, when literal reference is not known
                                                    Comments

                                                    When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                    When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                    Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                    Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                                    Control0..1
                                                    TypeIdentifier
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    146. DocumentReference.authenticator.display
                                                    Definition

                                                    Plain text narrative that identifies the resource in addition to the resource reference.

                                                    ShortText alternative for the resource
                                                    Comments

                                                    This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    148. DocumentReference.custodian
                                                    Definition

                                                    Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

                                                    ShortOrganization which maintains the document
                                                    Comments

                                                    Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

                                                    Control0..1
                                                    TypeReference(Organization)
                                                    Is Modifierfalse
                                                    Must Supportfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    150. DocumentReference.custodian.id
                                                    Definition

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

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typeid
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    152. DocumentReference.custodian.extension
                                                    Definition

                                                    An Extension

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

                                                      STU3: DocumentReference.custodian additional types from child elements (display, identifier, reference)

                                                      ShortSTU3: custodian additional types
                                                      Comments

                                                      Element DocumentReference.custodian is mapped to FHIR R4B element DocumentReference.custodian as SourceIsBroaderThanTarget. The mappings for DocumentReference.custodian do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.custodian with unmapped reference targets: Organization. Identifies the logical organization to go to find the current version, where to report issues, etc. This is different from the physical location of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

                                                      Control0..1
                                                      TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      156. DocumentReference.custodian.reference
                                                      Definition

                                                      A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                      ShortLiteral reference, Relative, internal or absolute URL
                                                      Comments

                                                      Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                      Control0..1
                                                      This element is affected by the following invariants: ref-1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      158. DocumentReference.custodian.type
                                                      Definition

                                                      The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                      The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                      ShortType the reference refers to (e.g. "Patient")
                                                      Comments

                                                      This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                      Control0..1
                                                      BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                      (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)
                                                      Typeuri
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      160. DocumentReference.custodian.identifier
                                                      Definition

                                                      An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                      ShortLogical reference, when literal reference is not known
                                                      Comments

                                                      When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                      When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                      Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                      Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                                      Control0..1
                                                      TypeIdentifier
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      162. DocumentReference.custodian.display
                                                      Definition

                                                      Plain text narrative that identifies the resource in addition to the resource reference.

                                                      ShortText alternative for the resource
                                                      Comments

                                                      This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      164. DocumentReference.relatesTo
                                                      Definition

                                                      Relationships that this document has with other document references that already exist.

                                                      ShortRelationships to other documents
                                                      Comments

                                                      This element is labeled as a modifier because documents that append to other documents are incomplete on their own.

                                                      Control0..*
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Must Supportfalse
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                                      166. DocumentReference.relatesTo.id
                                                      Definition

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

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

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

                                                      ShortAdditional content defined by implementations
                                                      Comments

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

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

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

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

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

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

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

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

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

                                                      The type of relationship that this document has with anther document.

                                                      Shortreplaces | transforms | signs | appends
                                                      Comments

                                                      If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

                                                      Control1..1
                                                      BindingThe codes SHALL be taken from DocumentRelationshipType
                                                      (required to http://hl7.org/fhir/ValueSet/document-relationship-type|4.3.0)

                                                      The type of relationship between documents.

                                                      Typecode
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supportfalse
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      174. DocumentReference.relatesTo.target
                                                      Definition

                                                      The target document of this relationship.

                                                      ShortTarget of the relationship
                                                      Control1..1
                                                      TypeReference(DocumentReference)
                                                      Is Modifierfalse
                                                      Must Supportfalse
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      176. DocumentReference.relatesTo.target.id
                                                      Definition

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

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typeid
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      178. DocumentReference.relatesTo.target.extension
                                                      Definition

                                                      An Extension

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

                                                        STU3: DocumentReference.relatesTo.target additional types from child elements (display, identifier, reference)

                                                        ShortSTU3: target additional types
                                                        Comments

                                                        Element DocumentReference.relatesTo.target is mapped to FHIR R4B element DocumentReference.relatesTo.target as SourceIsBroaderThanTarget. The mappings for DocumentReference.relatesTo.target do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.relatesTo.target with unmapped reference targets: DocumentReference.

