Implementierungsleitfaden E-Rechnung

R2: Rechnung validieren/einreichen (Bulk)

Die nachfolgende Interaktion ist relevant für den FD als Server, sowie für das RE-PS als Client. Anwendungsfall AF_10136 MUSS durch den FD über die spezifizierte API umgesetzt werden. Die Vorgaben aus "Tabelle 15: Use Case Rechnung mit Dokumenten validieren und versenden" des Feature-Dokumentes MÜSSEN eingehalten werden durch den FD.


HTTP-Methode	POST
Endpunkt	/Patient/[id-des-ermittelten-Rechnungsempfängers]

Die Input- und Output-Parameter werden durch die OperationDefinition https://gematik.de/fhir/erg/OperationDefinition/Submit beschrieben. Die ID des Rechnungsempfängers ist zuvor per R0: Abfrage des Rechnungsempfängers und dessen Einwilligung zum Rechnungsversand zu ermitteln.

Invocations

URL: [base]/Patient/[id]/$erechnung-submit

This operation changes content

Parameters (In)

Name	Cardinality	Type	Binding	Documentation
rechnung	1..1	DocumentReference		Vollständige E-Rechnung mit verschiedenen Attachments: 1) Rechnungs-PDF 2) Strukturierte Daten OHNE Signatur.
anhang	0..*	DocumentReference		Weitere Anhänge zur E-Rechnung als PDF.
modus	0..1	code	ERGRechnungSubmitModusVS (required)	Verarbeitungshinweis für die E-Rechnung. Default: normal.
angereichertesPDF	0..1	boolean		Indikation ob nur das durch den FD erstellte Dokumententoken zurückgegeben werden soll oder das gesamte PDF inkl. Dokumententoken. Default: false.

Return Values (Out)

Name	Cardinality	Type	Documentation
token	0..*		Token(s) zur eineindeutigen Identifizierung der Rechnungsdokumente/-anhänge (unabhängig von returnTokenPDF). Dieser Parameter ist NUR optional falls modus = 'test'.
token.id	1..1	id	Randomisiertes Token zur Identifikation eines Dokumentes.
token.docRef	1..1	Identifier	Eindeutiger Identifikatior der Rechnung und Anhänge auf welche sich das Token bezieht.
token.angereichertesPDF	0..1	Binary	PDF mit eingebetteten Token und strukturierten Daten, in Abhängigkeit vom angereichertesPDF-Parameter. Vgl. 4.1 Einreichung per Post des Feature-Dokumentes E-Rechnung.
warnungen	0..1	OperationOutcome	Warnhinweise und Fehlern zur Validierung der E-Rechnung. Diese MÜSSEN in jedem Verarbeitungsmodus ausgegeben werden.

API-Zustand	HTTP-Status-Code
Erfolgsfall	`200 - OK`
Weitere Parameter in HTTP-Anfrage enthalten	`400 - Bad Request`
Syntax für Parameter ist nicht korrekt oder Kardinalitäten werden nicht eingehalten	`400 - Bad Request`
Gravierende Fehler treten während der Validierung auf - Mode = 'normal'	`400 - Bad Request`
Kein valides Access-Token wird mitgesendet	`401 - Unauthorized`
Autorisierter Benutzer verfügt über keine ausreichende Berechtigung die Interaktion auszuführen	`403 - Forbidden`
Fehlende Berechtigung für den Leistungserbringer das Postfach zu verwenden	`404 - Not Found` In diesem Fall: OperationOutcome mit Hinweis, dass Einwilligung nicht vorliegt oder Benutzer nicht vorhanden ist
Andere HTTP-Methode wird verwendet	`405 - Method Not Allowed`

Dokumentenvalidierung

Der FD muss die syntaktischen und semantischen Prüfungen der Rechnung durchführen welche in AF_10136 unter 'Ablauf' beschrieben sind. Bei der Verarbeitung einer Rechnungen mit einer bereits im FD bekannten Signatur MUSS eine Validierungswarnung durch den FD herausgegeben werden. Zudem MÜSSEN die übermittelten Dokumente ein valides PDF/A sein. Andernfalls ist der Request mit 400 - Bad Request abzulehnen.

Signatur

Die Signatur wird durch den FD über die Konkatenation aller Base64-kodierten Inhalte der Rechnung (d.h. Rechnungrepräsentation in PDF/A-Form und den strukturierten Rechnungsinhalten) gebildet werden, in der Reihenfolge:

Attachment mit contentType = application/pdf
Attachment mit contentType = application/fhir+xml
Attachment mit contentType = application/fhir+json

Weitere Details zur Signatur, siehe TODO.

Rechnungsrepräsentation

Die DocumentReference-Ressourcen welche über die Parameter rechnung und anhang übermittelt werden MÜSSEN dem Profil https://gematik.de/fhir/StructureDefinition/erg-dokumentenmetadaten entsprechen.

Canonical	Status	Version	Basis
https://gematik.de/fhir/erg/StructureDefinition/erg-dokumentenmetadaten	active	1.1.0-RC1	http://hl7.org/fhir/StructureDefinition/DocumentReference

