ReteLabDiagnosticReportRefertato

ReteLabDiagnosticReportRefertato
- Descrizione
- ValueSet

Descrizione

Il profilo ReteLabDiagnosticReportRefertato è stato strutturato a partire dalla risorsa generica FHIR DiagnosticReport utilizzata per descrivere le informazioni relative al referto degli esami di laboratorio.

Di seguito è presentato il contenuto del profilo in diversi formati. La corrispondente definizione è consultabile al seguente link: ReteLabDiagnosticReportRefertato.

Snapshot View

DiagnosticReport	I		DiagnosticReport	Element Id DiagnosticReport Short description Profilo che contiene informazioni relative al referto degli esami di laboratorio. Alternate names Report, Test, Result, Results, Labs, Laboratory Definition Questo profilo può essere presente nei seguenti flussi: "Notifica refertato da LS a LR" Comments This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing. Data Type DiagnosticReport Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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-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-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act workflow:Event v2:ORU -> OBR rim:Observation[classCode=OBS, moodCode=EVN]
extension	I	1..*	Extension	There are no (further) constraints on this element Element Id DiagnosticReport.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 rim:N/A
refertoPadre	I	0..*	Extension(Identifier)	Element Id DiagnosticReport.extension:refertoPadre Short description Referto Padre Alternate names extensions, user content Definition Se la naturaDCE è: 02: integrativo 03: sostitutivo 04: annullativo è necessario indicare in quest'attributo o il link logico o l'identificativo del documento padre. Può essere di diversi tipi, e si riconosce dal system: id documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocTestuale id documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocStrutturato link documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocTestuale link documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocStrutturato 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(Identifier) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertoPadre 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
url		1..1	System.StringFixed Value	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data Type System.String Fixed Value https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertoPadre Mappings rim:N/A
value[x]		0..1		Element Id DiagnosticReport.extension:refertoPadre.value[x] Short description Value of extension Definition Link logico al repository o identificativo del documento padre. Sliced: Unordered, Open, by system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
(All Slices)				There are no (further) constraints on this element
valueIdentifier			Identifier	There are no (further) constraints on this element Data Type Identifier
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].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 rim:n/a 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 DiagnosticReport.extension:refertoPadre.value[x].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 rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].system Short description Namespace a cui appartiene il valore identificativo Definition Deve essere uno dei seguenti: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocTestuale https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocStrutturato https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocTestuale https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocStrutturato 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 rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].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 rim:n/a 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 I	0..1	Period	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].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())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
naturaDCE	I	1..1	Extension(CodeableConcept)	Element Id DiagnosticReport.extension:naturaDCE Short description Indica la natura del DCE da archiviare Alternate names extensions, user content Definition Può assumere i seguenti valori: 01: standard 02: integrativo 03: sostitutivo 04: annullativo 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(CodeableConcept) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertatoNaturaDCE 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
tipologiaDCE	I	0..*	Extension(code)	Element Id DiagnosticReport.extension:tipologiaDCE Short description Tipologia referto Alternate names extensions, user content Definition Corrispondente campo HL7 secondo specifiche regionali: OBX-3.3 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(code) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportTipologiaDCE 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
noteDocumento	I	0..*	Extension(Annotation)	Element Id DiagnosticReport.extension:noteDocumento Short description Optional Extensions Element Alternate names extensions, user content Definition Descrive la nota collegata al documento corrispondente campo HL7 secondo specifiche regionali: NTE. Può descrivere le seguenti casistiche: hashCDA hashReferto algoritmoHashCDA algoritmoHashReferto validazioneSchema sizeDocumentoReferto sizeDocumentoCDA linguaggioDocumentoReferto linguaggioDocumentoCDA versioneXSLT consultazioneElettronica sezioneFascicolo idTipoDocumentoLOINC idSetDocumentoPadre nVersionePadre flagInviareAlSiss prioritaNotifica idRichiedente idErogatore retePatologia marcaTemporale Codici di oscuramento (10,20,30,40,50, autorizzazioneConsultazione) NOTEREPERIBILITA dceSuppService^dip modRef^dip idRefertoService^dip codici relativi alla tabella "Tabella SISS - Attributi Specifici" 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(Annotation) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportNote 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
identifier	Σ	2..2	Identifier	Element Id DiagnosticReport.identifier Short description Identificativo univoco del referto Alternate names ReportID, Filler ID, Placer ID Definition Identificativo univoco del referto: identificativo del documento testuale identificativo del documento strutturato Devono essere presenti entrambi gli identificativi: uno per il documento PDF e l'altro per il documento CDA-2 Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-12 Data Type Identifier Sliced: Unordered, Open, by system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings 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 workflow:Event.identifier w5:FiveWs.identifier v2:OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4 rim:id
IdentificativoDocumentoTestuale	Σ	1..1	Identifier	Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale Short description Codice identificativo del documento testuale Alternate names ReportID, Filler ID, Placer ID Definition Identificativo del documento testuale (max 64) Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-12, EI-1 Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings 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 workflow:Event.identifier w5:FiveWs.identifier v2:OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4 rim:id
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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 rim:n/a 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 DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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 rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uriFixed Value	Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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())` Fixed Value https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoTestuale Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.value Short description Identificativo documento testuale 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 rim:n/a 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 I	0..1	Period	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
IdentificativoDocumentoStrutturato	Σ	1..1	Identifier	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato Short description Business identifier for report Alternate names ReportID, Filler ID, Placer ID Definition Identifiers assigned to this report by the performer or other systems. Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. Comments Usually assigned by the Information System of the diagnostic service provider (filler id). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings 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 workflow:Event.identifier w5:FiveWs.identifier v2:OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4 rim:id
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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 rim:n/a 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 DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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 rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uriFixed Value	Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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())` Fixed Value https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoStrutturato Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.value Short description Identificativo documento strutturato 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 rim:n/a 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 I	0..1	Period	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
basedOn	I	1..*	Reference(ReteLabServiceRequestRichiestaEsamiLab)	Element Id DiagnosticReport.basedOn Short description Richiesta di esame di laboratorio di cui si riportano i risultati Alternate names Request Definition Reference al profilo ReteLabServiceRequestRichiestaEsamiLab Requirements This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon. Comments Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports. Data Type Reference(ReteLabServiceRequestRichiestaEsamiLab) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.basedOn v2:ORC? OBR-2/3? rim:outboundRelationship[typeCode=FLFS].target