                                                        Control0..1
                                                        TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                        182. DocumentReference.relatesTo.target.reference
                                                        Definition

                                                        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                        ShortLiteral reference, Relative, internal or absolute URL
                                                        Comments

                                                        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                        Control0..1
                                                        This element is affected by the following invariants: ref-1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        184. DocumentReference.relatesTo.target.type
                                                        Definition

                                                        The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                        The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                        ShortType the reference refers to (e.g. "Patient")
                                                        Comments

                                                        This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                        Control0..1
                                                        BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                        (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)
                                                        Typeuri
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        186. DocumentReference.relatesTo.target.identifier
                                                        Definition

                                                        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                        ShortLogical reference, when literal reference is not known
                                                        Comments

                                                        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                                        Control0..1
                                                        TypeIdentifier
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        188. DocumentReference.relatesTo.target.display
                                                        Definition

                                                        Plain text narrative that identifies the resource in addition to the resource reference.

                                                        ShortText alternative for the resource
                                                        Comments

                                                        This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        190. DocumentReference.description
                                                        Definition

                                                        Human-readable description of the source document.

                                                        ShortHuman-readable description
                                                        Comments

                                                        What the document is about, a terse summary of the document.

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

                                                        Helps humans to assess whether the document is of interest.

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

                                                        A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.

                                                        ShortDocument security-tags
                                                        Comments

                                                        The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce.

                                                        In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.

                                                        Control0..*
                                                        BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                                        (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.3.0)

                                                        Security Labels from the Healthcare Privacy and Security Classification System.

                                                        TypeCodeableConcept
                                                        Is Modifierfalse
                                                        Must Supportfalse
                                                        Summarytrue
                                                        Requirements

                                                        Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

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

                                                        The document and format referenced. There may be multiple content element repetitions, each with a different format.

                                                        ShortDocument referenced
                                                        Control1..*
                                                        TypeBackboneElement
                                                        Is Modifierfalse
                                                        Must Supportfalse
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                                        196. DocumentReference.content.id
                                                        Definition

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

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

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

                                                        ShortAdditional content defined by implementations
                                                        Comments

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

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

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

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

                                                        ShortExtensions that cannot be ignored even if unrecognized
                                                        Comments

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

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

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

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

                                                        The document or URL of the document along with critical metadata to prove content has integrity.

                                                        ShortWhere to access the document
                                                        Control1..1
                                                        TypeAttachment
                                                        Is Modifierfalse
                                                        Must Supportfalse
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        204. DocumentReference.content.attachment.id
                                                        Definition

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

                                                        ShortUnique id for inter-element referencing
                                                        Control0..1
                                                        Typeid
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        206. DocumentReference.content.attachment.extension
                                                        Definition

                                                        An Extension

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

                                                          STU3: DocumentReference.content.attachment additional types (Attachment) additional types from child elements (contentType, creation, data, hash, language, size, title, url)

                                                          ShortSTU3: attachment additional types
                                                          Comments

                                                          Element DocumentReference.content.attachment is mapped to FHIR R4B element DocumentReference.content.attachment as SourceIsBroaderThanTarget. The mappings for DocumentReference.content.attachment do not cover the following types: Attachment. The mappings for DocumentReference.content.attachment do not cover the following types based on type expansion: contentType, creation, data, hash, language, size, title, url.

                                                          Control1..1
                                                          TypeExtension(STU3: attachment additional types) (Extension Type: Attachment)
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          210. DocumentReference.content.attachment.contentType
                                                          Definition

                                                          Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

                                                          ShortMime type of the content, with charset etc.
                                                          Control0..1
                                                          BindingThe codes SHALL be taken from Mime Types
                                                          (required to http://hl7.org/fhir/ValueSet/mimetypes|4.3.0)

                                                          BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)

                                                          Typecode
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Processors of the data need to be able to know how to interpret the data.

                                                          ExampleGeneral: text/plain; charset=UTF-8, image/png
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          212. DocumentReference.content.attachment.language
                                                          Definition

                                                          The human language of the content. The value can be any valid value according to BCP 47.

                                                          ShortHuman language of the content (BCP-47)
                                                          Control0..1
                                                          BindingThe codes SHOULD be taken from CommonLanguages
                                                          (preferred to http://hl7.org/fhir/ValueSet/languages|4.3.0)

                                                          IETF language tag

                                                          Additional BindingsPurpose
                                                          AllLanguagesMax Binding
                                                          Typecode
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Users need to be able to choose between the languages in a set of attachments.

