Extensions for Using Data Elements from FHIR R4B in FHIR R5
0.1.0 - STU
Extensions for Using Data Elements from FHIR R4B in FHIR R5
0.1.0 - STU
Extensions for Using Data Elements from FHIR R4B in FHIR R5 - Downloaded Version null See the Directory of published versions
| Official URL: http://hl7.org/fhir/4.3/StructureDefinition/profile-DocumentReference | Version: 0.1.0 | |||
| Standards status: Trial-use | Maturity Level: 0 | Computable Name: Profile_R4B_DocumentReference_R5 | ||
This cross-version profile allows R4B DocumentReference content to be represented via FHIR R5 DocumentReference resources.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍5.0.0 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | DocumentReference | A resource should have narrative for robust management |
text.`div`.exists()
|
| docRef-1 | warning | DocumentReference | facilityType SHALL only be present if context is not an encounter |
facilityType.empty() or context.where(resolve() is Encounter).empty()
|
| docRef-2 | warning | DocumentReference | practiceSetting SHALL only be present if context is not present |
practiceSetting.empty() or context.where(resolve() is Encounter).empty()
|
| ele-1 | error | DocumentReference.implicitRules, DocumentReference.modifierExtension, DocumentReference.status, DocumentReference.context, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.context.reference, DocumentReference.content, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | DocumentReference.modifierExtension, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from DocumentReference
| Name | Flags | Card. | Type | Description & Constraints Filter:   | ||||
|---|---|---|---|---|---|---|---|---|
  DocumentReference |
C | 0..* | DocumentReference(5.0.0) | A reference to a document Constraints: docRef-1, docRef-2 | ||||
  id |
Σ | 0..1 | id | Logical id of this artifact | ||||
 meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
 extension |
0..* | Extension | Additional content defined by implementations Constraints: ext-1 | |||||
 modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored Constraints: ext-1 | ||||
| identifier |
Σ | 0..* | Identifier | Business identifiers for the document | ||||
| version |
Σ | 0..1 | string | An explicitly assigned identifer of a variation of the content in the DocumentReference | ||||
 basedOn |
0..* | Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) | Procedure that caused this media to be created | |||||
| status |
?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. | ||||
| docStatus |
Σ | 0..1 | code | registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document. | ||||
| modality |
Σ | 0..* | CodeableConcept | Imaging modality used Binding: Modality  (extensible): Type of acquired data in the instance. | ||||
| type |
Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document. | ||||
| category |
Σ | 0..* | CodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. | ||||
 subject |
Σ | 0..1 | Reference(Resource) | Who/what is the subject of the document | ||||
 id |
0..1 | id | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
  extension:subject |
0..1 | Reference(Resource) | R4B: subject URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1 | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
ΣC | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
 display |
ΣC | 0..1 | string | Text alternative for the resource | ||||
| context |
C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content | ||||
| id |
0..1 | id | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
 extension:encounter |
0..* | Reference(Cross-version Profile for R4B.Encounter for use in FHIR R5(0.1.0) | Encounter | Cross-version Profile for R4B.EpisodeOfCare for use in FHIR R5(0.1.0) | EpisodeOfCare) | R4B: Context of the document content (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.encounter Constraints: ext-1 | |||||
| extension:event |
0..* | CodeableConcept | R4B: Main clinical acts documented (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.event Binding: http://terminology.hl7.org/ValueSet/v3-ActCode|2.0.0 (example): This list of codes represents the main clinical acts being documented. Constraints: ext-1 | |||||
| extension:period |
0..1 | Period | R4B: Time of service that is being documented (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.period Constraints: ext-1 | |||||
| extension:facilityType |
0..1 | CodeableConcept | R4B: Kind of facility where patient was seen (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.facilityType Constraints: ext-1 | |||||
| extension:practiceSetting |
0..1 | CodeableConcept | R4B: Additional details about where the content was created (e.g. clinical specialty) (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.practiceSetting Constraints: ext-1 | |||||
