A reference to a document of any kind for any purpose. While the term “document” implies a more narrow focus, for this resource this "document" encompasses any serialized object with a mime-type, it includes formal patient-centric documents (CDA), clinical notes, scanned paper, non-patient specific documents like policy text, as well as a photo, video, or audio recording acquired or used in healthcare. The DocumentReference resource provides metadata about the document so that the document can be discovered and managed. The actual content may be inline base64 encoded data or provided by direct reference.

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

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.

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 its narrative along with other profiles, value sets, etc.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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.

An Extension

STU3: DocumentReference.created (new:dateTime)

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 R5. 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.

STU3: DocumentReference.indexed (new:instant)

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 R5. Typically, this is because the element has been added (is a new element). Referencing/indexing time is used for tracking, organizing versions and searching.

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 managable, 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).

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.

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.

The status of this document reference.

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.

The status of the document reference.

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

An Extension

STU3: DocumentReference.context.encounter (new:Reference(Encounter))

Element DocumentReference.context.encounter has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.encounter has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.event (new:CodeableConcept)

Element DocumentReference.context.event has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.event has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). 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.

STU3: DocumentReference.context.period (new:Period)

Element DocumentReference.context.period has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.period has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.facilityType (new:CodeableConcept)

Element DocumentReference.context.facilityType has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.facilityType has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.practiceSetting (new:CodeableConcept)

Element DocumentReference.context.practiceSetting has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.practiceSetting has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). The value set for this content has an example binding because it is a value set decided by community policy. Other examples exist for consideration: * HITSP created the table HITSP/C80 Table 2-148 Clinical Specialty Value Set (a value set based upon SNOMED CT which is referenced by Direct (XDR and XDM for Direct Messaging Specification, Version 1), as well as Nationwide Health Information Network (NHIN). Query for Documents, Web Service Interface Specification, V 3.0, 07/27/2011 * ELGA (Austria) (ELGA CDA Implementie-rungsleitfäden Registrierung von CDA Dokumenten für ELGA mit IHE Cross-Enterprise Document Sharing: XDS Metadaten (XDSDocumentEntry), [1.2.40.0.34.7.6.3] * XDS Connect-a-thon practiceSettingCode.

STU3: DocumentReference.context.sourcePatientInfo (new:Reference(Patient))

Element DocumentReference.context.sourcePatientInfo has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.sourcePatientInfo has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.related (new:BackboneElement)

Element DocumentReference.context.related has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.related has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). May be identifiers or resources that caused the DocumentReference or referenced Document to be created.

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.

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.

The document and format referenced. If there are multiple content element repetitions, these must all represent the same document in different format, or attachment metadata.

content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.

Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.

An Extension

STU3: DocumentReference.content.format (new:Coding)

Element DocumentReference.content.format has a context of DocumentReference.content based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.content.format has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

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 managable, 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).

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.

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.

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

An Extension

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

Element DocumentReference.content.attachment is mapped to FHIR R5 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.

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

Element DocumentReference.meta is mapped to FHIR R5 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.

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

Element DocumentReference.text is mapped to FHIR R5 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.

STU3: DocumentReference.created (new:dateTime)

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 R5. 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.

STU3: DocumentReference.indexed (new:instant)

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 R5. Typically, this is because the element has been added (is a new element). Referencing/indexing time is used for tracking, organizing versions and searching.

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

Element DocumentReference.masterIdentifier is mapped to FHIR R5 element DocumentReference.identifier as RelatedTo. 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.

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

Element DocumentReference.identifier is mapped to FHIR R5 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.

STU3: DocumentReference.subject

Element DocumentReference.subject is mapped to FHIR R5 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.

STU3: DocumentReference.context.encounter (new:Reference(Encounter))

Element DocumentReference.context.encounter has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.encounter has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.event (new:CodeableConcept)

Element DocumentReference.context.event has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.event has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). 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.

STU3: DocumentReference.context.period (new:Period)

Element DocumentReference.context.period has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.period has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.facilityType (new:CodeableConcept)

Element DocumentReference.context.facilityType has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.facilityType has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.practiceSetting (new:CodeableConcept)

Element DocumentReference.context.practiceSetting has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.practiceSetting has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). The value set for this content has an example binding because it is a value set decided by community policy. Other examples exist for consideration: * HITSP created the table HITSP/C80 Table 2-148 Clinical Specialty Value Set (a value set based upon SNOMED CT which is referenced by Direct (XDR and XDM for Direct Messaging Specification, Version 1), as well as Nationwide Health Information Network (NHIN). Query for Documents, Web Service Interface Specification, V 3.0, 07/27/2011 * ELGA (Austria) (ELGA CDA Implementie-rungsleitfäden Registrierung von CDA Dokumenten für ELGA mit IHE Cross-Enterprise Document Sharing: XDS Metadaten (XDSDocumentEntry), [1.2.40.0.34.7.6.3] * XDS Connect-a-thon practiceSettingCode.

