US Core Implementation Guide
8.0.0-ballot - STU8 Ballot United States of America flag

This page is part of the US Core (v8.0.0-ballot: STU8 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 7.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: US Core ADI DocumentReference Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-adi-documentreference Version: 8.0.0-ballot
Standards status: Trial-use Maturity Level: 3 Computable Name: USCoreADIDocumentReferenceProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.4

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core ADI DocumentReference Profile inherits from the FHIR DocumentReference resource; refer to it for scope and usage definitions. This profile and the US Core Observation ADI Documentation Profile meet the U.S. Core Data for Interoperability (USCDI) Advance Directive Observation Data Element requirements. It sets minimum expectations for searching and fetching patient Advance Directive Information (ADI) documents using the DocumentReference resource. Examples of advance healthcare directive documents include physician order for life sustaining treatment (POLST), do not resuscitate order (DNR), and medical power of attorney. In addition to the document contents, it communicates the type of advance directive document, the author, the verifier, and other properties. To represent whether advance directive documents exist for a patient, see the US Core Observation ADI Documentation Profile. This profile sets minimum expectations for searching and fetching patient ADI documents using the DocumentReference resource. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

This page has new content for US Core Version 8.0.0

Example Usage Scenarios:

The following are example usage scenarios for the US Core ADI DocumentReference profile:

  • Query for all ADI documents belonging to a Patient
  • Query for a specific ADI Document type (e.g., POLST or Living Will)

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each DocumentReference Must Have:

  1. a status
  2. a code describing the type of ADI document (for example, Advanced Directive for intubation)
  3. an ADI document category (for example, Advanced Directives)
  4. a patient
  5. document referenced (content)
  6. the MIME type (i.e., contentType) of the document

Each DocumentReference Must Support:

  1. a business identifier for the DocumentReference (possibly generated by the transcription system or EHR)
  2. date and time the DocumentReference was created
  3. an author
  4. a verifier (in other words, an authenticator)
  5. a verification date
  6. a code identifying the specific details about the format of the document — over and above the content's MIME type

Profile Specific Implementation Guidance:

  • In addition to the Advance Healthcare Directive Categories Grouper value set, other category schemes may be used to facilitate the sharing of health documents.
  • The DocumentReference resources can represent the referenced content using either an address where the document can be retrieved using DocumentReference.attachment.url or the content as inline base64 encoded data using DocumentReference.attachment.data.
    • Although both are marked as Must Support, the Server system is not required to support an address and inline base64 encoded data, but SHALL support at least one of these elements.
    • The Client application SHALL support both elements.
    • The content.url may refer to a FHIR Binary Resource (i.e., [base]/Binary/[id]), FHIR Document Bundle (i.e., [base]/Bundle/[id], or another endpoint.
      • If the endpoint is outside the FHIR base URL, it SHOULD NOT require additional authorization to access.
    • If there are multiple DocumentReference.content element repetitions, these SHALL all represent the same document in different formats or attachment metadata. The content element SHALL NOT contain different versions of the same content. For version handling, use multiple DocumentReferences with DocumentReference.relatesTo.
  • Every DocumentReference must have a responsible Organization. The organization responsible for the DocumentReference SHALL be present either in DocumentReference.custodian or accessible in the Provenance resource targeting the DocumentReference using Provenance.agent.who or Provenance.agent.onBehalfOf.
    • Some systems may also expose the same organization in referenced Encounter in Encounter.serviceProvider.

Usage:

Changes since version 7.0.0:

  • New Content

    • Formal Views of Profile Content

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

    This structure is derived from DocumentReference

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. DocumentReference 0..* DocumentReference A reference to a document
    ... Slices for extension Content/Rules for all slices
    .... authenticationTime S 0..1 dateTime Authentication Time"
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
    ... identifier S 0..* Identifier Other identifiers for the document
    ... status S 1..1 code current | superseded | entered-in-error
    Binding: DocumentReferenceStatus (required)
    ... type S 1..1 CodeableConcept Kind of document (LOINC if possible)
    Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type

    ... Slices for category S 1..* CodeableConcept Categorization of document
    Slice: Unordered, Open by value:$this
    .... category:adi S 0..* CodeableConcept Categorization of ADI document"
    Binding: Advance Healthcare Directive Categories Grouper . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets

    ... subject S 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
    ... date S 0..1 instant When this document reference was created
    ... author S 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
    ... authenticator S 0..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) Who/what authenticated the document
    ... content S 1..* BackboneElement Document referenced
    .... attachment SC 1..1 Attachment Where to access the document
    us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    ..... contentType S 0..1 code Mime type of the content, with charset etc.
    ..... data SC 0..1 base64Binary Data inline, base64ed
    ..... url SC 0..1 url Uri where the data can be found
    .... format S 0..1 Coding Format/content rules for the document
    Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    DocumentReference.statusrequiredDocumentReferenceStatus
    http://hl7.org/fhir/ValueSet/document-reference-status
    from the FHIR Standard
    DocumentReference.typeextensibleAdvanceDirectivesContentType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
    DocumentReference.category:adirequiredAdvanceHealthcareDirectiveCategoriesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25
    DocumentReference.content.formatextensibleHL7FormatCodes
    http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-6errorDocumentReference.content.attachmentDocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    : url.exists() or data.exists()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. DocumentReference 0..* DocumentReference A reference to a document
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... Slices for extension Content/Rules for all slices
    .... authenticationTime S 0..1 dateTime Authentication Time"
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... identifier SΣ 0..* Identifier Other identifiers for the document
    ele-1: All FHIR elements must have a @value or children
    ... status ?!SΣ 1..1 code current | superseded | entered-in-error
    Binding: DocumentReferenceStatus (required)
    ele-1: All FHIR elements must have a @value or children
    ... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
    Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type


    ele-1: All FHIR elements must have a @value or children
    ... Slices for category SΣ 1..* CodeableConcept Categorization of document
    Slice: Unordered, Open by value:$this
    Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


    ele-1: All FHIR elements must have a @value or children
    .... category:adi SΣ 0..* CodeableConcept Categorization of ADI document"
    Binding: Advance Healthcare Directive Categories Grouper . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


    ele-1: All FHIR elements must have a @value or children
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
    ele-1: All FHIR elements must have a @value or children
    ... date SΣ 0..1 instant When this document reference was created
    ele-1: All FHIR elements must have a @value or children
    ... author SΣ 0..* Reference(US Core Practitioner Profile) Who and/or what authored the document
    ele-1: All FHIR elements must have a @value or children
    ... authenticator S 0..1 Reference(US Core Practitioner Profile) Who/what authenticated the document
    ele-1: All FHIR elements must have a @value or children
    ... content SΣ 1..* BackboneElement Document referenced
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... attachment SΣC 1..1 Attachment Where to access the document
    ele-1: All FHIR elements must have a @value or children
    us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    ..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
    Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.


    ele-1: All FHIR elements must have a @value or children
    Example General: text/plain; charset=UTF-8, image/png
    ..... data SC 0..1 base64Binary Data inline, base64ed
    ele-1: All FHIR elements must have a @value or children
    ..... url SΣC 0..1 url Uri where the data can be found
    ele-1: All FHIR elements must have a @value or children
    Example General: http://www.acme.com/logo-small.png
    .... format SΣ 0..1 Coding Format/content rules for the document
    Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)
    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    DocumentReference.statusrequiredDocumentReferenceStatus
    http://hl7.org/fhir/ValueSet/document-reference-status
    from the FHIR Standard
    DocumentReference.typeextensibleAdvanceDirectivesContentType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
    DocumentReference.categoryexampleDocumentClassValueSet
    http://hl7.org/fhir/ValueSet/document-classcodes
    from the FHIR Standard
    DocumentReference.category:adirequiredAdvanceHealthcareDirectiveCategoriesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25
    DocumentReference.content.attachment.contentTyperequiredMime Types (a valid code from urn:ietf:bcp:13)
    http://hl7.org/fhir/ValueSet/mimetypes|4.0.1
    from the FHIR Standard
    DocumentReference.content.formatextensibleHL7FormatCodes
    http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-6errorDocumentReference.content.attachmentDocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    : url.exists() or data.exists()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. DocumentReference 0..* DocumentReference A reference to a document
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... authenticationTime S 0..1 dateTime Authentication Time"
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... masterIdentifier Σ 0..1 Identifier Master Version Specific Identifier
    ... identifier SΣ 0..* Identifier Other identifiers for the document
    ... status ?!SΣ 1..1 code current | superseded | entered-in-error
    Binding: DocumentReferenceStatus (required)
    ... docStatus Σ 0..1 code preliminary | final | amended | entered-in-error
    Binding: CompositionStatus (required): Status of the underlying document.

    ... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
    Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type

    ... Slices for category SΣ 1..* CodeableConcept Categorization of document
    Slice: Unordered, Open by value:$this
    Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


    .... category:adi SΣ 0..* CodeableConcept Categorization of ADI document"
    Binding: Advance Healthcare Directive Categories Grouper . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
    ... date SΣ 0..1 instant When this document reference was created
    ... author SΣ 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
    ... authenticator S 0..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) Who/what authenticated 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
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code Σ 1..1 code replaces | transforms | signs | appends
    Binding: DocumentRelationshipType (required): The type of relationship between documents.

    .... target Σ 1..1 Reference(DocumentReference) Target of the relationship
    ... description Σ 0..1 string Human-readable description
    ... securityLabel Σ 0..* CodeableConcept Document security-tags
    Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


    ... content SΣ 1..* BackboneElement Document referenced
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... attachment SΣC 1..1 Attachment Where to access the document
    us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
    Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.


    Example General: text/plain; charset=UTF-8, image/png
    ..... language Σ 0..1 code Human language of the content (BCP-47)
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding

    Example General: en-AU
    ..... data SC 0..1 base64Binary Data inline, base64ed
    ..... url SΣC 0..1 url Uri where the data can be found
    Example General: http://www.acme.com/logo-small.png
    ..... size Σ 0..1 unsignedInt Number of bytes of content (if url provided)
    ..... hash Σ 0..1 base64Binary Hash of the data (sha-1, base64ed)
    ..... title Σ 0..1 string Label to display in place of the data
    Example General: Official Corporate Logo
    ..... creation Σ 0..1 dateTime Date attachment was first created
    .... format SΣ 0..1 Coding Format/content rules for the document
    Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)
    ... context Σ 0..1 BackboneElement Clinical context of document
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... encounter 0..* Reference(Encounter | EpisodeOfCare) Context of the document content
    .... event 0..* CodeableConcept Main clinical acts documented
    Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.


    .... period Σ 0..1 Period Time of service that is being documented
    .... facilityType 0..1 CodeableConcept Kind of facility where patient was seen
    Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.

    .... practiceSetting 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).

    .... sourcePatientInfo 0..1 Reference(Patient) Patient demographics from source
    .... related 0..* Reference(Resource) Related identifiers or resources

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    DocumentReference.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    DocumentReference.statusrequiredDocumentReferenceStatus
    http://hl7.org/fhir/ValueSet/document-reference-status
    from the FHIR Standard
    DocumentReference.docStatusrequiredCompositionStatus
    http://hl7.org/fhir/ValueSet/composition-status|4.0.1
    from the FHIR Standard
    DocumentReference.typeextensibleAdvanceDirectivesContentType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
    DocumentReference.categoryexampleDocumentClassValueSet
    http://hl7.org/fhir/ValueSet/document-classcodes
    from the FHIR Standard
    DocumentReference.category:adirequiredAdvanceHealthcareDirectiveCategoriesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25
    DocumentReference.relatesTo.coderequiredDocumentRelationshipType
    http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1
    from the FHIR Standard
    DocumentReference.securityLabelextensibleAll Security Labels
    http://hl7.org/fhir/ValueSet/security-labels
    from the FHIR Standard
    DocumentReference.content.attachment.contentTyperequiredMime Types (a valid code from urn:ietf:bcp:13)
    http://hl7.org/fhir/ValueSet/mimetypes|4.0.1
    from the FHIR Standard
    DocumentReference.content.attachment.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    DocumentReference.content.formatextensibleHL7FormatCodes
    http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
    DocumentReference.context.eventexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    DocumentReference.context.facilityTypeexampleFacilityTypeCodeValueSet
    http://hl7.org/fhir/ValueSet/c80-facilitycodes
    from the FHIR Standard
    DocumentReference.context.practiceSettingexamplePracticeSettingCodeValueSet
    http://hl7.org/fhir/ValueSet/c80-practice-codes
    from the FHIR Standard