status	Σ ?!	1..1	codeBindingFixed Value	Element Id DiagnosticReport.status Short description Stato del DiagnosticReport Definition The status of the diagnostic report. Requirements Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-17 Data Type code Binding The status of the diagnostic report. DiagnosticReportStatus (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed Value final Mappings rim:n/a workflow:Event.status w5:FiveWs.status v2:OBR-25 (not 1:1 mapping) rim:statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"
category	Σ	0..*	CodeableConceptFixed Value	Element Id DiagnosticReport.category Short description Referti di Laboratorio Alternate names Department, Sub-department, Service, Discipline Definition Valore fisso su LAB --> Laboratorio Comments Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code. Data Type CodeableConcept Binding Codes for diagnostic service sections. DiagnosticServiceSectionCodes (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed Value { "coding": [ { "code": "LAB", "display": "Laboratorio" } ] } Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class v2:OBR-24 rim:inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code
code	Σ	1..1	CodeableConceptBinding	Element Id DiagnosticReport.code Short description Codice diagnosticReport Alternate names Type Definition A code or name that describes this diagnostic report. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding Codes that describe Diagnostic Reports. LOINCDiagnosticReportCodes (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code w5:FiveWs.what[x] v2:OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel) rim:code
coding	Σ	0..*	Coding	Element Id DiagnosticReport.code.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 system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
LOINC	Σ	0..*	CodingBinding	Element Id DiagnosticReport.code.coding:LOINC 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 Codifica LOINC (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
TipoDocumento	Σ	0..*	CodingBinding	Element Id DiagnosticReport.code.coding:TipoDocumento Short description Tipologia documento. 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 Corrispondente campo HL7 secondo specifiche regionali: OBX-3.2. Data Type Coding Binding Tipologia Documento SISS (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
TipoDocumentoInterno	Σ	0..*	CodingBinding	Element Id DiagnosticReport.code.coding:TipoDocumentoInterno Short description Tipologia interna di documento. 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 Corrispondente campo HL7 secondo specifiche regionali: OBX-3.5. Data Type Coding Binding Tipologia documento interno (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding 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 DiagnosticReport.code.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 rim:n/a 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
subject	Σ I	0..1	Reference(ReteLabPatientCittadino)	Element Id DiagnosticReport.subject Short description Paziente al quale i risultati degli esami fanno riferimento Alternate names Patient Definition Reference al profilo ReteLabPatientCittadino Requirements SHALL know the subject context. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(ReteLabPatientCittadino) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject w5:FiveWs.subject[x] v2:PID-3 (no HL7 v2 mapping for Group or Device) rim:participation[typeCode=SBJ] w5:FiveWs.subject
encounter	Σ I	0..1	Reference(Encounter)	There are no (further) constraints on this element Element Id DiagnosticReport.encounter Short description Health care event when test ordered Alternate names Context Definition The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about. Requirements Links the request to the Encounter context. Comments This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests). Data Type Reference(Encounter) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.encounter w5:FiveWs.context v2:PV1-19 rim:inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
effective[x]	Σ	0..1		There are no (further) constraints on this element Element Id DiagnosticReport.effective[x] Short description Clinically relevant time/time-period for report Alternate names Observation time, Effective Time, Occurrence Definition The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself. Requirements Need to know where in the patient history to file/present this report. Comments If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.occurrence[x] w5:FiveWs.done[x] v2:OBR-7 rim:effectiveTime
effectiveDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
effectivePeriod			Period	There are no (further) constraints on this element Data Type Period
issued	Σ	0..1	instant	Element Id DiagnosticReport.issued Short description Data e ora di firma del documento Alternate names Date published, Date Issued, Date Verified Definition Obbligatorio per documenti firmati e/o marcati. Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Requirements Clinicians need to be able to check the date that the report was released. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-22 Data Type instant Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.recorded v2:OBR-22 rim:participation[typeCode=VRF or AUT].time
performer	Σ I	0..*	Reference(Practitioner \| PractitionerRole \| Organization \| CareTeam)	There are no (further) constraints on this element Element Id DiagnosticReport.performer Short description Responsible Diagnostic Service Alternate names Laboratory, Service, Practitioner, Department, Company, Authorized by, Director Definition The diagnostic service that is responsible for issuing the report. Requirements Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis. Comments This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report. Data Type Reference(Practitioner \| PractitionerRole \| Organization \| CareTeam) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor w5:FiveWs.actor v2:PRT-8 (where this PRT-4-Participation = "PO") rim:.participation[typeCode=PRF]
resultsInterpreter	Σ I	0..*	Reference(ReteLabPractitionerRoleMedico)	Element Id DiagnosticReport.resultsInterpreter Short description Dati dell'operatore che compila e referta Alternate names Analyzed by, Reported by Definition Reference al profilo ReteLabPractitionerRoleMedico Requirements Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-11 e PV1-8 Data Type Reference(ReteLabPractitionerRoleMedico) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor w5:FiveWs.actor v2:OBR-32, PRT-8 (where this PRT-4-Participation = "PI") rim:.participation[typeCode=PRF]
specimen	I	0..*	Reference(Specimen)	There are no (further) constraints on this element Element Id DiagnosticReport.specimen Short description Specimens this report is based on Definition Details about the specimens on which this diagnostic report is based. Requirements Need to be able to report information about the collected specimens on which the report is based. Comments If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group. Data Type Reference(Specimen) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:SPM rim:participation[typeCode=SBJ]
result	I	0..*	Reference(Observation)	There are no (further) constraints on this element Element Id DiagnosticReport.result Short description Observations Alternate names Data, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer Definition Observations that are part of this diagnostic report. Requirements Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful. Comments Observations can contain observations. Data Type Reference(Observation) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:OBXs rim:outboundRelationship[typeCode=COMP].target
imagingStudy	I	0..*	Reference(ImagingStudy)	There are no (further) constraints on this element Element Id DiagnosticReport.imagingStudy Short description Reference to full details of imaging associated with the diagnostic report Definition One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images. Comments ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided. Data Type Reference(ImagingStudy) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]
media	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id DiagnosticReport.media Short description Key images associated with this report Alternate names DICOM, Slides, Scans Definition A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest). Requirements Many diagnostic services include images in the report as part of their service. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:OBX? rim:outboundRelationship[typeCode=COMP].target
comment		0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.media.comment Short description Comment about the image (e.g. explanation) Definition A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features. Requirements The provider of the report should make a comment about each image included in the report. Comments The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion. 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 rim:.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value
link	Σ I	1..1	Reference(Media)	There are no (further) constraints on this element Element Id DiagnosticReport.media.link Short description Reference to the image source Definition Reference to the image source. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Media) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:.value.reference
conclusion		0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.conclusion Short description Clinical conclusion (interpretation) of test results Alternate names Report Definition Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report. Requirements Need to be able to provide a conclusion that is not lost among the basic result data. Comments Note that FHIR strings SHALL NOT exceed 1MB in size 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 v2:OBX rim:inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)