ERGDokumentenmetadaten (DocumentReference)	I		DocumentReference	Element id DocumentReference Short description A reference to a document Definition A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text. Comments Usually, this is used for documents other than those defined by FHIR. Data type DocumentReference Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() SignaturVerpflichtendRechnung: Eine Signature muss vorhanden sein, falls es sich bei der DocumentReference um eine Rechnung handelt. `type.coding.where(system = 'http://dvmd.de/fhir/CodeSystem/kdl' and code = 'AM010106').exists() implies extension.where(url = 'https://gematik.de/fhir/erg/StructureDefinition/erg-docref-signature').exists()` RechnungOderAnhang: Ein Dokument kann entweder ein Anhang enthalten oder ein Rechnungsdokument inkl. strukturierten Rechnungsinhalten. `content.format.where(system = 'https://gematik.de/fhir/erg/CodeSystem/erg-attachment-format-cs' and code = 'rechnungsanhang').exists() xor (content.format.where(system = 'https://gematik.de/fhir/erg/CodeSystem/erg-attachment-format-cs' and code = 'erechnung').exists() and content.format.where(system = 'https://gematik.de/fhir/erg/CodeSystem/erg-attachment-format-cs' and code = 'rechnungsinhalt').exists())` Mappings rim: Entity. Role, or Act workflow: Event fhircomposition: when describing a Composition rim: Document[classCode="DOC" and moodCode="EVN"] cda: when describing a CDA
id	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id DocumentReference.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.meta.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	S I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.meta.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
markierung	S I	0..*	Extension(Complex)	Element id DocumentReference.meta.extension:markierung Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments Vgl. Abschnitt '4.4.2 Markierungen' des Feature-Dokuments E-Rechnung Data type Extension(Complex) Extension URL https://gematik.de/fhir/erg/StructureDefinition/erg-documentreference-markierung Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
versionId	Σ	0..1	id	There are no (further) constraints on this element Element id DocumentReference.meta.versionId Short description Version specific identifier Definition The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. Comments The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes. Data type id Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
lastUpdated	Σ	0..1	instant	There are no (further) constraints on this element Element id DocumentReference.meta.lastUpdated Short description When the resource version last changed Definition When the resource last changed - e.g. when the version changed. Comments This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
source	Σ	0..1	uri	There are no (further) constraints on this element Element id DocumentReference.meta.source Short description Identifies where the resource comes from Definition A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. Comments In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
profile	Σ	0..*	canonical(StructureDefinition)	There are no (further) constraints on this element Element id DocumentReference.meta.profile Short description Profiles this resource claims to conform to Definition A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. Comments It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. Data type canonical(StructureDefinition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
security	Σ	0..*	CodingBinding	There are no (further) constraints on this element Element id DocumentReference.meta.security Short description Security Labels applied to this resource Definition Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. Comments The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Data type Coding Binding Security Labels from the Healthcare Privacy and Security Classification System. All Security Labels (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
tag	S Σ	0..*	Coding	Element id DocumentReference.meta.tag Short description Tags applied to this resource Definition Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. Comments Metaangaben zur E-Rechnung die sich auf das Rechnungsdokument als Ganzes beziehen und nicht Teil des durch den RE-PS erstellten Dokuments sind. Data type Coding Sliced: Unordered, Open, by $this(Pattern) Binding Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". CommonTags (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
erg-rechnungsstatus	S Σ	0..1	CodingBinding	Element id DocumentReference.meta.tag:erg-rechnungsstatus Short description Tags applied to this resource Definition Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. Comments Vgl. Abschnitt 4.4.1 Workflow einer Rechnung des Feature-Dokuments E-Rechnung Data type Coding Binding Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". ERGRechnungsstatusVS (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.meta.tag:erg-rechnungsstatus.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.meta.tag:erg-rechnungsstatus.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.meta.tag:erg-rechnungsstatus.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.meta.tag:erg-rechnungsstatus.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.meta.tag:erg-rechnungsstatus.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.meta.tag:erg-rechnungsstatus.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.meta.tag:erg-rechnungsstatus.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id DocumentReference.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id DocumentReference.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id DocumentReference.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	S I	0..*	Extension	Element id DocumentReference.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
docRef-signature	S I	0..1	Extension(Signature)	Element id DocumentReference.extension:docRef-signature Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension(Signature) Extension URL https://gematik.de/fhir/erg/StructureDefinition/erg-docref-signature Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
rechnungsdatum	S I	0..1	Extension(dateTime)	Element id DocumentReference.extension:rechnungsdatum Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments Siehe Abschnitt '4.8.1.1 Rechnung' des Feature-Dokuments E-Rechnung Data type Extension(dateTime) Extension URL https://gematik.de/fhir/erg/StructureDefinition/erg-documentreference-rechnungsdatum Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
zahlungszieldatum	S I	0..1	Extension(dateTime)	Element id DocumentReference.extension:zahlungszieldatum Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments Siehe Abschnitt '4.8.1.1 Rechnung' des Feature-Dokuments E-Rechnung Data type Extension(dateTime) Extension URL https://gematik.de/fhir/erg/StructureDefinition/erg-documentreference-zahlungszieldatum Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
gesamtbetrag	S I	0..1	Extension(Money)	Element id DocumentReference.extension:gesamtbetrag Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments Siehe Abschnitt '4.8.1.1 Rechnung' des Feature-Dokuments E-Rechnung Data type Extension(Money) Extension URL https://gematik.de/fhir/erg/StructureDefinition/erg-documentreference-gesamtbetrag Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
fachrichtung	S I	0..1	Extension(Coding)	Element id DocumentReference.extension:fachrichtung Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension(Coding) Extension URL https://gematik.de/fhir/erg/StructureDefinition/erg-docref-fachrichtung Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
leistungsart	S I	0..1	Extension(Coding)	Element id DocumentReference.extension:leistungsart Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension(Coding) Extension URL https://gematik.de/fhir/erg/StructureDefinition/erg-docref-leistungsart Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
behandlungsart	S I	0..1	Extension(Coding)	Element id DocumentReference.extension:behandlungsart Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension(Coding) Extension URL https://gematik.de/fhir/erg/StructureDefinition/erg-behandlungsart Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
masterIdentifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id DocumentReference.masterIdentifier Short description Master Version Specific Identifier Definition Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document. Requirements The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.). Comments CDA Document Id extension and root. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier fhircomposition: Composition.identifier v2: TXA-12 rim: .id xds: DocumentEntry.uniqueId cda: ClinicalDocument/id
identifier	S Σ	1..*	Identifier	Element id DocumentReference.identifier Short description Other identifiers for the document Definition Other identifiers associated with the document, including version independent identifiers. Comments Eindeutiger Identifikator vergeben durch das RE-PS (z.B. Interne Dokumentennummer). Das System MUSS eindeutig pro Leistungserbringer:in vergeben werden. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier v2: TXA-16? rim: .id / .setId xds: DocumentEntry.entryUUID
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.identifier.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.identifier.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.identifier.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: N/A rim: Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id DocumentReference.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CX.5 rim: Role.code or implied by context
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments Identifier.system is always case sensitive. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings v2: CX.4 / EI-2-4 rim: II.root or Role.id.root servd: ./IdentifierType
value	S Σ	1..1	string	There are no (further) constraints on this element Element id DocumentReference.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings v2: CX.1 / EI.1 rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd: ./Value
period	Σ	0..1	Period	There are no (further) constraints on this element Element id DocumentReference.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CX.7 + CX.8 rim: Role.effectiveTime or implied by context servd: ./StartDate and ./EndDate
assigner	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element id DocumentReference.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CX.4 / (CX.4,CX.9,CX.10) rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd: ./IdentifierIssuingAuthority
status	S Σ ?!	1..1	codeBindingPattern	Element id DocumentReference.status Short description current \| superseded \| entered-in-error Definition The status of this document reference. Comments Versionierung von Dokumenten ist nicht unterstützt. Nur jeweils die aktuelle Version des Dokumentes wird akzeptiert. Data type code Binding The status of the document reference. DocumentReferenceStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern current Mappings workflow: Event.status w5: FiveWs.status v2: TXA-19 rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete" xds: DocumentEntry.availabilityStatus
docStatus	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.docStatus Short description preliminary \| final \| amended \| entered-in-error Definition The status of the underlying document. Comments The document that is pointed to might be in various lifecycle states. Data type code Binding Status of the underlying document. CompositionStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.status fhircomposition: Composition.status v2: TXA-17 rim: .statusCode
type	S Σ	1..1	CodeableConceptBinding	Element id DocumentReference.type Short description Kind of document (LOINC if possible) Definition Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced. Comments Kodierung des Dokumentes als 'Rechnung', sowie darüber hinausgehende Klassifizierung per KDL Data type CodeableConcept Binding Precise type of clinical document. DocumentTypeValueSet (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code w5: FiveWs.class fhircomposition: Composition.type v2: TXA-2 rim: ./code xds: DocumentEntry.type cda: ClinicalDocument/code/@code The typeCode should be mapped from the ClinicalDocument/code element to a set of document type codes configured in the affinity domain. One suggested coding system to use for typeCode is LOINC, in which case the mapping step can be omitted.
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.type.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
coding	Σ	1..*	Coding	Element id DocumentReference.type.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Sliced: Unordered, Open, by $this(Pattern) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
DokumentenKlassifizierung	S Σ	0..1	CodingBindingPattern	Element id DocumentReference.type.coding:DokumentenKlassifizierung Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Binding ERGSonstigesDokumentTypeVS (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://dvmd.de/fhir/CodeSystem/kdl" } Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:DokumentenKlassifizierung.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.type.coding:DokumentenKlassifizierung.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uriPattern	There are no (further) constraints on this element Element id DocumentReference.type.coding:DokumentenKlassifizierung.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern http://dvmd.de/fhir/CodeSystem/kdl Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:DokumentenKlassifizierung.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.type.coding:DokumentenKlassifizierung.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	S Σ	1..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:DokumentenKlassifizierung.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.type.coding:DokumentenKlassifizierung.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Rechnungstyp	S Σ	0..1	CodingPattern	Element id DocumentReference.type.coding:Rechnungstyp Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://dvmd.de/fhir/CodeSystem/kdl", "code": "AM010106" } Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
text	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
category	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id DocumentReference.category Short description Categorization of document Alternate names claxs Definition A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type. Comments Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching. Data type CodeableConcept Binding High-level kind of a clinical document at a macro level. DocumentClassValueSet (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class fhircomposition: Composition.class rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code xds: DocumentEntry.class cda: Derived from a mapping of /ClinicalDocument/code/@code to an Affinity Domain specified coded value to use and coding system. Affinity Domains are encouraged to use the appropriate value for Type of Service, based on the LOINC Type of Service (see Page 53 of the LOINC User's Manual). Must be consistent with /ClinicalDocument/code/@code
subject	S Σ	1..1	Reference(Patient \| Practitioner \| Group \| Device)	Element id DocumentReference.subject Short description Who/what is the subject of the document Definition Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure). Comments Vollständiger Name der behandelten Person. Siehe Abschnitt '4.8.1.1 Rechnung' des Feature-Dokuments E-Rechnung. Data type Reference(Patient \| Practitioner \| Group \| Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.subject w5: FiveWs.subject[x] fhircomposition: Composition.subject v2: PID-3 (No standard way to define a Practitioner or Group subject in HL7 v2 MDM message) rim: .participation[typeCode="SBJ"].role[typeCode="PAT"] xds: DocumentEntry.patientId cda: ClinicalDocument/recordTarget/ w5: FiveWs.subject
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.subject.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.subject.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
reference	Σ I	0..1	string	There are no (further) constraints on this element Element id DocumentReference.subject.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id DocumentReference.subject.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id DocumentReference.subject.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .identifier
display	S Σ	1..1	string	There are no (further) constraints on this element Element id DocumentReference.subject.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
date	Σ	0..1	instant	There are no (further) constraints on this element Element id DocumentReference.date Short description When this document reference was created Alternate names indexed Definition When the document reference was created. Comments Referencing/indexing time is used for tracking, organizing versions and searching. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.recorded fhircomposition: Composition.date rim: .availabilityTime[type="TS"]
author	S Σ	0..*	Reference(Practitioner \| PractitionerRole \| Organization \| Device \| Patient \| RelatedPerson)	Element id DocumentReference.author Short description Who and/or what authored the document Definition Identifies who is responsible for adding the information to the document. Comments Der Fachdienst verknüpft alle Rechnungsdokumente mit der Telematik-ID des einreichenden Akteurs. Data type Reference(Practitioner \| PractitionerRole \| Organization \| Device \| Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor fhircomposition: Composition.author v2: TXA-9 (No standard way to indicate a Device in HL7 v2 MDM message) rim: .participation[typeCode="AUT"].role[classCode="ASSIGNED"] xds: DocumentEntry.author cda: ClinicalDocument/author
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.author.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.author.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
reference	Σ I	0..1	string	There are no (further) constraints on this element Element id DocumentReference.author.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id DocumentReference.author.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
identifier	S Σ	1..1	IdentifierTelematikId	Element id DocumentReference.author.identifier Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data type IdentifierTelematikId Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .identifier rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier
display	S Σ	1..1	string	There are no (further) constraints on this element Element id DocumentReference.author.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
authenticator		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id DocumentReference.authenticator Short description Who/what authenticated the document Definition Which person or organization authenticates that this document is valid. Comments Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor w5: FiveWs.witness fhircomposition: Composition.attester v2: TXA-10 rim: .participation[typeCode="AUTHEN"].role[classCode="ASSIGNED"] xds: DocumentEntry.legalAuthenticator cda: ClinicalDocument/legalAuthenticator
custodian		0..1	Reference(Organization)	There are no (further) constraints on this element Element id DocumentReference.custodian Short description Organization which maintains the document Definition Identifies the organization or group who is responsible for ongoing maintenance of and access to the document. Comments Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor fhircomposition: Composition.custodian rim: .participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]
relatesTo	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element id DocumentReference.relatesTo Short description Relationships to other documents Definition Relationships that this document has with other document references that already exist. Comments This element is labeled as a modifier because documents that append to other documents are incomplete on their own. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.relatesTo rim: .outboundRelationship xds: DocumentEntry Associations
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.relatesTo.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.relatesTo.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.relatesTo.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
code	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.relatesTo.code Short description replaces \| transforms \| signs \| appends Definition The type of relationship that this document has with anther document. Comments If this document appends another document, then the document cannot be fully understood without also accessing the referenced document. Data type code Binding The type of relationship between documents. DocumentRelationshipType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.relatesTo.code rim: .outboundRelationship.typeCode xds: DocumentEntry Associations type
target	Σ	1..1	Reference(DocumentReference)	There are no (further) constraints on this element Element id DocumentReference.relatesTo.target Short description Target of the relationship Definition The target document of this relationship. Data type Reference(DocumentReference) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.relatesTo.target rim: .target[classCode="DOC", moodCode="EVN"].id xds: DocumentEntry Associations reference
description	S Σ	1..1	string	Element id DocumentReference.description Short description Human-readable description Definition Human-readable description of the source document. Requirements Helps humans to assess whether the document is of interest. Comments Menschenlesbarer Titel des Dokumentes, der dem Versicherten in der UI angezeigt wird. Der Titel kann manuell erfasst oder vom Dateinamen/Metadaten abgeleitet werden. z.B. "Laborbefund vom 28.9.2023". Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: TXA-25 rim: .outboundRelationship[typeCode="SUBJ"].target.text xds: DocumentEntry.comments
securityLabel	Σ	0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id DocumentReference.securityLabel Short description Document security-tags Definition A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to. Requirements Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended. Comments The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce. In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects. Data type CodeableConcept Binding Security Labels from the Healthcare Privacy and Security Classification System. All Security Labels (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.confidentiality, Composition.meta.security v2: TXA-18 rim: .confidentialityCode xds: DocumentEntry.confidentialityCode cda: ClinicalDocument/confidentialityCode/@code
content	S Σ	1..*	BackboneElement	Element id DocumentReference.content Short description Document referenced Definition The document and format referenced. There may be multiple content element repetitions, each with a different format. Data type BackboneElement Sliced: Unordered, Open, by format(Pattern) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Bundle(Composition+) rim:* document.text
(All Slices)				There are no (further) constraints on this element
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
attachment	Σ	1..1	Attachment	There are no (further) constraints on this element Element id DocumentReference.content.attachment Short description Where to access the document Definition The document or URL of the document along with critical metadata to prove content has integrity. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.language, Composition.title, Composition.date v2: TXA-3 for mime type rim: document.text xds: DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime cda: ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content.attachment.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content.attachment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
contentType	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.content.attachment.contentType Short description Mime type of the content, with charset etc. Definition Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate. Requirements Processors of the data need to be able to know how to interpret the data. Data type code Binding The mime type of an attachment. Any valid mime type is allowed. Mime Types (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General text/plain; charset=UTF-8, image/png Mappings v2: ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used rim: ./mediaType, ./charset
language	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.content.attachment.language Short description Human language of the content (BCP-47) Definition The human language of the content. The value can be any valid value according to BCP 47. Requirements Users need to be able to choose between the languages in a set of attachments. Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General en-AU Mappings rim: ./language
data		0..1	base64Binary	There are no (further) constraints on this element Element id DocumentReference.content.attachment.data Short description Data inline, base64ed Definition The actual data of the attachment - a sequence of bytes, base64 encoded. Requirements The data needs to able to be transmitted inline. Comments The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: ED.5 rim: ./data
url	Σ	0..1	url	Element id DocumentReference.content.attachment.url Short description Uri where the data can be found Definition A location where the data can be accessed. Requirements The data needs to be transmitted by reference. Comments Der FD muss die Base64-kodierten Daten aus attachment.data extrahieren und in eine Binary-Ressource auslagern. Data type url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/logo-small.png Mappings v2: RP.1+RP.2 - if they refer to a URL (see v2.6) rim: ./reference/literal
size	Σ	0..1	unsignedInt	There are no (further) constraints on this element Element id DocumentReference.content.attachment.size Short description Number of bytes of content (if url provided) Definition The number of bytes of data that make up this attachment (before base64 encoding, if that is done). Requirements Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all. Comments The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
hash	Σ	0..1	base64Binary	There are no (further) constraints on this element Element id DocumentReference.content.attachment.hash Short description Hash of the data (sha-1, base64ed) Definition The calculated hash of the data using SHA-1. Represented using base64. Requirements Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version). Comments The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
title	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.content.attachment.title Short description Label to display in place of the data Definition A label or set of text to display in place of the data. Requirements Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General Official Corporate Logo Mappings rim: ./title/data
creation	Σ	0..1	dateTime	There are no (further) constraints on this element Element id DocumentReference.content.attachment.creation Short description Date attachment was first created Definition The date that the attachment was first created. Requirements This is often tracked as an integrity issue for use of the attachment. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