                                                          ExampleGeneral: en-AU
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          214. DocumentReference.content.attachment.data
                                                          Definition

                                                          The actual data of the attachment - a sequence of bytes, base64 encoded.

                                                          ShortData inline, base64ed
                                                          Comments

                                                          The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

                                                          Control0..1
                                                          Typebase64Binary
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summaryfalse
                                                          Requirements

                                                          The data needs to able to be transmitted inline.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          216. DocumentReference.content.attachment.url
                                                          Definition

                                                          A location where the data can be accessed.

                                                          ShortUri where the data can be found
                                                          Comments

                                                          If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

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

                                                          The data needs to be transmitted by reference.

                                                          ExampleGeneral: http://www.acme.com/logo-small.png
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          218. DocumentReference.content.attachment.size
                                                          Definition

                                                          The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

                                                          ShortNumber of bytes of content (if url provided)
                                                          Comments

                                                          The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.

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

                                                          Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          220. DocumentReference.content.attachment.hash
                                                          Definition

                                                          The calculated hash of the data using SHA-1. Represented using base64.

                                                          ShortHash of the data (sha-1, base64ed)
                                                          Comments

                                                          The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.

                                                          Control0..1
                                                          Typebase64Binary
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          222. DocumentReference.content.attachment.title
                                                          Definition

                                                          A label or set of text to display in place of the data.

                                                          ShortLabel to display in place of the data
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

                                                          ExampleGeneral: Official Corporate Logo
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          224. DocumentReference.content.attachment.creation
                                                          Definition

                                                          The date that the attachment was first created.

                                                          ShortDate attachment was first created
                                                          Control0..1
                                                          TypedateTime
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          This is often tracked as an integrity issue for use of the attachment.

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

                                                          An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

                                                          ShortFormat/content rules for the document
                                                          Comments

                                                          Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

                                                          Control0..1
                                                          BindingThe codes SHOULD be taken from DocumentReferenceFormatCodeSet
                                                          (preferred to http://hl7.org/fhir/ValueSet/formatcodes|4.3.0)

                                                          Document Format Codes.

                                                          TypeCoding
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          228. DocumentReference.context
                                                          Definition

                                                          The clinical context in which the document was prepared.

                                                          ShortClinical context of document
                                                          Comments

                                                          These values are primarily added to help with searching for interesting/relevant documents.

                                                          Control0..1
                                                          TypeBackboneElement
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                                          230. DocumentReference.context.id
                                                          Definition

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

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

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

                                                          ShortAdditional content defined by implementations
                                                          Comments

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

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

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

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

                                                          ShortExtensions that cannot be ignored even if unrecognized
                                                          Comments

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

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

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

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

                                                          Describes the clinical encounter or type of care that the document content is associated with.

                                                          ShortContext of the document content
                                                          Control0..*
                                                          TypeReference(Encounter, EpisodeOfCare)
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          238. DocumentReference.context.encounter.id
                                                          Definition

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

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typeid
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          240. DocumentReference.context.encounter.extension
                                                          Definition

                                                          An Extension

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

                                                            STU3: DocumentReference.context.encounter additional types from child elements (display, identifier, reference)

                                                            ShortSTU3: encounter additional types
                                                            Comments

                                                            Element DocumentReference.context.encounter is mapped to FHIR R4B element DocumentReference.context.encounter as RelatedTo. The mappings for DocumentReference.context.encounter do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.context.encounter with unmapped reference targets: Encounter.

                                                            Control0..1
                                                            TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            244. DocumentReference.context.encounter.reference
                                                            Definition

                                                            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                            ShortLiteral reference, Relative, internal or absolute URL
                                                            Comments

                                                            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                            Control0..1
                                                            This element is affected by the following invariants: ref-1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            246. DocumentReference.context.encounter.type
                                                            Definition

                                                            The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                            The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                            ShortType the reference refers to (e.g. "Patient")
                                                            Comments

                                                            This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                            Control0..1
                                                            BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                            (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)
                                                            Typeuri
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            248. DocumentReference.context.encounter.identifier
                                                            Definition

                                                            An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                            ShortLogical reference, when literal reference is not known
                                                            Comments

                                                            When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                            When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                            Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                            Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                            NoteThis is a business identifier, not a resource identifier (see discussion)
                                                            Control0..1
                                                            TypeIdentifier
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            250. DocumentReference.context.encounter.display
                                                            Definition

                                                            Plain text narrative that identifies the resource in addition to the resource reference.