conclusionCode		0..*	CodeableConcept	There are no (further) constraints on this element Element Id DiagnosticReport.conclusionCode Short description Codes for the clinical conclusion of test results Definition One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding Diagnosis codes provided as adjuncts to the report. SNOMEDCTClinicalFindings (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:OBX rim:inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)
presentedForm	I	1..2	Attachment	Element Id DiagnosticReport.presentedForm Short description Documento Allegato Definition Contenuto da archiviare (documento o link). In questo campo verranno allegati il documento in formato PDF e quello in formato CDA-2. Requirements Gives laboratory the ability to provide its own fully formatted report for clinical fidelity. Comments Corrispondente campo HL7 secondo specifiche regionali: OBX-5 Data Type Attachment Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` att-1:If the Attachment has data, it SHALL have a contentType `data.empty() or contentType.exists()` Mappings rim:n/a v2:ED/RP rim:ED v2:OBX rim:text (type=ED)
contentType	Σ	0..1	codeBinding	Element Id DiagnosticReport.presentedForm.contentType Short description Formato documento Definition tipo fisico del documento (obbligatorio). Valori ammessi: “PDF” “PDF-CDA2” “PDFA3” Requirements Processors of the data need to be able to know how to interpret the data. Comments Corrispondente campo HL7 secondo specifiche regionali: OBX-3 CE-6 OBX-5 : Contenuto da archiviare (documento o link). La compilazione del campo varia in funzione del contenuto: Documento OBX-5.2 = multipart OBX-5.3 = Octed-stream OBX-5.4 = Base64 OBX-5.5 = documento codificato in Base64 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 rim:n/a 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 DiagnosticReport.presentedForm.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. Comments Note that FHIR strings SHALL NOT exceed 1MB in size 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:n/a rim:./language
data		0..1	base64Binary	Element Id DiagnosticReport.presentedForm.data Short description Documento codificato in base64 Definition Tale campo sarà sempre valorizzato come "Documento codificato in base64" Requirements The data needs to able to be transmitted inline. Comments Corrispondente campo HL7 secondo specifiche regionali: OBX-5.5 Data Type base64Binary Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:ED.5 rim:./data
url	Σ	0..1	url	There are no (further) constraints on this element Element Id DiagnosticReport.presentedForm.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 rim:n/a 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 DiagnosticReport.presentedForm.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 rim:N/A (needs data type R3 proposal)
hash	Σ	0..1	base64Binary	There are no (further) constraints on this element Element Id DiagnosticReport.presentedForm.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:n/a rim:.integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
title	Σ	0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.presentedForm.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. Comments Note that FHIR strings SHALL NOT exceed 1MB in size 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:n/a rim:./title/data
creation	Σ	0..1	dateTime	Element Id DiagnosticReport.presentedForm.creation Short description Data e ora compilazione del documento Definition Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Requirements This is often tracked as an integrity issue for use of the attachment. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-6 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 rim:N/A (needs data type R3 proposal)

Differential View

DiagnosticReport	I		DiagnosticReport	Element Id DiagnosticReport Short description Profilo che contiene informazioni relative al referto degli esami di laboratorio. Alternate names Report, Test, Result, Results, Labs, Laboratory Definition Questo profilo può essere presente nei seguenti flussi: "Notifica refertato da LS a LR" Comments This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing. Data Type DiagnosticReport Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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-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-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act workflow:Event v2:ORU -> OBR rim:Observation[classCode=OBS, moodCode=EVN]
extension	I	1..*	Extension	There are no (further) constraints on this element Element Id DiagnosticReport.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 rim:N/A
refertoPadre	I	0..*	Extension(Identifier)	Element Id DiagnosticReport.extension:refertoPadre Short description Referto Padre Alternate names extensions, user content Definition Se la naturaDCE è: 02: integrativo 03: sostitutivo 04: annullativo è necessario indicare in quest'attributo o il link logico o l'identificativo del documento padre. Può essere di diversi tipi, e si riconosce dal system: id documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocTestuale id documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocStrutturato link documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocTestuale link documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocStrutturato 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(Identifier) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertoPadre 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
url		1..1	System.StringFixed Value	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data Type System.String Fixed Value https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertoPadre Mappings rim:N/A
value[x]		0..1		Element Id DiagnosticReport.extension:refertoPadre.value[x] Short description Value of extension Definition Link logico al repository o identificativo del documento padre. Sliced: Unordered, Open, by system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
(All Slices)				There are no (further) constraints on this element
valueIdentifier			Identifier	There are no (further) constraints on this element Data Type Identifier
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].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 rim:n/a 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 DiagnosticReport.extension:refertoPadre.value[x].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 rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].system Short description Namespace a cui appartiene il valore identificativo Definition Deve essere uno dei seguenti: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocTestuale https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocStrutturato https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocTestuale https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocStrutturato 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 rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].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 rim:n/a 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 I	0..1	Period	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].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())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
naturaDCE	I	1..1	Extension(CodeableConcept)	Element Id DiagnosticReport.extension:naturaDCE Short description Indica la natura del DCE da archiviare Alternate names extensions, user content Definition Può assumere i seguenti valori: 01: standard 02: integrativo 03: sostitutivo 04: annullativo 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(CodeableConcept) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertatoNaturaDCE 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
tipologiaDCE	I	0..*	Extension(code)	Element Id DiagnosticReport.extension:tipologiaDCE Short description Tipologia referto Alternate names extensions, user content Definition Corrispondente campo HL7 secondo specifiche regionali: OBX-3.3 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(code) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportTipologiaDCE 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
noteDocumento	I	0..*	Extension(Annotation)	Element Id DiagnosticReport.extension:noteDocumento Short description Optional Extensions Element Alternate names extensions, user content Definition Descrive la nota collegata al documento corrispondente campo HL7 secondo specifiche regionali: NTE. Può descrivere le seguenti casistiche: hashCDA hashReferto algoritmoHashCDA algoritmoHashReferto validazioneSchema sizeDocumentoReferto sizeDocumentoCDA linguaggioDocumentoReferto linguaggioDocumentoCDA versioneXSLT consultazioneElettronica sezioneFascicolo idTipoDocumentoLOINC idSetDocumentoPadre nVersionePadre flagInviareAlSiss prioritaNotifica idRichiedente idErogatore retePatologia marcaTemporale Codici di oscuramento (10,20,30,40,50, autorizzazioneConsultazione) NOTEREPERIBILITA dceSuppService^dip modRef^dip idRefertoService^dip codici relativi alla tabella "Tabella SISS - Attributi Specifici" 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(Annotation) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportNote 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
identifier	Σ	2..2	Identifier	Element Id DiagnosticReport.identifier Short description Identificativo univoco del referto Alternate names ReportID, Filler ID, Placer ID Definition Identificativo univoco del referto: identificativo del documento testuale identificativo del documento strutturato Devono essere presenti entrambi gli identificativi: uno per il documento PDF e l'altro per il documento CDA-2 Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-12 Data Type Identifier Sliced: Unordered, Open, by system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings 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 workflow:Event.identifier w5:FiveWs.identifier v2:OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4 rim:id
IdentificativoDocumentoTestuale	Σ	1..1	Identifier	Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale Short description Codice identificativo del documento testuale Alternate names ReportID, Filler ID, Placer ID Definition Identificativo del documento testuale (max 64) Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-12, EI-1 Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings 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 workflow:Event.identifier w5:FiveWs.identifier v2:OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4 rim:id