format	Σ	0..1	CodingBinding	There are no (further) constraints on this element Element id DocumentReference.content.format Short description Format/content rules for the document Definition An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType. Comments Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI. Data type Coding Binding Document Format Codes. DocumentReferenceFormatCodeSet (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.meta.profile rim: document.text xds: DocumentEntry.formatCode cda: derived from the IHE Profile or Implementation Guide templateID
rechnungspdf	S Σ	0..1	BackboneElement	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf Short description Document referenced Definition The document and format referenced. There may be multiple content element repetitions, each with a different format. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Bundle(Composition+) rim:* document.text
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
attachment	S Σ	1..1	Attachment	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.attachment Short description Where to access the document Definition The document or URL of the document along with critical metadata to prove content has integrity. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.language, Composition.title, Composition.date v2: TXA-3 for mime type rim: document.text xds: DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime cda: ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.attachment.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.attachment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
contentType	S Σ	1..1	codeBindingPattern	Element id DocumentReference.content:rechnungspdf.attachment.contentType Short description Mime type of the content, with charset etc. Definition Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate. Requirements Processors of the data need to be able to know how to interpret the data. Comments Zum Zeitpunkt der Veröffentlichung werden nur PDF-Dokumente als Rechnung seitens der Leistungserbringer:in unterstützt. Data type code Binding The mime type of an attachment. Any valid mime type is allowed. Mime Types (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern application/pdf Mappings v2: ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used rim: ./mediaType, ./charset
language	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.attachment.language Short description Human language of the content (BCP-47) Definition The human language of the content. The value can be any valid value according to BCP 47. Requirements Users need to be able to choose between the languages in a set of attachments. Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General en-AU Mappings rim: ./language
data	S	1..1	base64Binary	Element id DocumentReference.content:rechnungspdf.attachment.data Short description Data inline, base64ed Definition The actual data of the attachment - a sequence of bytes, base64 encoded. Requirements The data needs to able to be transmitted inline. Comments Base64-kodiertes PDF. Dieses Feld muss durch die Applikation der Leistungserbringer:in gefüllt werden. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: ED.5 rim: ./data
url	S Σ	0..1	url	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.attachment.url Short description Uri where the data can be found Definition A location where the data can be accessed. Requirements The data needs to be transmitted by reference. Comments If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data. Data type url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/logo-small.png Mappings v2: RP.1+RP.2 - if they refer to a URL (see v2.6) rim: ./reference/literal
size	Σ	0..1	unsignedInt	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.attachment.size Short description Number of bytes of content (if url provided) Definition The number of bytes of data that make up this attachment (before base64 encoding, if that is done). Requirements Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all. Comments The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
hash	Σ	0..1	base64Binary	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.attachment.hash Short description Hash of the data (sha-1, base64ed) Definition The calculated hash of the data using SHA-1. Represented using base64. Requirements Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version). Comments The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
title	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.attachment.title Short description Label to display in place of the data Definition A label or set of text to display in place of the data. Requirements Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General Official Corporate Logo Mappings rim: ./title/data
creation	Σ	0..1	dateTime	There are no (further) constraints on this element Element id DocumentReference.content:rechnungspdf.attachment.creation Short description Date attachment was first created Definition The date that the attachment was first created. Requirements This is often tracked as an integrity issue for use of the attachment. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
format	S Σ	1..1	CodingBindingPattern	Element id DocumentReference.content:rechnungspdf.format Short description Format/content rules for the document Definition An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType. Comments Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI. Data type Coding Binding Document Format Codes. DocumentReferenceFormatCodeSet (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://gematik.de/fhir/erg/CodeSystem/erg-attachment-format-cs", "code": "erechnung" } Mappings fhircomposition: Composition.meta.profile rim: document.text xds: DocumentEntry.formatCode cda: derived from the IHE Profile or Implementation Guide templateID
angereicherteRechnung	S Σ	0..1	BackboneElement	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung Short description Document referenced Definition The document and format referenced. There may be multiple content element repetitions, each with a different format. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Bundle(Composition+) rim:* document.text
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
attachment	S Σ	1..1	Attachment	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.attachment Short description Where to access the document Definition The document or URL of the document along with critical metadata to prove content has integrity. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.language, Composition.title, Composition.date v2: TXA-3 for mime type rim: document.text xds: DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime cda: ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.attachment.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.attachment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
contentType	S Σ	1..1	codeBindingPattern	Element id DocumentReference.content:angereicherteRechnung.attachment.contentType Short description Mime type of the content, with charset etc. Definition Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate. Requirements Processors of the data need to be able to know how to interpret the data. Comments Zum Zeitpunkt der Veröffentlichung werden nur PDF-Dokumente als Rechnung seitens der Leistungserbringer:in unterstützt. Data type code Binding The mime type of an attachment. Any valid mime type is allowed. Mime Types (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern application/pdf Mappings v2: ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used rim: ./mediaType, ./charset
language	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.attachment.language Short description Human language of the content (BCP-47) Definition The human language of the content. The value can be any valid value according to BCP 47. Requirements Users need to be able to choose between the languages in a set of attachments. Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General en-AU Mappings rim: ./language
data		0..0	base64Binary	Element id DocumentReference.content:angereicherteRechnung.attachment.data Short description Data inline, base64ed Definition The actual data of the attachment - a sequence of bytes, base64 encoded. Requirements The data needs to able to be transmitted inline. Comments Die angereicherte Rechnung wird durch den FD direkt als Binary-Ressource unter attachment.url referenziert. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: ED.5 rim: ./data
url	S Σ	0..1	url	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.attachment.url Short description Uri where the data can be found Definition A location where the data can be accessed. Requirements The data needs to be transmitted by reference. Comments If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data. Data type url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/logo-small.png Mappings v2: RP.1+RP.2 - if they refer to a URL (see v2.6) rim: ./reference/literal
size	Σ	0..1	unsignedInt	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.attachment.size Short description Number of bytes of content (if url provided) Definition The number of bytes of data that make up this attachment (before base64 encoding, if that is done). Requirements Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all. Comments The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
hash	Σ	0..1	base64Binary	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.attachment.hash Short description Hash of the data (sha-1, base64ed) Definition The calculated hash of the data using SHA-1. Represented using base64. Requirements Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version). Comments The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
title	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.attachment.title Short description Label to display in place of the data Definition A label or set of text to display in place of the data. Requirements Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General Official Corporate Logo Mappings rim: ./title/data
creation	Σ	0..1	dateTime	There are no (further) constraints on this element Element id DocumentReference.content:angereicherteRechnung.attachment.creation Short description Date attachment was first created Definition The date that the attachment was first created. Requirements This is often tracked as an integrity issue for use of the attachment. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
format	S Σ	1..1	CodingBindingPattern	Element id DocumentReference.content:angereicherteRechnung.format Short description Format/content rules for the document Definition An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType. Comments Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI. Data type Coding Binding Document Format Codes. DocumentReferenceFormatCodeSet (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://gematik.de/fhir/erg/CodeSystem/erg-attachment-format-cs", "code": "angereichertesPDF" } Mappings fhircomposition: Composition.meta.profile rim: document.text xds: DocumentEntry.formatCode cda: derived from the IHE Profile or Implementation Guide templateID
strukturierterRechnungsinhalt	S Σ	0..1	BackboneElement	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt Short description Document referenced Definition The document and format referenced. There may be multiple content element repetitions, each with a different format. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Bundle(Composition+) rim:* document.text
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
attachment	S Σ	1..1	Attachment	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment Short description Where to access the document Definition The document or URL of the document along with critical metadata to prove content has integrity. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.language, Composition.title, Composition.date v2: TXA-3 for mime type rim: document.text xds: DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime cda: ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
contentType	S Σ	1..1	codeBinding	Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.contentType Short description Mime type of the content, with charset etc. Definition Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate. Requirements Processors of the data need to be able to know how to interpret the data. Comments Strukturierte Rechnungsinhalte können seitens der Leistungserbringer:in sowohl als JSON als auch XML übergeben werden. Data type code Binding The mime type of an attachment. Any valid mime type is allowed. ERGRestrictedMimeTypesVS (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General text/plain; charset=UTF-8, image/png Mappings v2: ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used rim: ./mediaType, ./charset
language	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.language Short description Human language of the content (BCP-47) Definition The human language of the content. The value can be any valid value according to BCP 47. Requirements Users need to be able to choose between the languages in a set of attachments. Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General en-AU Mappings rim: ./language
data	S	1..1	base64Binary	Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.data Short description Data inline, base64ed Definition The actual data of the attachment - a sequence of bytes, base64 encoded. Requirements The data needs to able to be transmitted inline. Comments Base64-kodierte Repräsentation der Rechnungsinhalte. Dieses Feld muss durch die Applikation der Leistungserbringer:in gefüllt werden. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: ED.5 rim: ./data
url	S Σ	0..1	url	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.url Short description Uri where the data can be found Definition A location where the data can be accessed. Requirements The data needs to be transmitted by reference. Comments If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data. Data type url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/logo-small.png Mappings v2: RP.1+RP.2 - if they refer to a URL (see v2.6) rim: ./reference/literal
size	Σ	0..1	unsignedInt	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.size Short description Number of bytes of content (if url provided) Definition The number of bytes of data that make up this attachment (before base64 encoding, if that is done). Requirements Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all. Comments The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
hash	Σ	0..1	base64Binary	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.hash Short description Hash of the data (sha-1, base64ed) Definition The calculated hash of the data using SHA-1. Represented using base64. Requirements Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version). Comments The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
title	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.title Short description Label to display in place of the data Definition A label or set of text to display in place of the data. Requirements Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General Official Corporate Logo Mappings rim: ./title/data
creation	Σ	0..1	dateTime	There are no (further) constraints on this element Element id DocumentReference.content:strukturierterRechnungsinhalt.attachment.creation Short description Date attachment was first created Definition The date that the attachment was first created. Requirements This is often tracked as an integrity issue for use of the attachment. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
format	S Σ	1..1	CodingBindingPattern	Element id DocumentReference.content:strukturierterRechnungsinhalt.format Short description Format/content rules for the document Definition An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType. Comments Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI. Data type Coding Binding Document Format Codes. DocumentReferenceFormatCodeSet (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://gematik.de/fhir/erg/CodeSystem/erg-attachment-format-cs", "code": "rechnungsinhalt" } Mappings fhircomposition: Composition.meta.profile rim: document.text xds: DocumentEntry.formatCode cda: derived from the IHE Profile or Implementation Guide templateID
anhang	S Σ	0..1	BackboneElement	There are no (further) constraints on this element Element id DocumentReference.content:anhang Short description Document referenced Definition The document and format referenced. There may be multiple content element repetitions, each with a different format. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Bundle(Composition+) rim:* document.text
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:anhang.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:anhang.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:anhang.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
attachment	S Σ	1..1	Attachment	There are no (further) constraints on this element Element id DocumentReference.content:anhang.attachment Short description Where to access the document Definition The document or URL of the document along with critical metadata to prove content has integrity. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.language, Composition.title, Composition.date v2: TXA-3 for mime type rim: document.text xds: DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime cda: ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:anhang.attachment.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content:anhang.attachment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
contentType	S Σ	1..1	codeBindingPattern	Element id DocumentReference.content:anhang.attachment.contentType Short description Mime type of the content, with charset etc. Definition Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate. Requirements Processors of the data need to be able to know how to interpret the data. Comments Zum Zeitpunkt der Veröffentlichung werden nur PDF-Dokumente als Rechnungsanhänge seitens der Leistungserbringer:in unterstützt. Data type code Binding The mime type of an attachment. Any valid mime type is allowed. Mime Types (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern application/pdf Mappings v2: ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used rim: ./mediaType, ./charset
language	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.content:anhang.attachment.language Short description Human language of the content (BCP-47) Definition The human language of the content. The value can be any valid value according to BCP 47. Requirements Users need to be able to choose between the languages in a set of attachments. Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General en-AU Mappings rim: ./language
data	S	1..1	base64Binary	Element id DocumentReference.content:anhang.attachment.data Short description Data inline, base64ed Definition The actual data of the attachment - a sequence of bytes, base64 encoded. Requirements The data needs to able to be transmitted inline. Comments Base64-kodiertes PDF. Dieses Feld muss durch die Applikation der Leistungserbringer:in gefüllt werden. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: ED.5 rim: ./data
url	S Σ	0..1	url	There are no (further) constraints on this element Element id DocumentReference.content:anhang.attachment.url Short description Uri where the data can be found Definition A location where the data can be accessed. Requirements The data needs to be transmitted by reference. Comments If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data. Data type url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/logo-small.png Mappings v2: RP.1+RP.2 - if they refer to a URL (see v2.6) rim: ./reference/literal
size	Σ	0..1	unsignedInt	There are no (further) constraints on this element Element id DocumentReference.content:anhang.attachment.size Short description Number of bytes of content (if url provided) Definition The number of bytes of data that make up this attachment (before base64 encoding, if that is done). Requirements Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all. Comments The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
hash	Σ	0..1	base64Binary	There are no (further) constraints on this element Element id DocumentReference.content:anhang.attachment.hash Short description Hash of the data (sha-1, base64ed) Definition The calculated hash of the data using SHA-1. Represented using base64. Requirements Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version). Comments The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
title	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.content:anhang.attachment.title Short description Label to display in place of the data Definition A label or set of text to display in place of the data. Requirements Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General Official Corporate Logo Mappings rim: ./title/data
creation	Σ	0..1	dateTime	There are no (further) constraints on this element Element id DocumentReference.content:anhang.attachment.creation Short description Date attachment was first created Definition The date that the attachment was first created. Requirements This is often tracked as an integrity issue for use of the attachment. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
format	S Σ	1..1	CodingBindingPattern	Element id DocumentReference.content:anhang.format Short description Format/content rules for the document Definition An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType. Comments Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI. Data type Coding Binding Document Format Codes. DocumentReferenceFormatCodeSet (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://gematik.de/fhir/erg/CodeSystem/erg-attachment-format-cs", "code": "rechnungsanhang" } Mappings fhircomposition: Composition.meta.profile rim: document.text xds: DocumentEntry.formatCode cda: derived from the IHE Profile or Implementation Guide templateID
context	S Σ	0..1	BackboneElement	There are no (further) constraints on this element Element id DocumentReference.context Short description Clinical context of document Definition The clinical context in which the document was prepared. Comments These values are primarily added to help with searching for interesting/relevant documents. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: outboundRelationship[typeCode="SUBJ"].target[classCode<'ACT']
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
encounter		0..*	Reference(Encounter \| EpisodeOfCare)	There are no (further) constraints on this element Element id DocumentReference.context.encounter Short description Context of the document content Definition Describes the clinical encounter or type of care that the document content is associated with. Data type Reference(Encounter \| EpisodeOfCare) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.context w5: FiveWs.context fhircomposition: Composition.encounter rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
event		0..*	CodeableConcept	There are no (further) constraints on this element Element id DocumentReference.context.event Short description Main clinical acts documented Definition This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act. Comments An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation. Data type CodeableConcept Binding This list of codes represents the main clinical acts being documented. v3.ActCode (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.event.code rim: .code xds: DocumentEntry.eventCodeList
period	Σ	0..1	Period	There are no (further) constraints on this element Element id DocumentReference.context.period Short description Time of service that is being documented Definition The time period over which the service that is described by the document was provided. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.event.period rim: .effectiveTime xds: DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime cda: ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/low/ @value --> ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/high/ @value
facilityType		0..1	CodeableConcept	There are no (further) constraints on this element Element id DocumentReference.context.facilityType Short description Kind of facility where patient was seen Definition The kind of facility where the patient was seen. Data type CodeableConcept Binding XDS Facility Type. FacilityTypeCodeValueSet (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: usually from a mapping to a local ValueSet rim: .participation[typeCode="LOC"].role[classCode="DSDLOC"].code xds: DocumentEntry.healthcareFacilityTypeCode cda: usually a mapping to a local ValueSet. Must be consistent with /clinicalDocument/code
practiceSetting		0..1	CodeableConcept	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting Short description Additional details about where the content was created (e.g. clinical specialty) Definition This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty. Requirements This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content. Comments This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC. Data type CodeableConcept Binding Additional details about where the content was created (e.g. clinical specialty). PracticeSettingCodeValueSet (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: usually from a mapping to a local ValueSet rim: .participation[typeCode="LOC"].role[classCode="DSDLOC"].code xds: DocumentEntry.practiceSettingCode cda: usually from a mapping to a local ValueSet
sourcePatientInfo		0..1	Reference(Patient)	There are no (further) constraints on this element Element id DocumentReference.context.sourcePatientInfo Short description Patient demographics from source Definition The Patient Information as known when the document was published. May be a reference to a version specific, or contained. Data type Reference(Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.subject rim: .participation[typeCode="SBJ"].role[typeCode="PAT"] xds: DocumentEntry.sourcePatientInfo, DocumentEntry.sourcePatientId cda: ClinicalDocument/recordTarget/
related	S	1..*	Reference(Resource)	Element id DocumentReference.context.related Short description Related identifiers or resources Definition Related identifiers or resources associated with the DocumentReference. Comments Der Fachdienst verknüpft alle Rechnungsdokumente mit der Rechnungsempfänger:in. Data type Reference(Resource) Sliced: Unordered, Open, by $this.resolve()(Type) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.event.detail rim: ./outboundRelationship[typeCode="PERT" and isNormalActRelationship()] / target[isNormalAct] xds: DocumentEntry.referenceIdList cda: ClinicalDocument/relatedDocument
patient	S	1..1	Reference(Patient)	Element id DocumentReference.context.related:patient Short description Related identifiers or resources Definition Related identifiers or resources associated with the DocumentReference. Comments May be identifiers or resources that caused the DocumentReference or referenced Document to be created. Data type Reference(Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.event.detail rim: ./outboundRelationship[typeCode="PERT" and isNormalActRelationship()] / target[isNormalAct] xds: DocumentEntry.referenceIdList cda: ClinicalDocument/relatedDocument
anhaenge	S	0..*	Reference(DocumentReference)	Element id DocumentReference.context.related:anhaenge Short description Related identifiers or resources Definition Related identifiers or resources associated with the DocumentReference. Comments May be identifiers or resources that caused the DocumentReference or referenced Document to be created. Data type Reference(DocumentReference) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.event.detail rim: ./outboundRelationship[typeCode="PERT" and isNormalActRelationship()] / target[isNormalAct] xds: DocumentEntry.referenceIdList cda: ClinicalDocument/relatedDocument