STU3: DocumentReference.context.sourcePatientInfo (new:Reference(Patient))

Element DocumentReference.context.sourcePatientInfo has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.sourcePatientInfo has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.related (new:BackboneElement)

Element DocumentReference.context.related has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.related has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). May be identifiers or resources that caused the DocumentReference or referenced Document to be created.

STU3: DocumentReference.author

Element DocumentReference.author is mapped to FHIR R5 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).

STU3: DocumentReference.authenticator additional types (Reference(http://hl7.org/fhir/StructureDefinition/Practitioner), Reference(http://hl7.org/fhir/StructureDefinition/Organization)) additional types from child elements (display, identifier, reference)

Element DocumentReference.authenticator is mapped to FHIR R5 element DocumentReference.attester.mode as SourceIsBroaderThanTarget. The mappings for DocumentReference.authenticator do not cover the following types: Reference. The mappings for DocumentReference.authenticator do not cover the following types based on type expansion: display, identifier, reference. 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.

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

Element DocumentReference.custodian is mapped to FHIR R5 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.

STU3: DocumentReference.relatesTo.code additional codes

Element DocumentReference.relatesTo.code is mapped to FHIR R5 element DocumentReference.relatesTo.code as SourceIsNarrowerThanTarget. The mappings for DocumentReference.relatesTo.code do not allow expression of the necessary codes, per the bindings on the source and target. If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

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

Element DocumentReference.relatesTo.target is mapped to FHIR R5 element DocumentReference.relatesTo.target as RelatedTo. 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.

STU3: DocumentReference.content.format (new:Coding)

Element DocumentReference.content.format has a context of DocumentReference.content based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.content.format has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

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

Element DocumentReference.content.attachment is mapped to FHIR R5 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.

A reference to a document of any kind for any purpose. While the term “document” implies a more narrow focus, for this resource this "document" encompasses any serialized object with a mime-type, it includes formal patient-centric documents (CDA), clinical notes, scanned paper, non-patient specific documents like policy text, as well as a photo, video, or audio recording acquired or used in healthcare. The DocumentReference resource provides metadata about the document so that the document can be discovered and managed. The actual content may be inline base64 encoded data or provided by direct reference.

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

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

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

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.

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

An Extension

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

Element DocumentReference.meta is mapped to FHIR R5 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.

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.

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.

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

This element is generally omitted in instances submitted in a PUT or POST. Instead, it is populated in the response instance and when retrieving information using a GET. 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.

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.

The exact use of the source (and the possible implied Provenance.entity.role and agent.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. The source may correspond to Provenance.entity.what[x] or Provenance.agent.who[x], though it may be a more general or abstract reference.

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.

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

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.

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

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.

Unless not suitable, these codes SHALL be taken from AllSecurityLabels
(extensible to http://hl7.org/fhir/ValueSet/security-labels|5.0.0)

Security Labels from the Healthcare Privacy and Security Classification System.

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.

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.

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

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.

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 its narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

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).

IETF language tag for a human language

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.

Contained resources do not have a 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.

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

An Extension

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

Element DocumentReference.text is mapped to FHIR R5 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.

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.

The status of a resource narrative.

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

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.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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.

An Extension

STU3: DocumentReference.created (new:dateTime)

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 R5. 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.

STU3: DocumentReference.indexed (new:instant)

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 R5. Typically, this is because the element has been added (is a new element). Referencing/indexing time is used for tracking, organizing versions and searching.

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 managable, 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).

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.

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.

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

The structure and format of this identifier would be consistent with the specification corresponding to the format of the document. (e.g. for a DICOM standard document, a 64-character numeric UID; for an HL7 CDA format, the CDA Document Id root and extension).

Document identifiers usually assigned by the source of the document, or other business identifiers such as XDS DocumentEntry.uniqueId and DocumentEntry.entryUUID. These identifiers are specific to this instance of the document.

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

An Extension

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

Element DocumentReference.masterIdentifier is mapped to FHIR R5 element DocumentReference.identifier as RelatedTo. 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.

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

Element DocumentReference.identifier is mapped to FHIR R5 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.

The purpose of this identifier.

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

Identifies the purpose for this identifier, if known .

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

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

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.

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

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

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

Identifier.system is always case sensitive.

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.