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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 rim:n/a 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 DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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 rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uriFixed Value	Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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())` Fixed Value https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoTestuale Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.value Short description Identificativo documento testuale 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 rim:n/a 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 I	0..1	Period	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
IdentificativoDocumentoStrutturato	Σ	1..1	Identifier	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato Short description Business identifier for report Alternate names ReportID, Filler ID, Placer ID Definition Identifiers assigned to this report by the performer or other systems. Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. Comments Usually assigned by the Information System of the diagnostic service provider (filler id). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings 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 workflow:Event.identifier w5:FiveWs.identifier v2:OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4 rim:id
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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 rim:n/a 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 DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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 rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uriFixed Value	Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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())` Fixed Value https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoStrutturato Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.value Short description Identificativo documento strutturato 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 rim:n/a 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 I	0..1	Period	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
basedOn	I	1..*	Reference(ReteLabServiceRequestRichiestaEsamiLab)	Element Id DiagnosticReport.basedOn Short description Richiesta di esame di laboratorio di cui si riportano i risultati Alternate names Request Definition Reference al profilo ReteLabServiceRequestRichiestaEsamiLab Requirements This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon. Comments Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports. Data Type Reference(ReteLabServiceRequestRichiestaEsamiLab) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.basedOn v2:ORC? OBR-2/3? rim:outboundRelationship[typeCode=FLFS].target
status	Σ ?!	1..1	codeBindingFixed Value	Element Id DiagnosticReport.status Short description Stato del DiagnosticReport Definition The status of the diagnostic report. Requirements Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-17 Data Type code Binding The status of the diagnostic report. DiagnosticReportStatus (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed Value final Mappings rim:n/a workflow:Event.status w5:FiveWs.status v2:OBR-25 (not 1:1 mapping) rim:statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"
category	Σ	0..*	CodeableConceptFixed Value	Element Id DiagnosticReport.category Short description Referti di Laboratorio Alternate names Department, Sub-department, Service, Discipline Definition Valore fisso su LAB --> Laboratorio Comments Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code. Data Type CodeableConcept Binding Codes for diagnostic service sections. DiagnosticServiceSectionCodes (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed Value { "coding": [ { "code": "LAB", "display": "Laboratorio" } ] } Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class v2:OBR-24 rim:inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code
code	Σ	1..1	CodeableConceptBinding	Element Id DiagnosticReport.code Short description Codice diagnosticReport Alternate names Type Definition A code or name that describes this diagnostic report. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding Codes that describe Diagnostic Reports. LOINCDiagnosticReportCodes (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code w5:FiveWs.what[x] v2:OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel) rim:code
coding	Σ	0..*	Coding	Element Id DiagnosticReport.code.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 system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
LOINC	Σ	0..*	CodingBinding	Element Id DiagnosticReport.code.coding:LOINC 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 Codifica LOINC (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
TipoDocumento	Σ	0..*	CodingBinding	Element Id DiagnosticReport.code.coding:TipoDocumento Short description Tipologia documento. 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 Corrispondente campo HL7 secondo specifiche regionali: OBX-3.2. Data Type Coding Binding Tipologia Documento SISS (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
TipoDocumentoInterno	Σ	0..*	CodingBinding	Element Id DiagnosticReport.code.coding:TipoDocumentoInterno Short description Tipologia interna di documento. 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 Corrispondente campo HL7 secondo specifiche regionali: OBX-3.5. Data Type Coding Binding Tipologia documento interno (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding 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 DiagnosticReport.code.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 rim:n/a 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
subject	Σ I	0..1	Reference(ReteLabPatientCittadino)	Element Id DiagnosticReport.subject Short description Paziente al quale i risultati degli esami fanno riferimento Alternate names Patient Definition Reference al profilo ReteLabPatientCittadino Requirements SHALL know the subject context. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(ReteLabPatientCittadino) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject w5:FiveWs.subject[x] v2:PID-3 (no HL7 v2 mapping for Group or Device) rim:participation[typeCode=SBJ] w5:FiveWs.subject
encounter	Σ I	0..1	Reference(Encounter)	There are no (further) constraints on this element Element Id DiagnosticReport.encounter Short description Health care event when test ordered Alternate names Context Definition The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about. Requirements Links the request to the Encounter context. Comments This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests). Data Type Reference(Encounter) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.encounter w5:FiveWs.context v2:PV1-19 rim:inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
effective[x]	Σ	0..1		There are no (further) constraints on this element Element Id DiagnosticReport.effective[x] Short description Clinically relevant time/time-period for report Alternate names Observation time, Effective Time, Occurrence Definition The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself. Requirements Need to know where in the patient history to file/present this report. Comments If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.occurrence[x] w5:FiveWs.done[x] v2:OBR-7 rim:effectiveTime
effectiveDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
effectivePeriod			Period	There are no (further) constraints on this element Data Type Period
issued	Σ	0..1	instant	Element Id DiagnosticReport.issued Short description Data e ora di firma del documento Alternate names Date published, Date Issued, Date Verified Definition Obbligatorio per documenti firmati e/o marcati. Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Requirements Clinicians need to be able to check the date that the report was released. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-22 Data Type instant Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.recorded v2:OBR-22 rim:participation[typeCode=VRF or AUT].time
performer	Σ I	0..*	Reference(Practitioner \| PractitionerRole \| Organization \| CareTeam)	There are no (further) constraints on this element Element Id DiagnosticReport.performer Short description Responsible Diagnostic Service Alternate names Laboratory, Service, Practitioner, Department, Company, Authorized by, Director Definition The diagnostic service that is responsible for issuing the report. Requirements Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis. Comments This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report. Data Type Reference(Practitioner \| PractitionerRole \| Organization \| CareTeam) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor w5:FiveWs.actor v2:PRT-8 (where this PRT-4-Participation = "PO") rim:.participation[typeCode=PRF]
resultsInterpreter	Σ I	0..*	Reference(ReteLabPractitionerRoleMedico)	Element Id DiagnosticReport.resultsInterpreter Short description Dati dell'operatore che compila e referta Alternate names Analyzed by, Reported by Definition Reference al profilo ReteLabPractitionerRoleMedico Requirements Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-11 e PV1-8 Data Type Reference(ReteLabPractitionerRoleMedico) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor w5:FiveWs.actor v2:OBR-32, PRT-8 (where this PRT-4-Participation = "PI") rim:.participation[typeCode=PRF]
specimen	I	0..*	Reference(Specimen)	There are no (further) constraints on this element Element Id DiagnosticReport.specimen Short description Specimens this report is based on Definition Details about the specimens on which this diagnostic report is based. Requirements Need to be able to report information about the collected specimens on which the report is based. Comments If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group. Data Type Reference(Specimen) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:SPM rim:participation[typeCode=SBJ]