                                                            ShortText alternative for the resource
                                                            Comments

                                                            This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            252. DocumentReference.context.event
                                                            Definition

                                                            This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.

                                                            ShortMain clinical acts documented
                                                            Comments

                                                            An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation.

                                                            Control0..*
                                                            BindingFor example codes, see ActCode (3.0.0)
                                                            (example to http://terminology.hl7.org/ValueSet/v3-ActCode|3.0.0)

                                                            This list of codes represents the main clinical acts being documented.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Must Supportfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            254. DocumentReference.context.period
                                                            Definition

                                                            The time period over which the service that is described by the document was provided.

                                                            ShortTime of service that is being documented
                                                            Control0..1
                                                            TypePeriod
                                                            Is Modifierfalse
                                                            Must Supportfalse
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            256. DocumentReference.context.period.id
                                                            Definition

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

                                                            ShortUnique id for inter-element referencing
                                                            Control0..1
                                                            Typeid
                                                            Is Modifierfalse
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Summaryfalse
                                                            258. DocumentReference.context.period.extension
                                                            Definition

                                                            An Extension

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

                                                              STU3: DocumentReference.context.period additional types (Period) additional types from child elements (end, start)

                                                              ShortSTU3: period additional types
                                                              Comments

                                                              Element DocumentReference.context.period is mapped to FHIR R4B element DocumentReference.context.period as SourceIsBroaderThanTarget. The mappings for DocumentReference.context.period do not cover the following types: Period. The mappings for DocumentReference.context.period do not cover the following types based on type expansion: end, start.

                                                              Control0..1
                                                              TypeExtension(STU3: period additional types) (Extension Type: Period)
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                              262. DocumentReference.context.period.start
                                                              Definition

                                                              The start of the period. The boundary is inclusive.

                                                              ShortStarting time with inclusive boundary
                                                              Comments

                                                              If the low element is missing, the meaning is that the low boundary is not known.

                                                              Control0..1
                                                              This element is affected by the following invariants: per-1
                                                              TypedateTime
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              264. DocumentReference.context.period.end
                                                              Definition

                                                              The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                                                              ShortEnd time with inclusive boundary, if not ongoing
                                                              Comments

                                                              The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

                                                              Control0..1
                                                              This element is affected by the following invariants: per-1
                                                              TypedateTime
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              266. DocumentReference.context.facilityType
                                                              Definition

                                                              The kind of facility where the patient was seen.

                                                              ShortKind of facility where patient was seen
                                                              Control0..1
                                                              BindingFor example codes, see FacilityTypeCodeValueSet
                                                              (example to http://hl7.org/fhir/ValueSet/c80-facilitycodes|4.3.0)

                                                              XDS Facility Type.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              268. DocumentReference.context.practiceSetting
                                                              Definition

                                                              This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.

                                                              ShortAdditional details about where the content was created (e.g. clinical specialty)
                                                              Comments

                                                              This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.

                                                              Control0..1
                                                              BindingFor example codes, see PracticeSettingCodeValueSet
                                                              (example to http://hl7.org/fhir/ValueSet/c80-practice-codes|4.3.0)

                                                              Additional details about where the content was created (e.g. clinical specialty).

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Requirements

                                                              This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

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

                                                              The Patient Information as known when the document was published. May be a reference to a version specific, or contained.

                                                              ShortPatient demographics from source
                                                              Control0..1
                                                              TypeReference(Patient)
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              272. DocumentReference.context.sourcePatientInfo.id
                                                              Definition

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

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              Typeid
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              274. DocumentReference.context.sourcePatientInfo.extension
                                                              Definition

                                                              An Extension

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

                                                                STU3: DocumentReference.context.sourcePatientInfo additional types from child elements (display, identifier, reference)

                                                                ShortSTU3: sourcePatientInfo additional types
                                                                Comments

                                                                Element DocumentReference.context.sourcePatientInfo is mapped to FHIR R4B element DocumentReference.context.sourcePatientInfo as SourceIsBroaderThanTarget. The mappings for DocumentReference.context.sourcePatientInfo do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.context.sourcePatientInfo with unmapped reference targets: Patient.