| extension:sourcePatientInfo |
0..1 | Reference(Cross-version Profile for R4B.Patient for use in FHIR R5(0.1.0) | Patient) | R4B: Patient demographics from source (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo Constraints: ext-1 | |||||
| extension:related |
0..* | Reference(Cross-version Profile for R4B.Resource for use in FHIR R5(0.1.0) | Resource) | R4B: Related identifiers or resources (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.related Constraints: ext-1 | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
ΣC | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
ΣC | 0..1 | string | Text alternative for the resource | ||||
| event |
0..* | CodeableReference() | Main clinical acts documented Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented. | |||||
| bodySite |
Σ | 0..* | CodeableReference(BodyStructure) | Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts | ||||
| facilityType |
C | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. | ||||
| practiceSetting |
C | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty). | ||||
| period |
Σ | 0..1 | Period | Time of service that is being documented | ||||
| date |
Σ | 0..1 | instant | When this document reference was created | ||||
| author |
Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) | Who and/or what authored the document | ||||
| attester |
0..* | BackboneElement | Attests to accuracy of the document | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Constraints: ext-1 | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized Constraints: ext-1 | ||||
| mode |
1..1 | CodeableConcept | personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document. | |||||
| id |
0..1 | id | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
| extension:authenticator |
0..1 | Reference(Cross-version Profile for R4B.Practitioner for use in FHIR R5(0.1.0) | Practitioner | Cross-version Profile for R4B.PractitionerRole for use in FHIR R5(0.1.0) | PractitionerRole | Cross-version Profile for R4B.Organization for use in FHIR R5(0.1.0) | Organization) | R4B: Who/what authenticated the document additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.authenticator Constraints: ext-1 | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| time |
0..1 | dateTime | When the document was attested | |||||
| party |
0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the document | |||||
| custodian |
0..1 | Reference(Organization) | Organization which maintains the document | |||||
| relatesTo |
Σ | 0..* | BackboneElement | Relationships to other documents | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Constraints: ext-1 | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized Constraints: ext-1 | ||||
| code |
Σ | 1..1 | CodeableConcept | The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents. | ||||
| id |
0..1 | id | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
| extension:code |
1..1 | code | R4B: replaces | transforms | signs | appends additional codes URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.relatesTo.code Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: ext-1 | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| target |
Σ | 1..1 | Reference(DocumentReference) | Target of the relationship | ||||
| description |
Σ | 0..1 | markdown | Human-readable description | ||||
| securityLabel |
Σ | 0..* | CodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System. | ||||
 content |
Σ | 1..* | BackboneElement | Document referenced | ||||
 id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
| extension:format |
0..1 | Coding | R4B: Format/content rules for the document (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.content.format Binding: R4BFormatcodesForR5 (0.1.0) (preferred): Document Format Codes. Constraints: ext-1 | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized Constraints: ext-1 | ||||
| attachment |
Σ | 1..1 | Attachment | Where to access the document | ||||
| profile |
Σ | 0..* | BackboneElement | Content profile rules for the document | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Constraints: ext-1 | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized Constraints: ext-1 | ||||
 value[x] |
Σ | 1..1 | Code|uri|canonical Binding: HL7FormatCodes (2.1.0) (preferred): Document Format Codes. | |||||
| valueCoding |
Coding | |||||||
| valueUri |
uri | |||||||
| valueCanonical |
canonical(Any) | |||||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.language | Base | required | All Languages | 📍5.0.0 | FHIR Std. |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍5.0.0 | FHIR Std. |
| DocumentReference.docStatus | Base | required | Composition Status | 📍5.0.0 | FHIR Std. |
| DocumentReference.modality | Base | extensible |
Modality
|
⏿2025.3.20250714 | tx.fhir.org |
| DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍5.0.0 | FHIR Std. |
| DocumentReference.category | Base | example | Referenced Item Category Value Set | 📍5.0.0 | FHIR Std. |
| DocumentReference.subject.type | Base | extensible |
Resource Types
|
📍5.0.0 | tx.fhir.org |
| DocumentReference.context.type | Base | extensible |
Resource Types
|
📍5.0.0 | tx.fhir.org |
| DocumentReference.event | Base | example | v3 Code System ActCode | 📍3.0.0 | THO v7.1 |
| DocumentReference.bodySite | Base | example | SNOMED CT Body Structures | 📍5.0.0 | FHIR Std. |
| DocumentReference.facilityType | Base | example | Facility Type Code Value Set | 📍5.0.0 | FHIR Std. |
| DocumentReference.practiceSetting | Base | example | Practice Setting Code Value Set | 📍5.0.0 | FHIR Std. |
| DocumentReference.attester.mode | Base | preferred | Composition Attestation Mode | 📍5.0.0 | FHIR Std. |
| DocumentReference.relatesTo.code | Base | extensible | Document Relationship Type | 📍5.0.0 | FHIR Std. |
| DocumentReference.securityLabel | Base | example | Example set of Security Labels | 📍5.0.0 | FHIR Std. |
| DocumentReference.content.profile.value[x] | Base | preferred | HL7 ValueSet of Format Codes for use with Document Sharing | 📍2.1.0 | THO v7.1 |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | DocumentReference | A resource should have narrative for robust management |
text.`div`.exists()
|
| docRef-1 | warning | DocumentReference | facilityType SHALL only be present if context is not an encounter |
facilityType.empty() or context.where(resolve() is Encounter).empty()
|
| docRef-2 | warning | DocumentReference | practiceSetting SHALL only be present if context is not present |
practiceSetting.empty() or context.where(resolve() is Encounter).empty()
|
| ele-1 | error | DocumentReference.meta, DocumentReference.implicitRules, DocumentReference.language, DocumentReference.text, DocumentReference.extension, DocumentReference.modifierExtension, DocumentReference.identifier, DocumentReference.version, DocumentReference.basedOn, DocumentReference.status, DocumentReference.docStatus, DocumentReference.modality, DocumentReference.type, DocumentReference.category, DocumentReference.subject, DocumentReference.subject.extension, DocumentReference.subject.extension:subject, DocumentReference.subject.reference, DocumentReference.subject.type, DocumentReference.subject.identifier, DocumentReference.subject.display, DocumentReference.context, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.context.reference, DocumentReference.context.type, DocumentReference.context.identifier, DocumentReference.context.display, DocumentReference.event, DocumentReference.bodySite, DocumentReference.facilityType, DocumentReference.practiceSetting, DocumentReference.period, DocumentReference.date, DocumentReference.author, DocumentReference.attester, DocumentReference.attester.extension, DocumentReference.attester.modifierExtension, DocumentReference.attester.mode, DocumentReference.attester.mode.extension, DocumentReference.attester.mode.extension:authenticator, DocumentReference.attester.mode.coding, DocumentReference.attester.mode.text, DocumentReference.attester.time, DocumentReference.attester.party, DocumentReference.custodian, DocumentReference.relatesTo, DocumentReference.relatesTo.extension, DocumentReference.relatesTo.modifierExtension, DocumentReference.relatesTo.code, DocumentReference.relatesTo.code.extension, DocumentReference.relatesTo.code.extension:code, DocumentReference.relatesTo.code.coding, DocumentReference.relatesTo.code.text, DocumentReference.relatesTo.target, DocumentReference.description, DocumentReference.securityLabel, DocumentReference.content, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment, DocumentReference.content.profile, DocumentReference.content.profile.extension, DocumentReference.content.profile.modifierExtension, DocumentReference.content.profile.value[x] | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | DocumentReference.extension, DocumentReference.modifierExtension, DocumentReference.subject.extension, DocumentReference.subject.extension:subject, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.attester.extension, DocumentReference.attester.modifierExtension, DocumentReference.attester.mode.extension, DocumentReference.attester.mode.extension:authenticator, DocumentReference.relatesTo.extension, DocumentReference.relatesTo.modifierExtension, DocumentReference.relatesTo.code.extension, DocumentReference.relatesTo.code.extension:code, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.profile.extension, DocumentReference.content.profile.modifierExtension | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from DocumentReference
Summary
Extensions
This structure refers to these extensions:
Maturity: 0
Key Elements View