result	I	0..*	Reference(Observation)	There are no (further) constraints on this element Element Id DiagnosticReport.result Short description Observations Alternate names Data, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer Definition Observations that are part of this diagnostic report. Requirements Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful. Comments Observations can contain observations. Data Type Reference(Observation) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:OBXs rim:outboundRelationship[typeCode=COMP].target
imagingStudy	I	0..*	Reference(ImagingStudy)	There are no (further) constraints on this element Element Id DiagnosticReport.imagingStudy Short description Reference to full details of imaging associated with the diagnostic report Definition One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images. Comments ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided. Data Type Reference(ImagingStudy) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]
media	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id DiagnosticReport.media Short description Key images associated with this report Alternate names DICOM, Slides, Scans Definition A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest). Requirements Many diagnostic services include images in the report as part of their service. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:OBX? rim:outboundRelationship[typeCode=COMP].target
comment		0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.media.comment Short description Comment about the image (e.g. explanation) Definition A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features. Requirements The provider of the report should make a comment about each image included in the report. Comments The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion. 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 rim:.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value
link	Σ I	1..1	Reference(Media)	There are no (further) constraints on this element Element Id DiagnosticReport.media.link Short description Reference to the image source Definition Reference to the image source. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Media) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:.value.reference
conclusion		0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.conclusion Short description Clinical conclusion (interpretation) of test results Alternate names Report Definition Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report. Requirements Need to be able to provide a conclusion that is not lost among the basic result data. Comments Note that FHIR strings SHALL NOT exceed 1MB in size 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 v2:OBX rim:inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)
conclusionCode		0..*	CodeableConcept	There are no (further) constraints on this element Element Id DiagnosticReport.conclusionCode Short description Codes for the clinical conclusion of test results Definition One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding Diagnosis codes provided as adjuncts to the report. SNOMEDCTClinicalFindings (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:OBX rim:inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)
presentedForm	I	1..2	Attachment	Element Id DiagnosticReport.presentedForm Short description Documento Allegato Definition Contenuto da archiviare (documento o link). In questo campo verranno allegati il documento in formato PDF e quello in formato CDA-2. Requirements Gives laboratory the ability to provide its own fully formatted report for clinical fidelity. Comments Corrispondente campo HL7 secondo specifiche regionali: OBX-5 Data Type Attachment Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` att-1:If the Attachment has data, it SHALL have a contentType `data.empty() or contentType.exists()` Mappings rim:n/a v2:ED/RP rim:ED v2:OBX rim:text (type=ED)
contentType	Σ	0..1	codeBinding	Element Id DiagnosticReport.presentedForm.contentType Short description Formato documento Definition tipo fisico del documento (obbligatorio). Valori ammessi: “PDF” “PDF-CDA2” “PDFA3” Requirements Processors of the data need to be able to know how to interpret the data. Comments Corrispondente campo HL7 secondo specifiche regionali: OBX-3 CE-6 OBX-5 : Contenuto da archiviare (documento o link). La compilazione del campo varia in funzione del contenuto: Documento OBX-5.2 = multipart OBX-5.3 = Octed-stream OBX-5.4 = Base64 OBX-5.5 = documento codificato in Base64 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 rim:n/a 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 DiagnosticReport.presentedForm.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. Comments Note that FHIR strings SHALL NOT exceed 1MB in size 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:n/a rim:./language
data		0..1	base64Binary	Element Id DiagnosticReport.presentedForm.data Short description Documento codificato in base64 Definition Tale campo sarà sempre valorizzato come "Documento codificato in base64" Requirements The data needs to able to be transmitted inline. Comments Corrispondente campo HL7 secondo specifiche regionali: OBX-5.5 Data Type base64Binary Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:ED.5 rim:./data
url	Σ	0..1	url	There are no (further) constraints on this element Element Id DiagnosticReport.presentedForm.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 rim:n/a 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 DiagnosticReport.presentedForm.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 rim:N/A (needs data type R3 proposal)
hash	Σ	0..1	base64Binary	There are no (further) constraints on this element Element Id DiagnosticReport.presentedForm.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:n/a rim:.integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
title	Σ	0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.presentedForm.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. Comments Note that FHIR strings SHALL NOT exceed 1MB in size 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:n/a rim:./title/data
creation	Σ	0..1	dateTime	Element Id DiagnosticReport.presentedForm.creation Short description Data e ora compilazione del documento Definition Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Requirements This is often tracked as an integrity issue for use of the attachment. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-6 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 rim:N/A (needs data type R3 proposal)

Hybrid View

DiagnosticReport	I		DiagnosticReport	Element Id DiagnosticReport Short description Profilo che contiene informazioni relative al referto degli esami di laboratorio. Alternate names Report, Test, Result, Results, Labs, Laboratory Definition Questo profilo può essere presente nei seguenti flussi: "Notifica refertato da LS a LR" Comments This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing. Data Type DiagnosticReport Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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-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-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act workflow:Event v2:ORU -> OBR rim:Observation[classCode=OBS, moodCode=EVN]
extension	I	1..*	Extension	There are no (further) constraints on this element Element Id DiagnosticReport.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 rim:N/A
refertoPadre	I	0..*	Extension(Identifier)	Element Id DiagnosticReport.extension:refertoPadre Short description Referto Padre Alternate names extensions, user content Definition Se la naturaDCE è: 02: integrativo 03: sostitutivo 04: annullativo è necessario indicare in quest'attributo o il link logico o l'identificativo del documento padre. Può essere di diversi tipi, e si riconosce dal system: id documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocTestuale id documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocStrutturato link documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocTestuale link documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocStrutturato 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(Identifier) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertoPadre 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
url		1..1	System.StringFixed Value	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data Type System.String Fixed Value https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertoPadre Mappings rim:N/A
value[x]		0..1		Element Id DiagnosticReport.extension:refertoPadre.value[x] Short description Value of extension Definition Link logico al repository o identificativo del documento padre. Sliced: Unordered, Open, by system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
(All Slices)				There are no (further) constraints on this element
valueIdentifier			Identifier	There are no (further) constraints on this element Data Type Identifier
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].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 rim:n/a 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 DiagnosticReport.extension:refertoPadre.value[x].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 rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].system Short description Namespace a cui appartiene il valore identificativo Definition Deve essere uno dei seguenti: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocTestuale https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocStrutturato https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocTestuale https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocStrutturato 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 rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].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 rim:n/a 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 I	0..1	Period	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id DiagnosticReport.extension:refertoPadre.value[x].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())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