Folgende Implementierungshinweise sind zu beachten:

DocumentReference.meta.extension:markierung	Vgl. Abschnitt '4.4.2 Markierungen' des Feature-Dokuments E-Rechnung
DocumentReference.meta.tag	Metaangaben zur E-Rechnung die sich auf das Rechnungsdokument als Ganzes beziehen und nicht Teil des durch den RE-PS erstellten Dokuments sind.
DocumentReference.meta.tag:erg-rechnungsstatus	Vgl. Abschnitt 4.4.1 Workflow einer Rechnung des Feature-Dokuments E-Rechnung
DocumentReference.extension:rechnungsdatum	Siehe Abschnitt '4.8.1.1 Rechnung' des Feature-Dokuments E-Rechnung
DocumentReference.extension:zahlungszieldatum	Siehe Abschnitt '4.8.1.1 Rechnung' des Feature-Dokuments E-Rechnung
DocumentReference.extension:gesamtbetrag	Siehe Abschnitt '4.8.1.1 Rechnung' des Feature-Dokuments E-Rechnung
DocumentReference.identifier	Eindeutiger Identifikator vergeben durch das RE-PS (z.B. Interne Dokumentennummer). Das System MUSS eindeutig pro Leistungserbringer:in vergeben werden.
DocumentReference.status	Versionierung von Dokumenten ist nicht unterstützt. Nur jeweils die aktuelle Version des Dokumentes wird akzeptiert.
DocumentReference.type	Kodierung des Dokumentes als 'Rechnung', sowie darüber hinausgehende Klassifizierung per KDL
DocumentReference.subject	Vollständiger Name der behandelten Person. Siehe Abschnitt '4.8.1.1 Rechnung' des Feature-Dokuments E-Rechnung.
DocumentReference.author	Der Fachdienst verknüpft alle Rechnungsdokumente mit der Telematik-ID des einreichenden Akteurs.
DocumentReference.description	Menschenlesbarer Titel des Dokumentes, der dem Versicherten in der UI angezeigt wird. Der Titel kann manuell erfasst oder vom Dateinamen/Metadaten abgeleitet werden. z.B. "Laborbefund vom 28.9.2023".
DocumentReference.content.attachment.url	Der FD muss die Base64-kodierten Daten aus attachment.data extrahieren und in eine Binary-Ressource auslagern.
DocumentReference.content:rechnungspdf.attachment.contentType	Zum Zeitpunkt der Veröffentlichung werden nur PDF-Dokumente als Rechnung seitens der Leistungserbringer:in unterstützt.
DocumentReference.content:rechnungspdf.attachment.data	Base64-kodiertes PDF. Dieses Feld muss durch die Applikation der Leistungserbringer:in gefüllt werden.
DocumentReference.content:angereicherteRechnung.attachment.contentType	Zum Zeitpunkt der Veröffentlichung werden nur PDF-Dokumente als Rechnung seitens der Leistungserbringer:in unterstützt.
DocumentReference.content:angereicherteRechnung.attachment.data	Die angereicherte Rechnung wird durch den FD direkt als Binary-Ressource unter attachment.url referenziert.
DocumentReference.content:strukturierterRechnungsinhalt.attachment.contentType	Strukturierte Rechnungsinhalte können seitens der Leistungserbringer:in sowohl als JSON als auch XML übergeben werden.
DocumentReference.content:strukturierterRechnungsinhalt.attachment.data	Base64-kodierte Repräsentation der Rechnungsinhalte. Dieses Feld muss durch die Applikation der Leistungserbringer:in gefüllt werden.
DocumentReference.content:anhang.attachment.contentType	Zum Zeitpunkt der Veröffentlichung werden nur PDF-Dokumente als Rechnungsanhänge seitens der Leistungserbringer:in unterstützt.
DocumentReference.content:anhang.attachment.data	Base64-kodiertes PDF. Dieses Feld muss durch die Applikation der Leistungserbringer:in gefüllt werden.
DocumentReference.context.related	Der Fachdienst verknüpft alle Rechnungsdokumente mit der Rechnungsempfänger:in.