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

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 http://hl7.org/fhir/StructureDefinition/rendered-value). 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.

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

Organization that issued/manages the identifier.

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.

An explicitly assigned identifer of a variation of the content in the DocumentReference.

While each resource, including the DocumentReference itself, has its own version identifier, this is a formal identifier for the logical version of the DocumentReference as a whole. It would remain constant if the resources were moved to a new server, and all got new individual resource versions, for example.

A procedure that is fulfilled in whole or in part by the creation of this media.

Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

The status of this document reference.

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.

The status of the document reference.

The status of the underlying document.

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

Status of the underlying document.

Imaging modality used. This may include both acquisition and non-acquisition modalities.

Unless not suitable, these codes SHALL be taken from Modality
(extensible to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html)

Type of acquired data in the instance.

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.

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.

Precise type of clinical document.

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.

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.

High-level kind of document at a macro level.

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).

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

An Extension

STU3: DocumentReference.subject

Element DocumentReference.subject is mapped to FHIR R5 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.

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.

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.

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).

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 known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

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.

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).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

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

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.

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

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

An Extension

STU3: DocumentReference.context.encounter (new:Reference(Encounter))

Element DocumentReference.context.encounter has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.encounter has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.event (new:CodeableConcept)

Element DocumentReference.context.event has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.event has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). 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.

STU3: DocumentReference.context.period (new:Period)

Element DocumentReference.context.period has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.period has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.facilityType (new:CodeableConcept)

Element DocumentReference.context.facilityType has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.facilityType has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.practiceSetting (new:CodeableConcept)

Element DocumentReference.context.practiceSetting has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.practiceSetting has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). The value set for this content has an example binding because it is a value set decided by community policy. Other examples exist for consideration: * HITSP created the table HITSP/C80 Table 2-148 Clinical Specialty Value Set (a value set based upon SNOMED CT which is referenced by Direct (XDR and XDM for Direct Messaging Specification, Version 1), as well as Nationwide Health Information Network (NHIN). Query for Documents, Web Service Interface Specification, V 3.0, 07/27/2011 * ELGA (Austria) (ELGA CDA Implementie-rungsleitfäden Registrierung von CDA Dokumenten für ELGA mit IHE Cross-Enterprise Document Sharing: XDS Metadaten (XDSDocumentEntry), [1.2.40.0.34.7.6.3] * XDS Connect-a-thon practiceSettingCode.

STU3: DocumentReference.context.sourcePatientInfo (new:Reference(Patient))

Element DocumentReference.context.sourcePatientInfo has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.sourcePatientInfo has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: DocumentReference.context.related (new:BackboneElement)

Element DocumentReference.context.related has a context of DocumentReference.context based on following the parent source element upwards and mapping to DocumentReference. Element DocumentReference.context.related has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). May be identifiers or resources that caused the DocumentReference or referenced Document to be created.

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.

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.

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).

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 known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

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.

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).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

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

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.

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.

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.

For 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.

The anatomic structures included in the document.

SNOMED CT Body site concepts

The kind of facility where the patient was seen.

XDS Facility Type.

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

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.

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

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

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

When the document reference was created.

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

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

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

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

An Extension

STU3: DocumentReference.author

Element DocumentReference.author is mapped to FHIR R5 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).

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.

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.

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).

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 known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

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.

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).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

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

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.

A participant who has authenticated the accuracy of the document.

Only list each attester once.

Identifies responsibility for the accuracy of the document content.

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

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 managable, 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.

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.

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 managable, 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).

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.

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.

The type of attestation the authenticator offers.

The way in which a person authenticated a document.

Indicates the level of authority of the attestation.

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

An Extension

STU3: DocumentReference.authenticator additional types (Reference(http://hl7.org/fhir/StructureDefinition/Practitioner), Reference(http://hl7.org/fhir/StructureDefinition/Organization)) additional types from child elements (display, identifier, reference)

Element DocumentReference.authenticator is mapped to FHIR R5 element DocumentReference.attester.mode as SourceIsBroaderThanTarget. The mappings for DocumentReference.authenticator do not cover the following types: Reference. The mappings for DocumentReference.authenticator do not cover the following types based on type expansion: display, identifier, reference. 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.

A reference to a code defined by a terminology system.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Very often the text is the same as a displayName of one of the codings.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

When the document was attested by the party.

Identifies when the information in the document was deemed accurate. (Things may have changed since then.).

Who attested the document in the specified way.

Identifies who has taken on the responsibility for accuracy of the document content.

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

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.

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

An Extension

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

Element DocumentReference.custodian is mapped to FHIR R5 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.

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.

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.

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).

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 known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

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.

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).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.