naturaDCE	I	1..1	Extension(CodeableConcept)	Element Id DiagnosticReport.extension:naturaDCE Short description Indica la natura del DCE da archiviare Alternate names extensions, user content Definition Può assumere i seguenti valori: 01: standard 02: integrativo 03: sostitutivo 04: annullativo 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(CodeableConcept) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertatoNaturaDCE 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
tipologiaDCE	I	0..*	Extension(code)	Element Id DiagnosticReport.extension:tipologiaDCE Short description Tipologia referto Alternate names extensions, user content Definition Corrispondente campo HL7 secondo specifiche regionali: OBX-3.3 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(code) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportTipologiaDCE 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
noteDocumento	I	0..*	Extension(Annotation)	Element Id DiagnosticReport.extension:noteDocumento Short description Optional Extensions Element Alternate names extensions, user content Definition Descrive la nota collegata al documento corrispondente campo HL7 secondo specifiche regionali: NTE. Può descrivere le seguenti casistiche: hashCDA hashReferto algoritmoHashCDA algoritmoHashReferto validazioneSchema sizeDocumentoReferto sizeDocumentoCDA linguaggioDocumentoReferto linguaggioDocumentoCDA versioneXSLT consultazioneElettronica sezioneFascicolo idTipoDocumentoLOINC idSetDocumentoPadre nVersionePadre flagInviareAlSiss prioritaNotifica idRichiedente idErogatore retePatologia marcaTemporale Codici di oscuramento (10,20,30,40,50, autorizzazioneConsultazione) NOTEREPERIBILITA dceSuppService^dip modRef^dip idRefertoService^dip codici relativi alla tabella "Tabella SISS - Attributi Specifici" 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(Annotation) Extension URL https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportNote 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
identifier	Σ	2..2	Identifier	Element Id DiagnosticReport.identifier Short description Identificativo univoco del referto Alternate names ReportID, Filler ID, Placer ID Definition Identificativo univoco del referto: identificativo del documento testuale identificativo del documento strutturato Devono essere presenti entrambi gli identificativi: uno per il documento PDF e l'altro per il documento CDA-2 Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-12 Data Type Identifier Sliced: Unordered, Open, by system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings 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 workflow:Event.identifier w5:FiveWs.identifier v2:OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4 rim:id
IdentificativoDocumentoTestuale	Σ	1..1	Identifier	Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale Short description Codice identificativo del documento testuale Alternate names ReportID, Filler ID, Placer ID Definition Identificativo del documento testuale (max 64) Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-12, EI-1 Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings 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 workflow:Event.identifier w5:FiveWs.identifier v2:OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4 rim:id
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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 rim:n/a 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 DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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 rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uriFixed Value	Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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())` Fixed Value https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoTestuale Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.value Short description Identificativo documento testuale 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 rim:n/a 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 I	0..1	Period	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoTestuale.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())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
IdentificativoDocumentoStrutturato	Σ	1..1	Identifier	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato Short description Business identifier for report Alternate names ReportID, Filler ID, Placer ID Definition Identifiers assigned to this report by the performer or other systems. Requirements Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. Comments Usually assigned by the Information System of the diagnostic service provider (filler id). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings 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 workflow:Event.identifier w5:FiveWs.identifier v2:OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4 rim:id
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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 rim:n/a 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 DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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 rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uriFixed Value	Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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())` Fixed Value https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoStrutturato Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.value Short description Identificativo documento strutturato 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 rim:n/a 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 I	0..1	Period	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.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())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
basedOn	I	1..*	Reference(ReteLabServiceRequestRichiestaEsamiLab)	Element Id DiagnosticReport.basedOn Short description Richiesta di esame di laboratorio di cui si riportano i risultati Alternate names Request Definition Reference al profilo ReteLabServiceRequestRichiestaEsamiLab Requirements This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon. Comments Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports. Data Type Reference(ReteLabServiceRequestRichiestaEsamiLab) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.basedOn v2:ORC? OBR-2/3? rim:outboundRelationship[typeCode=FLFS].target
status	Σ ?!	1..1	codeBindingFixed Value	Element Id DiagnosticReport.status Short description Stato del DiagnosticReport Definition The status of the diagnostic report. Requirements Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-17 Data Type code Binding The status of the diagnostic report. DiagnosticReportStatus (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed Value final Mappings rim:n/a workflow:Event.status w5:FiveWs.status v2:OBR-25 (not 1:1 mapping) rim:statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"
category	Σ	0..*	CodeableConceptFixed Value	Element Id DiagnosticReport.category Short description Referti di Laboratorio Alternate names Department, Sub-department, Service, Discipline Definition Valore fisso su LAB --> Laboratorio Comments Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code. Data Type CodeableConcept Binding Codes for diagnostic service sections. DiagnosticServiceSectionCodes (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed Value { "coding": [ { "code": "LAB", "display": "Laboratorio" } ] } Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class v2:OBR-24 rim:inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code
code	Σ	1..1	CodeableConceptBinding	Element Id DiagnosticReport.code Short description Codice diagnosticReport Alternate names Type Definition A code or name that describes this diagnostic report. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding Codes that describe Diagnostic Reports. LOINCDiagnosticReportCodes (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code w5:FiveWs.what[x] v2:OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel) rim:code
coding	Σ	0..*	Coding	Element Id DiagnosticReport.code.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 system(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
LOINC	Σ	0..*	CodingBinding	Element Id DiagnosticReport.code.coding:LOINC 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 Codifica LOINC (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
TipoDocumento	Σ	0..*	CodingBinding	Element Id DiagnosticReport.code.coding:TipoDocumento Short description Tipologia documento. 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 Corrispondente campo HL7 secondo specifiche regionali: OBX-3.2. Data Type Coding Binding Tipologia Documento SISS (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
TipoDocumentoInterno	Σ	0..*	CodingBinding	Element Id DiagnosticReport.code.coding:TipoDocumentoInterno Short description Tipologia interna di documento. 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 Corrispondente campo HL7 secondo specifiche regionali: OBX-3.5. Data Type Coding Binding Tipologia documento interno (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding 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 DiagnosticReport.code.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 rim:n/a 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
subject	Σ I	0..1	Reference(ReteLabPatientCittadino)	Element Id DiagnosticReport.subject Short description Paziente al quale i risultati degli esami fanno riferimento Alternate names Patient Definition Reference al profilo ReteLabPatientCittadino Requirements SHALL know the subject context. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(ReteLabPatientCittadino) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject w5:FiveWs.subject[x] v2:PID-3 (no HL7 v2 mapping for Group or Device) rim:participation[typeCode=SBJ] w5:FiveWs.subject