Beispiele

DocumentReference

id : BeispielDocumentReferenceRechnung3-LE

extension

url : http://example.org/StructureDefinition/signatur

value

type

system : urn:iso-astm:E1762-95:2013

code : 1.2.840.10065.1.12.1.1

display : Author's Signature

when : 2015-02-07T13:28:17.239+02:00

who

display : Arzt

status : current

type

coding

system : http://dvmd.de/fhir/CodeSystem/kdl

code : AM010106

display : Rechnung ambulante/stationäre Behandlung

subject

identifier

system : http://fhir.de/sid/gkv/kvid-10

value : A000000000

description : Rechnung Reiseimpfung vom 10.01.2024

content

attachment

contentType : application/pdf

data : DIESISTNUREINBEISPIELDIESISTKEINVALIDESPDF00

content

attachment

contentType : application/xml

data : DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00

format

code : xrechnung

content

attachment

contentType : application/fhir+xml

data : DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00

format

code : gematik-erechnung

<DocumentReference xmlns="http://hl7.org/fhir">
    <id value="BeispielDocumentReferenceRechnung3-LE" />
    <extension url="http://example.org/StructureDefinition/signatur">
        <valueSignature>
            <type>
                <system value="urn:iso-astm:E1762-95:2013" />
                <code value="1.2.840.10065.1.12.1.1" />
                <display value="Author&#39;s Signature" />
            </type>
            <when value="2015-02-07T13:28:17.239+02:00" />
            <who>
                <display value="Arzt" />
            </who>
        </valueSignature>
    </extension>
    <status value="current" />
    <type>
        <coding>
            <system value="http://dvmd.de/fhir/CodeSystem/kdl" />
            <code value="AM010106" />
            <display value="Rechnung ambulante/station&#228;re Behandlung" />
        </coding>
    </type>
    <subject>
        <identifier>
            <system value="http://fhir.de/sid/gkv/kvid-10" />
            <value value="A000000000" />
        </identifier>
    </subject>
    <description value="Rechnung Reiseimpfung vom 10.01.2024" />
    <content>
        <attachment>
            <contentType value="application/pdf" />
            <data value="DIESISTNUREINBEISPIELDIESISTKEINVALIDESPDF00" />
        </attachment>
    </content>
    <content>
        <attachment>
            <contentType value="application/xml" />
            <data value="DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00" />
        </attachment>
        <format>
            <code value="xrechnung" />
        </format>
    </content>
    <content>
        <attachment>
            <contentType value="application/fhir+xml" />
            <data value="DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00" />
        </attachment>
        <format>
            <code value="gematik-erechnung" />
        </format>
    </content>
</DocumentReference>