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍5.0.0 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | DocumentReference | A resource should have narrative for robust management |
text.`div`.exists()
|
| docRef-1 | warning | DocumentReference | facilityType SHALL only be present if context is not an encounter |
facilityType.empty() or context.where(resolve() is Encounter).empty()
|
| docRef-2 | warning | DocumentReference | practiceSetting SHALL only be present if context is not present |
practiceSetting.empty() or context.where(resolve() is Encounter).empty()
|
| ele-1 | error | DocumentReference.implicitRules, DocumentReference.modifierExtension, DocumentReference.status, DocumentReference.context, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.context.reference, DocumentReference.content, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | DocumentReference.modifierExtension, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
This structure is derived from DocumentReference
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| DocumentReference |
C | 0..* | DocumentReference(5.0.0) | A reference to a document Constraints: docRef-1, docRef-2 | ||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| extension |
0..* | Extension | Additional content defined by implementations Constraints: ext-1 | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored Constraints: ext-1 | ||||
| identifier |
Σ | 0..* | Identifier | Business identifiers for the document | ||||
| version |
Σ | 0..1 | string | An explicitly assigned identifer of a variation of the content in the DocumentReference | ||||
| basedOn |
0..* | Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) | Procedure that caused this media to be created | |||||
| status |
?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. | ||||
| docStatus |
Σ | 0..1 | code | registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document. | ||||
| modality |
Σ | 0..* | CodeableConcept | Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance. | ||||
| type |
Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document. | ||||
| category |
Σ | 0..* | CodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. | ||||
| subject |
Σ | 0..1 | Reference(Resource) | Who/what is the subject of the document | ||||
| id |
0..1 | id | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
| extension:subject |
0..1 | Reference(Resource) | R4B: subject URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1 | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
ΣC | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
ΣC | 0..1 | string | Text alternative for the resource | ||||
| context |
C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content | ||||
| id |
0..1 | id | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
| extension:encounter |
0..* | Reference(Cross-version Profile for R4B.Encounter for use in FHIR R5(0.1.0) | Encounter | Cross-version Profile for R4B.EpisodeOfCare for use in FHIR R5(0.1.0) | EpisodeOfCare) | R4B: Context of the document content (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.encounter Constraints: ext-1 | |||||
| extension:event |
0..* | CodeableConcept | R4B: Main clinical acts documented (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.event Binding: http://terminology.hl7.org/ValueSet/v3-ActCode|2.0.0 (example): This list of codes represents the main clinical acts being documented. Constraints: ext-1 | |||||
| extension:period |
0..1 | Period | R4B: Time of service that is being documented (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.period Constraints: ext-1 | |||||
| extension:facilityType |
0..1 | CodeableConcept | R4B: Kind of facility where patient was seen (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.facilityType Constraints: ext-1 | |||||
| extension:practiceSetting |
0..1 | CodeableConcept | R4B: Additional details about where the content was created (e.g. clinical specialty) (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.practiceSetting Constraints: ext-1 | |||||
| extension:sourcePatientInfo |
0..1 | Reference(Cross-version Profile for R4B.Patient for use in FHIR R5(0.1.0) | Patient) | R4B: Patient demographics from source (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.sourcePatientInfo Constraints: ext-1 | |||||
| extension:related |
0..* | Reference(Cross-version Profile for R4B.Resource for use in FHIR R5(0.1.0) | Resource) | R4B: Related identifiers or resources (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.context.related Constraints: ext-1 | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
ΣC | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
ΣC | 0..1 | string | Text alternative for the resource | ||||
| event |
0..* | CodeableReference() | Main clinical acts documented Binding: ActCode (3.0.0) (example): This list of codes represents the main clinical acts being documented. | |||||