encounter	Σ I	0..1	Reference(Encounter)	There are no (further) constraints on this element Element Id DiagnosticReport.encounter Short description Health care event when test ordered Alternate names Context Definition The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about. Requirements Links the request to the Encounter context. Comments This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests). Data Type Reference(Encounter) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.encounter w5:FiveWs.context v2:PV1-19 rim:inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
effective[x]	Σ	0..1		There are no (further) constraints on this element Element Id DiagnosticReport.effective[x] Short description Clinically relevant time/time-period for report Alternate names Observation time, Effective Time, Occurrence Definition The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself. Requirements Need to know where in the patient history to file/present this report. Comments If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.occurrence[x] w5:FiveWs.done[x] v2:OBR-7 rim:effectiveTime
effectiveDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
effectivePeriod			Period	There are no (further) constraints on this element Data Type Period
issued	Σ	0..1	instant	Element Id DiagnosticReport.issued Short description Data e ora di firma del documento Alternate names Date published, Date Issued, Date Verified Definition Obbligatorio per documenti firmati e/o marcati. Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Requirements Clinicians need to be able to check the date that the report was released. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-22 Data Type instant Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.recorded v2:OBR-22 rim:participation[typeCode=VRF or AUT].time
performer	Σ I	0..*	Reference(Practitioner \| PractitionerRole \| Organization \| CareTeam)	There are no (further) constraints on this element Element Id DiagnosticReport.performer Short description Responsible Diagnostic Service Alternate names Laboratory, Service, Practitioner, Department, Company, Authorized by, Director Definition The diagnostic service that is responsible for issuing the report. Requirements Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis. Comments This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report. Data Type Reference(Practitioner \| PractitionerRole \| Organization \| CareTeam) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor w5:FiveWs.actor v2:PRT-8 (where this PRT-4-Participation = "PO") rim:.participation[typeCode=PRF]
resultsInterpreter	Σ I	0..*	Reference(ReteLabPractitionerRoleMedico)	Element Id DiagnosticReport.resultsInterpreter Short description Dati dell'operatore che compila e referta Alternate names Analyzed by, Reported by Definition Reference al profilo ReteLabPractitionerRoleMedico Requirements Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-11 e PV1-8 Data Type Reference(ReteLabPractitionerRoleMedico) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor w5:FiveWs.actor v2:OBR-32, PRT-8 (where this PRT-4-Participation = "PI") rim:.participation[typeCode=PRF]
specimen	I	0..*	Reference(Specimen)	There are no (further) constraints on this element Element Id DiagnosticReport.specimen Short description Specimens this report is based on Definition Details about the specimens on which this diagnostic report is based. Requirements Need to be able to report information about the collected specimens on which the report is based. Comments If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group. Data Type Reference(Specimen) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:SPM rim:participation[typeCode=SBJ]
result	I	0..*	Reference(Observation)	There are no (further) constraints on this element Element Id DiagnosticReport.result Short description Observations Alternate names Data, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer Definition Observations that are part of this diagnostic report. Requirements Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful. Comments Observations can contain observations. Data Type Reference(Observation) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:OBXs rim:outboundRelationship[typeCode=COMP].target
imagingStudy	I	0..*	Reference(ImagingStudy)	There are no (further) constraints on this element Element Id DiagnosticReport.imagingStudy Short description Reference to full details of imaging associated with the diagnostic report Definition One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images. Comments ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided. Data Type Reference(ImagingStudy) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]
media	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id DiagnosticReport.media Short description Key images associated with this report Alternate names DICOM, Slides, Scans Definition A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest). Requirements Many diagnostic services include images in the report as part of their service. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:OBX? rim:outboundRelationship[typeCode=COMP].target
comment		0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.media.comment Short description Comment about the image (e.g. explanation) Definition A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features. Requirements The provider of the report should make a comment about each image included in the report. Comments The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion. 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 rim:.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value
link	Σ I	1..1	Reference(Media)	There are no (further) constraints on this element Element Id DiagnosticReport.media.link Short description Reference to the image source Definition Reference to the image source. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Media) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:.value.reference
conclusion		0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.conclusion Short description Clinical conclusion (interpretation) of test results Alternate names Report Definition Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report. Requirements Need to be able to provide a conclusion that is not lost among the basic result data. Comments Note that FHIR strings SHALL NOT exceed 1MB in size 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 v2:OBX rim:inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)
conclusionCode		0..*	CodeableConcept	There are no (further) constraints on this element Element Id DiagnosticReport.conclusionCode Short description Codes for the clinical conclusion of test results Definition One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding Diagnosis codes provided as adjuncts to the report. SNOMEDCTClinicalFindings (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:OBX rim:inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)
presentedForm	I	1..2	Attachment	Element Id DiagnosticReport.presentedForm Short description Documento Allegato Definition Contenuto da archiviare (documento o link). In questo campo verranno allegati il documento in formato PDF e quello in formato CDA-2. Requirements Gives laboratory the ability to provide its own fully formatted report for clinical fidelity. Comments Corrispondente campo HL7 secondo specifiche regionali: OBX-5 Data Type Attachment Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` att-1:If the Attachment has data, it SHALL have a contentType `data.empty() or contentType.exists()` Mappings rim:n/a v2:ED/RP rim:ED v2:OBX rim:text (type=ED)
contentType	Σ	0..1	codeBinding	Element Id DiagnosticReport.presentedForm.contentType Short description Formato documento Definition tipo fisico del documento (obbligatorio). Valori ammessi: “PDF” “PDF-CDA2” “PDFA3” Requirements Processors of the data need to be able to know how to interpret the data. Comments Corrispondente campo HL7 secondo specifiche regionali: OBX-3 CE-6 OBX-5 : Contenuto da archiviare (documento o link). La compilazione del campo varia in funzione del contenuto: Documento OBX-5.2 = multipart OBX-5.3 = Octed-stream OBX-5.4 = Base64 OBX-5.5 = documento codificato in Base64 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 rim:n/a 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 DiagnosticReport.presentedForm.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. Comments Note that FHIR strings SHALL NOT exceed 1MB in size 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:n/a rim:./language
data		0..1	base64Binary	Element Id DiagnosticReport.presentedForm.data Short description Documento codificato in base64 Definition Tale campo sarà sempre valorizzato come "Documento codificato in base64" Requirements The data needs to able to be transmitted inline. Comments Corrispondente campo HL7 secondo specifiche regionali: OBX-5.5 Data Type base64Binary Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:ED.5 rim:./data
url	Σ	0..1	url	There are no (further) constraints on this element Element Id DiagnosticReport.presentedForm.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 rim:n/a 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 DiagnosticReport.presentedForm.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 rim:N/A (needs data type R3 proposal)
hash	Σ	0..1	base64Binary	There are no (further) constraints on this element Element Id DiagnosticReport.presentedForm.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:n/a rim:.integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
title	Σ	0..1	string	There are no (further) constraints on this element Element Id DiagnosticReport.presentedForm.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. Comments Note that FHIR strings SHALL NOT exceed 1MB in size 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:n/a rim:./title/data
creation	Σ	0..1	dateTime	Element Id DiagnosticReport.presentedForm.creation Short description Data e ora compilazione del documento Definition Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Requirements This is often tracked as an integrity issue for use of the attachment. Comments Corrispondente campo HL7 secondo specifiche regionali: TXA-6 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 rim:N/A (needs data type R3 proposal)

Table View

DiagnosticReport		..