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-6errorDocumentReference.content.attachmentDocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    : url.exists() or data.exists()

    Differential View

    This structure is derived from DocumentReference

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. DocumentReference 0..* DocumentReference A reference to a document
    ... Slices for extension Content/Rules for all slices
    .... authenticationTime S 0..1 dateTime Authentication Time"
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
    ... identifier S 0..* Identifier Other identifiers for the document
    ... status S 1..1 code current | superseded | entered-in-error
    Binding: DocumentReferenceStatus (required)
    ... type S 1..1 CodeableConcept Kind of document (LOINC if possible)
    Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type

    ... Slices for category S 1..* CodeableConcept Categorization of document
    Slice: Unordered, Open by value:$this
    .... category:adi S 0..* CodeableConcept Categorization of ADI document"
    Binding: Advance Healthcare Directive Categories Grouper . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets

    ... subject S 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
    ... date S 0..1 instant When this document reference was created
    ... author S 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
    ... authenticator S 0..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) Who/what authenticated the document
    ... content S 1..* BackboneElement Document referenced
    .... attachment SC 1..1 Attachment Where to access the document
    us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    ..... contentType S 0..1 code Mime type of the content, with charset etc.
    ..... data SC 0..1 base64Binary Data inline, base64ed
    ..... url SC 0..1 url Uri where the data can be found
    .... format S 0..1 Coding Format/content rules for the document
    Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    DocumentReference.statusrequiredDocumentReferenceStatus
    http://hl7.org/fhir/ValueSet/document-reference-status
    from the FHIR Standard
    DocumentReference.typeextensibleAdvanceDirectivesContentType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
    DocumentReference.category:adirequiredAdvanceHealthcareDirectiveCategoriesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25
    DocumentReference.content.formatextensibleHL7FormatCodes
    http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-6errorDocumentReference.content.attachmentDocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    : url.exists() or data.exists()

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. DocumentReference 0..* DocumentReference A reference to a document
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... Slices for extension Content/Rules for all slices
    .... authenticationTime S 0..1 dateTime Authentication Time"
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... identifier SΣ 0..* Identifier Other identifiers for the document
    ele-1: All FHIR elements must have a @value or children
    ... status ?!SΣ 1..1 code current | superseded | entered-in-error
    Binding: DocumentReferenceStatus (required)
    ele-1: All FHIR elements must have a @value or children
    ... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
    Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type


    ele-1: All FHIR elements must have a @value or children
    ... Slices for category SΣ 1..* CodeableConcept Categorization of document
    Slice: Unordered, Open by value:$this
    Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


    ele-1: All FHIR elements must have a @value or children
    .... category:adi SΣ 0..* CodeableConcept Categorization of ADI document"
    Binding: Advance Healthcare Directive Categories Grouper . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


    ele-1: All FHIR elements must have a @value or children
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
    ele-1: All FHIR elements must have a @value or children
    ... date SΣ 0..1 instant When this document reference was created
    ele-1: All FHIR elements must have a @value or children
    ... author SΣ 0..* Reference(US Core Practitioner Profile) Who and/or what authored the document
    ele-1: All FHIR elements must have a @value or children
    ... authenticator S 0..1 Reference(US Core Practitioner Profile) Who/what authenticated the document
    ele-1: All FHIR elements must have a @value or children
    ... content SΣ 1..* BackboneElement Document referenced
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... attachment SΣC 1..1 Attachment Where to access the document
    ele-1: All FHIR elements must have a @value or children
    us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    ..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
    Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.


    ele-1: All FHIR elements must have a @value or children
    Example General: text/plain; charset=UTF-8, image/png
    ..... data SC 0..1 base64Binary Data inline, base64ed
    ele-1: All FHIR elements must have a @value or children
    ..... url SΣC 0..1 url Uri where the data can be found
    ele-1: All FHIR elements must have a @value or children
    Example General: http://www.acme.com/logo-small.png
    .... format SΣ 0..1 Coding Format/content rules for the document
    Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)
    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    DocumentReference.statusrequiredDocumentReferenceStatus
    http://hl7.org/fhir/ValueSet/document-reference-status
    from the FHIR Standard
    DocumentReference.typeextensibleAdvanceDirectivesContentType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
    DocumentReference.categoryexampleDocumentClassValueSet
    http://hl7.org/fhir/ValueSet/document-classcodes
    from the FHIR Standard
    DocumentReference.category:adirequiredAdvanceHealthcareDirectiveCategoriesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25
    DocumentReference.content.attachment.contentTyperequiredMime Types (a valid code from urn:ietf:bcp:13)
    http://hl7.org/fhir/ValueSet/mimetypes|4.0.1
    from the FHIR Standard
    DocumentReference.content.formatextensibleHL7FormatCodes
    http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-6errorDocumentReference.content.attachmentDocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    : url.exists() or data.exists()