| bodySite |
Σ | 0..* | CodeableReference(BodyStructure) | Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts | ||||
| facilityType |
C | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. | ||||
| practiceSetting |
C | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty). | ||||
| period |
Σ | 0..1 | Period | Time of service that is being documented | ||||
| date |
Σ | 0..1 | instant | When this document reference was created | ||||
| author |
Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) | Who and/or what authored the document | ||||
| attester |
0..* | BackboneElement | Attests to accuracy of the document | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Constraints: ext-1 | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized Constraints: ext-1 | ||||
| mode |
1..1 | CodeableConcept | personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document. | |||||
| id |
0..1 | id | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
| extension:authenticator |
0..1 | Reference(Cross-version Profile for R4B.Practitioner for use in FHIR R5(0.1.0) | Practitioner | Cross-version Profile for R4B.PractitionerRole for use in FHIR R5(0.1.0) | PractitionerRole | Cross-version Profile for R4B.Organization for use in FHIR R5(0.1.0) | Organization) | R4B: Who/what authenticated the document additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.authenticator Constraints: ext-1 | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| time |
0..1 | dateTime | When the document was attested | |||||
| party |
0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the document | |||||
| custodian |
0..1 | Reference(Organization) | Organization which maintains the document | |||||
| relatesTo |
Σ | 0..* | BackboneElement | Relationships to other documents | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Constraints: ext-1 | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized Constraints: ext-1 | ||||
| code |
Σ | 1..1 | CodeableConcept | The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents. | ||||
| id |
0..1 | id | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
| extension:code |
1..1 | code | R4B: replaces | transforms | signs | appends additional codes URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.relatesTo.code Binding: DocumentRelationshipType (required): The type of relationship between documents. Constraints: ext-1 | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| target |
Σ | 1..1 | Reference(DocumentReference) | Target of the relationship | ||||
| description |
Σ | 0..1 | markdown | Human-readable description | ||||
| securityLabel |
Σ | 0..* | CodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| content |
Σ | 1..* | BackboneElement | Document referenced | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Constraints: ext-1 | |||||
| extension:format |
0..1 | Coding | R4B: Format/content rules for the document (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-DocumentReference.content.format Binding: R4BFormatcodesForR5 (0.1.0) (preferred): Document Format Codes. Constraints: ext-1 | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized Constraints: ext-1 | ||||
| attachment |
Σ | 1..1 | Attachment | Where to access the document | ||||
| profile |
Σ | 0..* | BackboneElement | Content profile rules for the document | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Constraints: ext-1 | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized Constraints: ext-1 | ||||
| value[x] |
Σ | 1..1 | Code|uri|canonical Binding: HL7FormatCodes (2.1.0) (preferred): Document Format Codes. | |||||
| valueCoding |
Coding | |||||||
| valueUri |
uri | |||||||
| valueCanonical |
canonical(Any) | |||||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.language | Base | required | All Languages | 📍5.0.0 | FHIR Std. |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍5.0.0 | FHIR Std. |
| DocumentReference.docStatus | Base | required | Composition Status | 📍5.0.0 | FHIR Std. |
| DocumentReference.modality | Base | extensible |
Modality
|
⏿2025.3.20250714 | tx.fhir.org |
| DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍5.0.0 | FHIR Std. |
| DocumentReference.category | Base | example | Referenced Item Category Value Set | 📍5.0.0 | FHIR Std. |
| DocumentReference.subject.type | Base | extensible |
Resource Types
|
📍5.0.0 | tx.fhir.org |
| DocumentReference.context.type | Base | extensible |
Resource Types
|
📍5.0.0 | tx.fhir.org |
| DocumentReference.event | Base | example | v3 Code System ActCode | 📍3.0.0 | THO v7.1 |
| DocumentReference.bodySite | Base | example | SNOMED CT Body Structures | 📍5.0.0 | FHIR Std. |
| DocumentReference.facilityType | Base | example | Facility Type Code Value Set | 📍5.0.0 | FHIR Std. |