{
    "resourceType": "DocumentReference",
    "id": "BeispielDocumentReferenceRechnung3-LE",
    "status": "current",
    "type": {
        "coding":  [
            {
                "code": "AM010106",
                "system": "http://dvmd.de/fhir/CodeSystem/kdl",
                "display": "Rechnung ambulante/stationäre Behandlung"
            }
        ]
    },
    "description": "Rechnung Reiseimpfung vom 10.01.2024",
    "subject": {
        "identifier": {
            "system": "http://fhir.de/sid/gkv/kvid-10",
            "value": "A000000000"
        }
    },
    "content":  [
        {
            "attachment": {
                "contentType": "application/pdf",
                "data": "DIESISTNUREINBEISPIELDIESISTKEINVALIDESPDF00"
            }
        },
        {
            "format": {
                "code": "xrechnung"
            },
            "attachment": {
                "contentType": "application/xml",
                "data": "DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00"
            }
        },
        {
            "format": {
                "code": "gematik-erechnung"
            },
            "attachment": {
                "contentType": "application/fhir+xml",
                "data": "DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00"
            }
        }
    ],
    "extension":  [
        {
            "url": "http://example.org/StructureDefinition/signatur",
            "valueSignature": {
                "type":  [
                    {
                        "code": "1.2.840.10065.1.12.1.1",
                        "system": "urn:iso-astm:E1762-95:2013",
                        "display": "Author's Signature"
                    }
                ],
                "when": "02/07/2015 11:28:17",
                "who": {
                    "display": "Arzt"
                }
            }
        }
    ]
}

BeispielDocumentReferenceRechnung3-LE

HTTP POST [fachdienst-endpunkt]/Patient/[id-des-ermittelten-Rechnungsempfängers]/$submit

Parameters

id : BeispielParameterSubmitInput3-LE

parameter

name : rechnung

resource

id : BeispielDocumentReferenceRechnung3-LE

extension

url : http://example.org/StructureDefinition/signatur

value

type

system : urn:iso-astm:E1762-95:2013

code : 1.2.840.10065.1.12.1.1

display : Author's Signature

when : 2015-02-07T13:28:17.239+02:00

who

display : Arzt

status : current

type

coding

system : http://dvmd.de/fhir/CodeSystem/kdl

code : AM010106

display : Rechnung ambulante/stationäre Behandlung

subject

identifier

system : http://fhir.de/sid/gkv/kvid-10

value : A000000000

description : Rechnung Reiseimpfung vom 10.01.2024

content

attachment

contentType : application/pdf

data : DIESISTNUREINBEISPIELDIESISTKEINVALIDESPDF00

content

attachment

contentType : application/xml

data : DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00

format

code : xrechnung

content

attachment

contentType : application/fhir+xml

data : DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00

format

code : gematik-erechnung

parameter

name : anhang

resource

id : BeispielDocumentReferenceSonstigesDokument3-LE

status : current

type

coding

system : http://dvmd.de/fhir/CodeSystem/kdl

code : PT130102

display : Molekularpathologiebefund

subject

reference : Patient/BeispielPatient3-FD

description : Molekularpathologiebefund vom 31.12.21

content

attachment

contentType : application/pdf

data : DIESISTNUREINBEISPIELDIESISTKEINVALIDESPDF00

<Parameters xmlns="http://hl7.org/fhir">
    <id value="BeispielParameterSubmitInput3-LE" />
    <parameter>
        <name value="rechnung" />
        <resource>
            <DocumentReference>
                <id value="BeispielDocumentReferenceRechnung3-LE" />
                <extension url="http://example.org/StructureDefinition/signatur">
                    <valueSignature>
                        <type>
                            <system value="urn:iso-astm:E1762-95:2013" />
                            <code value="1.2.840.10065.1.12.1.1" />
                            <display value="Author&#39;s Signature" />
                        </type>
                        <when value="2015-02-07T13:28:17.239+02:00" />
                        <who>
                            <display value="Arzt" />
                        </who>
                    </valueSignature>
                </extension>
                <status value="current" />
                <type>
                    <coding>
                        <system value="http://dvmd.de/fhir/CodeSystem/kdl" />
                        <code value="AM010106" />
                        <display value="Rechnung ambulante/station&#228;re Behandlung" />
                    </coding>
                </type>
                <subject>
                    <identifier>
                        <system value="http://fhir.de/sid/gkv/kvid-10" />
                        <value value="A000000000" />
                    </identifier>
                </subject>
                <description value="Rechnung Reiseimpfung vom 10.01.2024" />
                <content>
                    <attachment>
                        <contentType value="application/pdf" />
                        <data value="DIESISTNUREINBEISPIELDIESISTKEINVALIDESPDF00" />
                    </attachment>
                </content>
                <content>
                    <attachment>
                        <contentType value="application/xml" />
                        <data value="DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00" />
                    </attachment>
                    <format>
                        <code value="xrechnung" />
                    </format>
                </content>
                <content>
                    <attachment>
                        <contentType value="application/fhir+xml" />
                        <data value="DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00" />
                    </attachment>
                    <format>
                        <code value="gematik-erechnung" />
                    </format>
                </content>
            </DocumentReference>
        </resource>
    </parameter>
    <parameter>
        <name value="anhang" />
        <resource>
            <DocumentReference>
                <id value="BeispielDocumentReferenceSonstigesDokument3-LE" />
                <status value="current" />
                <type>
                    <coding>
                        <system value="http://dvmd.de/fhir/CodeSystem/kdl" />
                        <code value="PT130102" />
                        <display value="Molekularpathologiebefund" />
                    </coding>
                </type>
                <subject>
                    <reference value="Patient/BeispielPatient3-FD" />
                </subject>
                <description value="Molekularpathologiebefund vom 31.12.21" />
                <content>
                    <attachment>
                        <contentType value="application/pdf" />
                        <data value="DIESISTNUREINBEISPIELDIESISTKEINVALIDESPDF00" />
                    </attachment>
                </content>
            </DocumentReference>
        </resource>
    </parameter>
</Parameters>

{
    "resourceType": "Parameters",
    "id": "BeispielParameterSubmitInput3-LE",
    "parameter":  [
        {
            "name": "rechnung",
            "resource": {
                "resourceType": "DocumentReference",
                "id": "BeispielDocumentReferenceRechnung3-LE",
                "status": "current",
                "type": {
                    "coding":  [
                        {
                            "code": "AM010106",
                            "system": "http://dvmd.de/fhir/CodeSystem/kdl",
                            "display": "Rechnung ambulante/stationäre Behandlung"
                        }
                    ]
                },
                "description": "Rechnung Reiseimpfung vom 10.01.2024",
                "subject": {
                    "identifier": {
                        "system": "http://fhir.de/sid/gkv/kvid-10",
                        "value": "A000000000"
                    }
                },
                "content":  [
                    {
                        "attachment": {
                            "contentType": "application/pdf",
                            "data": "DIESISTNUREINBEISPIELDIESISTKEINVALIDESPDF00"
                        }
                    },
                    {
                        "format": {
                            "code": "xrechnung"
                        },
                        "attachment": {
                            "contentType": "application/xml",
                            "data": "DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00"
                        }
                    },
                    {
                        "format": {
                            "code": "gematik-erechnung"
                        },
                        "attachment": {
                            "contentType": "application/fhir+xml",
                            "data": "DIESISTNUREINBEISPIELDIESISTKEINVALIDESXML00"
                        }
                    }
                ],
                "extension":  [
                    {
                        "url": "http://example.org/StructureDefinition/signatur",
                        "valueSignature": {
                            "type":  [
                                {
                                    "code": "1.2.840.10065.1.12.1.1",
                                    "system": "urn:iso-astm:E1762-95:2013",
                                    "display": "Author's Signature"
                                }
                            ],
                            "when": "02/07/2015 11:28:17",
                            "who": {
                                "display": "Arzt"
                            }
                        }
                    }
                ]
            }
        },
        {
            "name": "anhang",
            "resource": {
                "resourceType": "DocumentReference",
                "id": "BeispielDocumentReferenceSonstigesDokument3-LE",
                "status": "current",
                "type": {
                    "coding":  [
                        {
                            "code": "PT130102",
                            "system": "http://dvmd.de/fhir/CodeSystem/kdl",
                            "display": "Molekularpathologiebefund"
                        }
                    ]
                },
                "description": "Molekularpathologiebefund vom 31.12.21",
                "subject": {
                    "reference": "Patient/BeispielPatient3-FD"
                },
                "content":  [
                    {
                        "attachment": {
                            "contentType": "application/pdf",
                            "data": "DIESISTNUREINBEISPIELDIESISTKEINVALIDESPDF00"
                        }
                    }
                ]
            }
        }
    ]
}

Parameters

Antwort des Fachdienstes im Erfolgsfall:

Rückgabe von Rechung und Anhang jeweils mit aufgebrachtem Token und separiertem Inhalt. Bei Verwendung des Parameters "returnTokenPDF" werden die Binaries mit den PDF/A-Dokumenten (incl. Token-Barcode) als Parameter direkt mit ausgegeben.