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. DocumentReference 0..* DocumentReference A reference to a document
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... authenticationTime S 0..1 dateTime Authentication Time"
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... masterIdentifier Σ 0..1 Identifier Master Version Specific Identifier
    ... identifier SΣ 0..* Identifier Other identifiers for the document
    ... status ?!SΣ 1..1 code current | superseded | entered-in-error
    Binding: DocumentReferenceStatus (required)
    ... docStatus Σ 0..1 code preliminary | final | amended | entered-in-error
    Binding: CompositionStatus (required): Status of the underlying document.

    ... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
    Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type

    ... Slices for category SΣ 1..* CodeableConcept Categorization of document
    Slice: Unordered, Open by value:$this
    Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


    .... category:adi SΣ 0..* CodeableConcept Categorization of ADI document"
    Binding: Advance Healthcare Directive Categories Grouper . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
    ... date SΣ 0..1 instant When this document reference was created
    ... author SΣ 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
    ... authenticator S 0..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core PractitionerRole Profile) Who/what authenticated 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
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code Σ 1..1 code replaces | transforms | signs | appends
    Binding: DocumentRelationshipType (required): The type of relationship between documents.

    .... target Σ 1..1 Reference(DocumentReference) Target of the relationship
    ... description Σ 0..1 string Human-readable description
    ... securityLabel Σ 0..* CodeableConcept Document security-tags
    Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


    ... content SΣ 1..* BackboneElement Document referenced
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... attachment SΣC 1..1 Attachment Where to access the document
    us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
    Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.


    Example General: text/plain; charset=UTF-8, image/png
    ..... language Σ 0..1 code Human language of the content (BCP-47)
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding

    Example General: en-AU
    ..... data SC 0..1 base64Binary Data inline, base64ed
    ..... url SΣC 0..1 url Uri where the data can be found
    Example General: http://www.acme.com/logo-small.png
    ..... size Σ 0..1 unsignedInt Number of bytes of content (if url provided)
    ..... hash Σ 0..1 base64Binary Hash of the data (sha-1, base64ed)
    ..... title Σ 0..1 string Label to display in place of the data
    Example General: Official Corporate Logo
    ..... creation Σ 0..1 dateTime Date attachment was first created
    .... format SΣ 0..1 Coding Format/content rules for the document
    Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)
    ... context Σ 0..1 BackboneElement Clinical context of document
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... encounter 0..* Reference(Encounter | EpisodeOfCare) Context of the document content
    .... event 0..* CodeableConcept Main clinical acts documented
    Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.


    .... period Σ 0..1 Period Time of service that is being documented
    .... facilityType 0..1 CodeableConcept Kind of facility where patient was seen
    Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.

    .... practiceSetting 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).

    .... sourcePatientInfo 0..1 Reference(Patient) Patient demographics from source
    .... related 0..* Reference(Resource) Related identifiers or resources

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    DocumentReference.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    DocumentReference.statusrequiredDocumentReferenceStatus
    http://hl7.org/fhir/ValueSet/document-reference-status
    from the FHIR Standard
    DocumentReference.docStatusrequiredCompositionStatus
    http://hl7.org/fhir/ValueSet/composition-status|4.0.1
    from the FHIR Standard
    DocumentReference.typeextensibleAdvanceDirectivesContentType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
    DocumentReference.categoryexampleDocumentClassValueSet
    http://hl7.org/fhir/ValueSet/document-classcodes
    from the FHIR Standard
    DocumentReference.category:adirequiredAdvanceHealthcareDirectiveCategoriesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25
    DocumentReference.relatesTo.coderequiredDocumentRelationshipType
    http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1
    from the FHIR Standard
    DocumentReference.securityLabelextensibleAll Security Labels
    http://hl7.org/fhir/ValueSet/security-labels
    from the FHIR Standard
    DocumentReference.content.attachment.contentTyperequiredMime Types (a valid code from urn:ietf:bcp:13)
    http://hl7.org/fhir/ValueSet/mimetypes|4.0.1
    from the FHIR Standard
    DocumentReference.content.attachment.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    DocumentReference.content.formatextensibleHL7FormatCodes
    http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
    DocumentReference.context.eventexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    DocumentReference.context.facilityTypeexampleFacilityTypeCodeValueSet
    http://hl7.org/fhir/ValueSet/c80-facilitycodes
    from the FHIR Standard
    DocumentReference.context.practiceSettingexamplePracticeSettingCodeValueSet
    http://hl7.org/fhir/ValueSet/c80-practice-codes
    from the FHIR Standard