                                                                Control0..1
                                                                TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                278. DocumentReference.context.sourcePatientInfo.reference
                                                                Definition

                                                                A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                ShortLiteral reference, Relative, internal or absolute URL
                                                                Comments

                                                                Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                Control0..1
                                                                This element is affected by the following invariants: ref-1
                                                                Typestring
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                280. DocumentReference.context.sourcePatientInfo.type
                                                                Definition

                                                                The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                ShortType the reference refers to (e.g. "Patient")
                                                                Comments

                                                                This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                Control0..1
                                                                BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)
                                                                Typeuri
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                282. DocumentReference.context.sourcePatientInfo.identifier
                                                                Definition

                                                                An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                ShortLogical reference, when literal reference is not known
                                                                Comments

                                                                When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                Control0..1
                                                                TypeIdentifier
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                284. DocumentReference.context.sourcePatientInfo.display
                                                                Definition

                                                                Plain text narrative that identifies the resource in addition to the resource reference.

                                                                ShortText alternative for the resource
                                                                Comments

                                                                This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                286. DocumentReference.context.related
                                                                Definition

                                                                Related identifiers or resources associated with the DocumentReference.

                                                                ShortRelated identifiers or resources
                                                                Comments

                                                                May be identifiers or resources that caused the DocumentReference or referenced Document to be created.

                                                                Control0..*
                                                                TypeReference(Resource)
                                                                Is Modifierfalse
                                                                Must Supportfalse
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                288. DocumentReference.context.related.id
                                                                Definition

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

                                                                ShortUnique id for inter-element referencing
                                                                Control0..1
                                                                Typeid
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                290. DocumentReference.context.related.extension
                                                                Definition

                                                                An Extension

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

                                                                  STU3: DocumentReference.context.related.identifier (new:Identifier)

                                                                  ShortSTU3: Identifier of related objects or events (new)
                                                                  Comments

                                                                  Element DocumentReference.context.related.identifier has a context of DocumentReference.context.related based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.related.identifier has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). Order numbers, accession numbers, XDW workflow numbers.

                                                                  Control0..1
                                                                  TypeExtension(STU3: Identifier of related objects or events (new)) (Extension Type: Identifier)
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                  294. DocumentReference.context.related.extension:ref
                                                                  Slice Nameref
                                                                  Definition

                                                                  STU3: DocumentReference.context.related.ref additional types from child elements (display, identifier, reference)

                                                                  ShortSTU3: Related Resource additional types
                                                                  Comments

                                                                  Element DocumentReference.context.related.ref is mapped to FHIR R4B element DocumentReference.context.related as RelatedTo. The mappings for DocumentReference.context.related.ref do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element DocumentReference.context.related.ref with unmapped reference targets: Resource. Order, ProcedureRequest, Procedure, EligibilityRequest, etc.

                                                                  Control0..1
                                                                  TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                  296. DocumentReference.context.related.reference
                                                                  Definition

                                                                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                  ShortLiteral reference, Relative, internal or absolute URL
                                                                  Comments

                                                                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                  Control0..1
                                                                  This element is affected by the following invariants: ref-1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  298. DocumentReference.context.related.type
                                                                  Definition

                                                                  The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                  The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                  ShortType the reference refers to (e.g. "Patient")
                                                                  Comments

                                                                  This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                  Control0..1
                                                                  BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                  (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)
                                                                  Typeuri
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  300. DocumentReference.context.related.identifier
                                                                  Definition

                                                                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                  ShortLogical reference, when literal reference is not known
                                                                  Comments

                                                                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                  Control0..1
                                                                  TypeIdentifier
                                                                  Is Modifierfalse
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  302. DocumentReference.context.related.display
                                                                  Definition

                                                                  Plain text narrative that identifies the resource in addition to the resource reference.

                                                                  ShortText alternative for the resource
                                                                  Comments

                                                                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))