HTTP 200 OK

mit Body:

Parameters

id : BeispielParameterSubmitOutput3-FD

parameter

name : rechnung

resource

id : BeispielDocumentReferenceRechnung3-FD

identifier

system : https://gematik.de/fhir/sid/erg-token

value : 123-456-789

status : current

type

coding

system : http://dvmd.de/fhir/CodeSystem/kdl

code : AM010106

display : Rechnung ambulante/stationäre Behandlung

subject

identifier

system : http://fhir.de/sid/gkv/kvid-10

value : A000000000

relatesTo

code : transforms

target

reference : DocumentReference/BeispielDocumentReferenceRechnung3-LE

description : Rechnung Reiseimpfung vom 10.01.2024

content

attachment

contentType : application/pdf

url : [FD-endpunkt]/Binary/pdf-mit-token-barcode

content

attachment

contentType : application/xml

url : [FD-endpunkt]/Binary/xrechnung

format

code : xrechnung

content

attachment

contentType : application/fhir+xml

url : [FD-endpunkt]/Binary/invoice

format

code : gematik-erechnung

parameter

name : anhang

resource

id : BeispielDocumentReferenceSonstigesDokument3-FD

identifier

system : https://gematik.de/fhir/sid/erg-token

value : 987-654-321

status : current

type

coding

system : http://dvmd.de/fhir/CodeSystem/kdl

code : PT130102

display : Molekularpathologiebefund

subject

reference : Patient/BeispielPatient3-FD

relatesTo

code : transforms

target

reference : DocumentReference/BeispielDocumentReferenceSonstigesDokument3-LE

description : Molekularpathologiebefund vom 31.12.21

content

attachment

contentType : application/pdf

url : [FD-endpunkt]/Binary/patho-mit-token-barcode

<Parameters xmlns="http://hl7.org/fhir">
    <id value="BeispielParameterSubmitOutput3-FD" />
    <parameter>
        <name value="rechnung" />
        <resource>
            <DocumentReference>
                <id value="BeispielDocumentReferenceRechnung3-FD" />
                <identifier>
                    <system value="https://gematik.de/fhir/sid/erg-token" />
                    <value value="123-456-789" />
                </identifier>
                <status value="current" />
                <type>
                    <coding>
                        <system value="http://dvmd.de/fhir/CodeSystem/kdl" />
                        <code value="AM010106" />
                        <display value="Rechnung ambulante/station&#228;re Behandlung" />
                    </coding>
                </type>
                <subject>
                    <identifier>
                        <system value="http://fhir.de/sid/gkv/kvid-10" />
                        <value value="A000000000" />
                    </identifier>
                </subject>
                <relatesTo>
                    <code value="transforms" />
                    <target>
                        <reference value="DocumentReference/BeispielDocumentReferenceRechnung3-LE" />
                    </target>
                </relatesTo>
                <description value="Rechnung Reiseimpfung vom 10.01.2024" />
                <content>
                    <attachment>
                        <contentType value="application/pdf" />
                        <url value="[FD-endpunkt]/Binary/pdf-mit-token-barcode" />
                    </attachment>
                </content>
                <content>
                    <attachment>
                        <contentType value="application/xml" />
                        <url value="[FD-endpunkt]/Binary/xrechnung" />
                    </attachment>
                    <format>
                        <code value="xrechnung" />
                    </format>
                </content>
                <content>
                    <attachment>
                        <contentType value="application/fhir+xml" />
                        <url value="[FD-endpunkt]/Binary/invoice" />
                    </attachment>
                    <format>
                        <code value="gematik-erechnung" />
                    </format>
                </content>
            </DocumentReference>
        </resource>
    </parameter>
    <parameter>
        <name value="anhang" />
        <resource>
            <DocumentReference>
                <id value="BeispielDocumentReferenceSonstigesDokument3-FD" />
                <identifier>
                    <system value="https://gematik.de/fhir/sid/erg-token" />
                    <value value="987-654-321" />
                </identifier>
                <status value="current" />
                <type>
                    <coding>
                        <system value="http://dvmd.de/fhir/CodeSystem/kdl" />
                        <code value="PT130102" />
                        <display value="Molekularpathologiebefund" />
                    </coding>
                </type>
                <subject>
                    <reference value="Patient/BeispielPatient3-FD" />
                </subject>
                <relatesTo>
                    <code value="transforms" />
                    <target>
                        <reference value="DocumentReference/BeispielDocumentReferenceSonstigesDokument3-LE" />
                    </target>
                </relatesTo>
                <description value="Molekularpathologiebefund vom 31.12.21" />
                <content>
                    <attachment>
                        <contentType value="application/pdf" />
                        <url value="[FD-endpunkt]/Binary/patho-mit-token-barcode" />
                    </attachment>
                </content>
            </DocumentReference>
        </resource>
    </parameter>
</Parameters>

{
    "resourceType": "Parameters",
    "id": "BeispielParameterSubmitOutput3-FD",
    "parameter":  [
        {
            "name": "rechnung",
            "resource": {
                "resourceType": "DocumentReference",
                "id": "BeispielDocumentReferenceRechnung3-FD",
                "identifier":  [
                    {
                        "system": "https://gematik.de/fhir/sid/erg-token",
                        "value": "123-456-789"
                    }
                ],
                "status": "current",
                "type": {
                    "coding":  [
                        {
                            "code": "AM010106",
                            "system": "http://dvmd.de/fhir/CodeSystem/kdl",
                            "display": "Rechnung ambulante/stationäre Behandlung"
                        }
                    ]
                },
                "description": "Rechnung Reiseimpfung vom 10.01.2024",
                "subject": {
                    "identifier": {
                        "system": "http://fhir.de/sid/gkv/kvid-10",
                        "value": "A000000000"
                    }
                },
                "content":  [
                    {
                        "attachment": {
                            "contentType": "application/pdf",
                            "url": "[FD-endpunkt]/Binary/pdf-mit-token-barcode"
                        }
                    },
                    {
                        "format": {
                            "code": "xrechnung"
                        },
                        "attachment": {
                            "contentType": "application/xml",
                            "url": "[FD-endpunkt]/Binary/xrechnung"
                        }
                    },
                    {
                        "format": {
                            "code": "gematik-erechnung"
                        },
                        "attachment": {
                            "contentType": "application/fhir+xml",
                            "url": "[FD-endpunkt]/Binary/invoice"
                        }
                    }
                ],
                "relatesTo":  [
                    {
                        "code": "transforms",
                        "target": {
                            "reference": "DocumentReference/BeispielDocumentReferenceRechnung3-LE"
                        }
                    }
                ]
            }
        },
        {
            "name": "anhang",
            "resource": {
                "resourceType": "DocumentReference",
                "id": "BeispielDocumentReferenceSonstigesDokument3-FD",
                "identifier":  [
                    {
                        "system": "https://gematik.de/fhir/sid/erg-token",
                        "value": "987-654-321"
                    }
                ],
                "status": "current",
                "type": {
                    "coding":  [
                        {
                            "code": "PT130102",
                            "system": "http://dvmd.de/fhir/CodeSystem/kdl",
                            "display": "Molekularpathologiebefund"
                        }
                    ]
                },
                "description": "Molekularpathologiebefund vom 31.12.21",
                "subject": {
                    "reference": "Patient/BeispielPatient3-FD"
                },
                "content":  [
                    {
                        "attachment": {
                            "contentType": "application/pdf",
                            "url": "[FD-endpunkt]/Binary/patho-mit-token-barcode"
                        }
                    }
                ],
                "relatesTo":  [
                    {
                        "code": "transforms",
                        "target": {
                            "reference": "DocumentReference/BeispielDocumentReferenceSonstigesDokument3-LE"
                        }
                    }
                ]
            }
        }
    ]
}

Parameters

Verarbeitungsschritte im FD

Bei der Entgegennahme der Dokumente MÜSSEN durch den FD die nachfolgenden Schritte durchgeführt werden. Es ist zu beachten, dass dies asynchron durchgeführt werden kann durch den FD. Lediglich MUSS der FD sicherstellen, dass dieser Prozess vor dem Abruf der Dokumente durch das eRg FdV oder dem RE-PS abgearbeitet wurde.