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-6errorDocumentReference.content.attachmentDocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
    : url.exists() or data.exists()

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Quick Start

    Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

    • See the Search Syntax section for a description of the US Core search syntax.
    • See the General Requirements section for additional rules and expectations when a Server requires status parameters.
    • See the General Guidance section for additional guidance on searching for multiple patients.

    Mandatory Search Parameters:

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support both read DocumentReference by id AND DocumentReference search using the _id search parameter:

      GET [base]/DocumentReference/[id] or GET [base]/DocumentReference?_id=[id]

      Example:

      1. GET [base]/DocumentReference/2169591
      2. GET [base]/DocumentReference?_id=2169591

      Implementation Notes: Fetches a single DocumentReference. The document itself is represented as a base64 encoded binary data element or retrieved using the link provided by the resource. If the document is a relative link to a [Binary] resource like a resource reference, it can be subsequently retrieved using: GET [base]/Binary/[id]. (how to search by the logical id of the resource)

    2. SHALL support searching for all documentreferences for a patient using the patient search parameter:

      GET [base]/DocumentReference?patient={Type/}[id]

      Example:

      1. GET [base]/DocumentReference?patient=1137192

      Implementation Notes: Fetches a bundle of all DocumentReference resources for the specified patient. See the implementation notes above for how to access the actual document. (how to search by reference)

    3. SHALL support searching using the combination of the patient and category search parameters:

      GET [base]/DocumentReference?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category|clinical-note

      Example:

      1. GET [base]/DocumentReference?patient=1235541&category=http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category|clinical-note

      Implementation Notes: Fetches a bundle of all DocumentReference resources for the specified patient and category = clinical-note. See the implementation notes above for how to access the actual document. (how to search by reference and how to search by token)

    4. SHALL support searching using the combination of the patient and category and date search parameters:
      • including support for these date comparators: gt,lt,ge,le
      • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

      GET [base]/DocumentReference?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category|clinical-note&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/DocumentReference?patient=1235541&category=http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category|clinical-note&date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all DocumentReference resources for the specified patient and category = clinical=note and date. See the implementation notes above for how to access the actual document. (how to search by reference and how to search by token and how to search by date)

    5. SHALL support searching using the combination of the patient and type search parameters:

      GET [base]/DocumentReference?patient={Type/}[id]&type={system|}[code]

      Example:

      1. GET [base]/DocumentReference?patient=1316024&type=http://loinc.org|18842-5

      Implementation Notes: Fetches a bundle of all DocumentReference resources for the specified patient and type. See the implementation notes above for how to access the actual document. (how to search by reference and how to search by token)

    Optional Search Parameters:

    The following search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and status search parameters:
      • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/DocumentReference?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/DocumentReference?patient=1235541

      Implementation Notes: Fetches a bundle of all DocumentReference resources for the specified patient and status. See the implementation notes above for how to access the actual document. (how to search by reference and how to search by token)

    2. SHOULD support searching using the combination of the patient and type and period search parameters:
      • including support for these period comparators: gt,lt,ge,le
      • including optional support for AND search on period (e.g.period=[date]&period=[date]]&...)

      GET [base]/DocumentReference?patient={Type/}[id]&type={system|}[code]&period={gt|lt|ge|le}[date]{&period={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/DocumentReference?patient=2169591&type=http://loinc.org |34133-9&period=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all DocumentReference resources for the specified patient and type and period. See the implementation notes above for how to access the actual document. (how to search by reference and how to search by token and how to search by date)