| DocumentReference.practiceSetting | Base | example | Practice Setting Code Value Set | 📍5.0.0 | FHIR Std. |
| DocumentReference.attester.mode | Base | preferred | Composition Attestation Mode | 📍5.0.0 | FHIR Std. |
| DocumentReference.relatesTo.code | Base | extensible | Document Relationship Type | 📍5.0.0 | FHIR Std. |
| DocumentReference.securityLabel | Base | example | Example set of Security Labels | 📍5.0.0 | FHIR Std. |
| DocumentReference.content.profile.value[x] | Base | preferred | HL7 ValueSet of Format Codes for use with Document Sharing | 📍2.1.0 | THO v7.1 |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | DocumentReference | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | DocumentReference | A resource should have narrative for robust management |
text.`div`.exists()
|
| docRef-1 | warning | DocumentReference | facilityType SHALL only be present if context is not an encounter |
facilityType.empty() or context.where(resolve() is Encounter).empty()
|
| docRef-2 | warning | DocumentReference | practiceSetting SHALL only be present if context is not present |
practiceSetting.empty() or context.where(resolve() is Encounter).empty()
|
| ele-1 | error | DocumentReference.meta, DocumentReference.implicitRules, DocumentReference.language, DocumentReference.text, DocumentReference.extension, DocumentReference.modifierExtension, DocumentReference.identifier, DocumentReference.version, DocumentReference.basedOn, DocumentReference.status, DocumentReference.docStatus, DocumentReference.modality, DocumentReference.type, DocumentReference.category, DocumentReference.subject, DocumentReference.subject.extension, DocumentReference.subject.extension:subject, DocumentReference.subject.reference, DocumentReference.subject.type, DocumentReference.subject.identifier, DocumentReference.subject.display, DocumentReference.context, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.context.reference, DocumentReference.context.type, DocumentReference.context.identifier, DocumentReference.context.display, DocumentReference.event, DocumentReference.bodySite, DocumentReference.facilityType, DocumentReference.practiceSetting, DocumentReference.period, DocumentReference.date, DocumentReference.author, DocumentReference.attester, DocumentReference.attester.extension, DocumentReference.attester.modifierExtension, DocumentReference.attester.mode, DocumentReference.attester.mode.extension, DocumentReference.attester.mode.extension:authenticator, DocumentReference.attester.mode.coding, DocumentReference.attester.mode.text, DocumentReference.attester.time, DocumentReference.attester.party, DocumentReference.custodian, DocumentReference.relatesTo, DocumentReference.relatesTo.extension, DocumentReference.relatesTo.modifierExtension, DocumentReference.relatesTo.code, DocumentReference.relatesTo.code.extension, DocumentReference.relatesTo.code.extension:code, DocumentReference.relatesTo.code.coding, DocumentReference.relatesTo.code.text, DocumentReference.relatesTo.target, DocumentReference.description, DocumentReference.securityLabel, DocumentReference.content, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.attachment, DocumentReference.content.profile, DocumentReference.content.profile.extension, DocumentReference.content.profile.modifierExtension, DocumentReference.content.profile.value[x] | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | DocumentReference.extension, DocumentReference.modifierExtension, DocumentReference.subject.extension, DocumentReference.subject.extension:subject, DocumentReference.context.extension, DocumentReference.context.extension:encounter, DocumentReference.context.extension:event, DocumentReference.context.extension:period, DocumentReference.context.extension:facilityType, DocumentReference.context.extension:practiceSetting, DocumentReference.context.extension:sourcePatientInfo, DocumentReference.context.extension:related, DocumentReference.attester.extension, DocumentReference.attester.modifierExtension, DocumentReference.attester.mode.extension, DocumentReference.attester.mode.extension:authenticator, DocumentReference.relatesTo.extension, DocumentReference.relatesTo.modifierExtension, DocumentReference.relatesTo.code.extension, DocumentReference.relatesTo.code.extension:code, DocumentReference.content.extension, DocumentReference.content.extension:format, DocumentReference.content.modifierExtension, DocumentReference.content.profile.extension, DocumentReference.content.profile.modifierExtension | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from DocumentReference
Summary
Extensions
This structure refers to these extensions:
Maturity: 0
Other representations of profile: CSV, Excel, Schematron
IG © 2025+ FHIR Infrastructure. Package hl7.fhir.uv.xver-r4b.r5#0.1.0 based on FHIR 5.0.0. Generated 2026-03-20
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