DocumentReference.attachment.data muss aus der übermittelten DocumentReference herausgelöst werden. Der Inhalt MUSS in einer durch den FD neu angelegten Binary-Ressource gespeichert werden. Die Binary-Ressource MUSS unter attachment.url mit einer absoluten URL referenziert werden. DocumentReference.attachment.data ist anschließend zu löschen. Dies gilt für alle durch den Client übermittelte Dokumente.
Die originale Rechnung (DocumentReference.type = KDL#AM010106) MUSS angereichert werden mit den strukturierten Rechnungsinhalten. Der FD MUSS die Inhalte strukturiert im FHIR-Format innerhalb eines PDF/A einbetten.
Das neu erzeugte PDF/A muss als Binary nach den Vorgaben von DocumentReference.content:angereicherteRechnung aus dem oben aufgeführten Profil hinterlegt werden.
Für jedes PDF/A-Dokument MUSS der FD ein Token unter Einhaltung einer ausreichenden Entropie erstellen. Der FD MUSS zusätzlich einen Barcode auf dem Rechnungs- oder Anhangdokument unterbringen welcher das Dokumententoken kodiert enthält. Die Lesbarkeit der Inhalte des Dokumtes darf hierdurch nicht eingeschränkt werden. Die Zugehörigkeit eines Tokens zu einem Dokument MUSS gespeichert werden, um den Abruf eines Dokumentes mit diesem Token zu ermöglichen.
DocumentReference.context.related MUSS durch den FD auf die ID des ermittelten Rechnungsempfängers gesetzt werden.
DocumentReference.author.identifier MUSS durch den FD auf die im Access-Token enthaltene Telematik-ID gesetzt werden. Durch den Client übermittelte Angaben in DocumentReference.author sind zu überschreiben.
Hinweis: In der FHIR-Repräsentation erfolgt keine Differenzierung zwischen dem Datenobjekt für die Rechnungsdokumente und dem Rechnungsworkflow. Der Workflowstatus wird somit innerhalb der DocumentReference abgebildet. DocumentReference.meta.tag:erg-rechnungsstatus MUSS durch den FD auf "Offen" gesetzt werden beim Empfang der Rechnung.

Hinweise zur Abbildung des Workflow-Objektes (fachliches Datenmodell)

Im fachlichen Datenmodell des Feature-Dokuments E-Rechnung ist dargestellt, dass jede Rechnung,sowie jedes ergänzende Dokument mit einem Rechnungsworkflow-Objekt verbunden ist. Dieses Workflow-Objekt bündelt das Rechnungsdokument sowie die Anhänge zusammen und gibt diesen Dokumenten einen gemeinsamen Status. Zur Vereinfachung der Implementierung seitens des FD und des eRg FDV wird in der FHIR-Repräsentation kein weiteres Datenobjekt hierfür verwendet. Hingegen enthält das Profil 'ERGDokumentenmetadaten' eine Extension 'erg-rechnungsstatus' für diesen Zweck. Der Status zusammenhängender Dokumente MUSS stets synchron gehalten werden. Diese Extension gilt für das Rechnungsdokument sowie alle Anhänge, die innerhalb einer Submit-Operation im gleichen Kontext übermittelt worden sind wie die Rechnung. Der FD MUSS den Zusammenhang zwischen diesen Dokumenten in der Verarbeitungslogik vorhalten.

Beispiele

Beispiel: Rechnungsdokument nach Verarbeitung auf Server

DocumentReference

id : BeispielDocumentReferenceRechnung3-FD

identifier

system : https://gematik.de/fhir/sid/erg-token

value : 123-456-789

status : current

type

coding

system : http://dvmd.de/fhir/CodeSystem/kdl

code : AM010106

display : Rechnung ambulante/stationäre Behandlung

subject

identifier

system : http://fhir.de/sid/gkv/kvid-10

value : A000000000

relatesTo

code : transforms

target

reference : DocumentReference/BeispielDocumentReferenceRechnung3-LE

description : Rechnung Reiseimpfung vom 10.01.2024

content

attachment

contentType : application/pdf

url : [FD-endpunkt]/Binary/pdf-mit-token-barcode

content

attachment

contentType : application/xml

url : [FD-endpunkt]/Binary/xrechnung

format

code : xrechnung

content

attachment

contentType : application/fhir+xml

url : [FD-endpunkt]/Binary/invoice

format

code : gematik-erechnung

<DocumentReference xmlns="http://hl7.org/fhir">
    <id value="BeispielDocumentReferenceRechnung3-FD" />
    <identifier>
        <system value="https://gematik.de/fhir/sid/erg-token" />
        <value value="123-456-789" />
    </identifier>
    <status value="current" />
    <type>
        <coding>
            <system value="http://dvmd.de/fhir/CodeSystem/kdl" />
            <code value="AM010106" />
            <display value="Rechnung ambulante/station&#228;re Behandlung" />
        </coding>
    </type>
    <subject>
        <identifier>
            <system value="http://fhir.de/sid/gkv/kvid-10" />
            <value value="A000000000" />
        </identifier>
    </subject>
    <relatesTo>
        <code value="transforms" />
        <target>
            <reference value="DocumentReference/BeispielDocumentReferenceRechnung3-LE" />
        </target>
    </relatesTo>
    <description value="Rechnung Reiseimpfung vom 10.01.2024" />
    <content>
        <attachment>
            <contentType value="application/pdf" />
            <url value="[FD-endpunkt]/Binary/pdf-mit-token-barcode" />
        </attachment>
    </content>
    <content>
        <attachment>
            <contentType value="application/xml" />
            <url value="[FD-endpunkt]/Binary/xrechnung" />
        </attachment>
        <format>
            <code value="xrechnung" />
        </format>
    </content>
    <content>
        <attachment>
            <contentType value="application/fhir+xml" />
            <url value="[FD-endpunkt]/Binary/invoice" />
        </attachment>
        <format>
            <code value="gematik-erechnung" />
        </format>
    </content>
</DocumentReference>

{
    "resourceType": "DocumentReference",
    "id": "BeispielDocumentReferenceRechnung3-FD",
    "identifier":  [
        {
            "system": "https://gematik.de/fhir/sid/erg-token",
            "value": "123-456-789"
        }
    ],
    "status": "current",
    "type": {
        "coding":  [
            {
                "code": "AM010106",
                "system": "http://dvmd.de/fhir/CodeSystem/kdl",
                "display": "Rechnung ambulante/stationäre Behandlung"
            }
        ]
    },
    "description": "Rechnung Reiseimpfung vom 10.01.2024",
    "subject": {
        "identifier": {
            "system": "http://fhir.de/sid/gkv/kvid-10",
            "value": "A000000000"
        }
    },
    "content":  [
        {
            "attachment": {
                "contentType": "application/pdf",
                "url": "[FD-endpunkt]/Binary/pdf-mit-token-barcode"
            }
        },
        {
            "format": {
                "code": "xrechnung"
            },
            "attachment": {
                "contentType": "application/xml",
                "url": "[FD-endpunkt]/Binary/xrechnung"
            }
        },
        {
            "format": {
                "code": "gematik-erechnung"
            },
            "attachment": {
                "contentType": "application/fhir+xml",
                "url": "[FD-endpunkt]/Binary/invoice"
            }
        }
    ],
    "relatesTo":  [
        {
            "code": "transforms",
            "target": {
                "reference": "DocumentReference/BeispielDocumentReferenceRechnung3-LE"
            }
        }
    ]
}

BeispielDocumentReferenceRechnung3-FD

Beispiel: sonstiges Dokument nach Verarbeitung auf Server

DocumentReference

id : BeispielDocumentReferenceSonstigesDokument3-FD

identifier

system : https://gematik.de/fhir/sid/erg-token

value : 987-654-321

status : current

type

coding

system : http://dvmd.de/fhir/CodeSystem/kdl

code : PT130102

display : Molekularpathologiebefund

subject

reference : Patient/BeispielPatient3-FD

relatesTo

code : transforms

target

reference : DocumentReference/BeispielDocumentReferenceSonstigesDokument3-LE

description : Molekularpathologiebefund vom 31.12.21

content

attachment

contentType : application/pdf

url : [FD-endpunkt]/Binary/patho-mit-token-barcode

<DocumentReference xmlns="http://hl7.org/fhir">
    <id value="BeispielDocumentReferenceSonstigesDokument3-FD" />
    <identifier>
        <system value="https://gematik.de/fhir/sid/erg-token" />
        <value value="987-654-321" />
    </identifier>
    <status value="current" />
    <type>
        <coding>
            <system value="http://dvmd.de/fhir/CodeSystem/kdl" />
            <code value="PT130102" />
            <display value="Molekularpathologiebefund" />
        </coding>
    </type>
    <subject>
        <reference value="Patient/BeispielPatient3-FD" />
    </subject>
    <relatesTo>
        <code value="transforms" />
        <target>
            <reference value="DocumentReference/BeispielDocumentReferenceSonstigesDokument3-LE" />
        </target>
    </relatesTo>
    <description value="Molekularpathologiebefund vom 31.12.21" />
    <content>
        <attachment>
            <contentType value="application/pdf" />
            <url value="[FD-endpunkt]/Binary/patho-mit-token-barcode" />
        </attachment>
    </content>
</DocumentReference>

{
    "resourceType": "DocumentReference",
    "id": "BeispielDocumentReferenceSonstigesDokument3-FD",
    "identifier":  [
        {
            "system": "https://gematik.de/fhir/sid/erg-token",
            "value": "987-654-321"
        }
    ],
    "status": "current",
    "type": {
        "coding":  [
            {
                "code": "PT130102",
                "system": "http://dvmd.de/fhir/CodeSystem/kdl",
                "display": "Molekularpathologiebefund"
            }
        ]
    },
    "description": "Molekularpathologiebefund vom 31.12.21",
    "subject": {
        "reference": "Patient/BeispielPatient3-FD"
    },
    "content":  [
        {
            "attachment": {
                "contentType": "application/pdf",
                "url": "[FD-endpunkt]/Binary/patho-mit-token-barcode"
            }
        }
    ],
    "relatesTo":  [
        {
            "code": "transforms",
            "target": {
                "reference": "DocumentReference/BeispielDocumentReferenceSonstigesDokument3-LE"
            }
        }
    ]
}

BeispielDocumentReferenceSonstigesDokument3-FD