DiagnosticReport.extension		1..
DiagnosticReport.extension	Extension	..
DiagnosticReport.extension.value[x]		..
DiagnosticReport.extension	Extension	1..1
DiagnosticReport.extension	Extension	..
DiagnosticReport.extension	Extension	..
DiagnosticReport.identifier		2..2
DiagnosticReport.identifier		1..1
DiagnosticReport.identifier.system		..
DiagnosticReport.identifier.value		..
DiagnosticReport.identifier		1..1
DiagnosticReport.identifier.system		..
DiagnosticReport.identifier.value		..
DiagnosticReport.basedOn	Reference(ReteLabServiceRequestRichiestaEsamiLab)	1..
DiagnosticReport.status		..
DiagnosticReport.category		..
DiagnosticReport.code		..
DiagnosticReport.code.coding		..
DiagnosticReport.code.coding		..
DiagnosticReport.code.coding		..
DiagnosticReport.code.coding		..
DiagnosticReport.subject	Reference(ReteLabPatientCittadino)	..
DiagnosticReport.issued		..
DiagnosticReport.resultsInterpreter	Reference(ReteLabPractitionerRoleMedico)	..
DiagnosticReport.presentedForm		1..2
DiagnosticReport.presentedForm.contentType		..
DiagnosticReport.presentedForm.data		..
DiagnosticReport.presentedForm.creation		..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <url value="https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertato" />
    <name value="ReteLabDiagnosticReportRefertato" />
    <status value="active" />
    <date value="2024-01-09T09:49:12.3358619+00:00" />
    <description value="Profilo che contiene informazioni relative al referto degli esami di laboratorio." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="DiagnosticReport" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport" />
    <derivation value="constraint" />
    <differential>
        <element id="DiagnosticReport">
            <path value="DiagnosticReport" />
            <short value="Profilo che contiene informazioni relative al referto degli esami di laboratorio." />
            <definition value="Questo profilo pu&#242; essere presente nei seguenti flussi: &quot;Notifica refertato da LS a LR&quot;" />
        </element>
        <element id="DiagnosticReport.extension">
            <path value="DiagnosticReport.extension" />
            <min value="1" />
        </element>
        <element id="DiagnosticReport.extension:refertoPadre">
            <path value="DiagnosticReport.extension" />
            <sliceName value="refertoPadre" />
            <short value="Referto Padre" />
            <definition value="Se la naturaDCE &#232;: \n- 02: integrativo\n- 03: sostitutivo \n- 04: annullativo\n\n &#232; necessario indicare in quest&#39;attributo o il link logico o l&#39;identificativo del documento padre.\nPu&#242; essere di diversi tipi, e si riconosce dal system: \n- id documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocTestuale\n- id documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocStrutturato\n- link documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocTestuale\n- link documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocStrutturato" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertoPadre" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="DiagnosticReport.extension:refertoPadre.value[x]">
            <path value="DiagnosticReport.extension.value[x]" />
            <definition value="Link logico al repository o identificativo del documento padre." />
        </element>
        <element id="DiagnosticReport.extension:naturaDCE">
            <path value="DiagnosticReport.extension" />
            <sliceName value="naturaDCE" />
            <short value="Indica la natura del DCE da archiviare" />
            <definition value="Pu&#242; assumere i seguenti valori:\n- 01: standard\n- 02: integrativo\n- 03: sostitutivo \n- 04: annullativo" />
            <min value="1" />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertatoNaturaDCE" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="DiagnosticReport.extension:tipologiaDCE">
            <path value="DiagnosticReport.extension" />
            <sliceName value="tipologiaDCE" />
            <short value="Tipologia referto" />
            <definition value="Corrispondente campo HL7 secondo specifiche regionali: OBX-3.3" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportTipologiaDCE" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="DiagnosticReport.extension:noteDocumento">
            <path value="DiagnosticReport.extension" />
            <sliceName value="noteDocumento" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportNote" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="DiagnosticReport.identifier">
            <path value="DiagnosticReport.identifier" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="system" />
                </discriminator>
                <rules value="open" />
            </slicing>
            <short value="Identificativo univoco del referto" />
            <definition value="Identificativo univoco del referto: \n1. identificativo del documento testuale \n2. identificativo del documento strutturato\n\nDevono essere presenti entrambi gli identificativi: uno per il documento PDF e l&#39;altro per il documento CDA-2" />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: TXA-12" />
            <min value="2" />
            <max value="2" />
        </element>
        <element id="DiagnosticReport.identifier:IdentificativoDocumentoTestuale">
            <path value="DiagnosticReport.identifier" />
            <sliceName value="IdentificativoDocumentoTestuale" />
            <short value="Codice identificativo del documento testuale" />
            <definition value="Identificativo del documento testuale (max 64)" />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: TXA-12, EI-1" />
            <min value="1" />
            <max value="1" />
        </element>
        <element id="DiagnosticReport.identifier:IdentificativoDocumentoTestuale.system">
            <path value="DiagnosticReport.identifier.system" />
            <fixedUri value="https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoTestuale" />
        </element>
        <element id="DiagnosticReport.identifier:IdentificativoDocumentoTestuale.value">
            <path value="DiagnosticReport.identifier.value" />
            <short value="Identificativo documento testuale" />
        </element>
        <element id="DiagnosticReport.identifier:IdentificativoDocumentoStrutturato">
            <path value="DiagnosticReport.identifier" />
            <sliceName value="IdentificativoDocumentoStrutturato" />
            <min value="1" />
            <max value="1" />
        </element>
        <element id="DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.system">
            <path value="DiagnosticReport.identifier.system" />
            <fixedUri value="https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoStrutturato" />
        </element>
        <element id="DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.value">
            <path value="DiagnosticReport.identifier.value" />
            <short value="Identificativo documento strutturato" />
        </element>
        <element id="DiagnosticReport.basedOn">
            <path value="DiagnosticReport.basedOn" />
            <short value="Richiesta di esame di laboratorio di cui si riportano i risultati" />
            <definition value="Reference al profilo ReteLabServiceRequestRichiestaEsamiLab" />
            <min value="1" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabServiceRequestRichiestaEsamiLab" />
            </type>
        </element>
        <element id="DiagnosticReport.status">
            <path value="DiagnosticReport.status" />
            <short value="Stato del DiagnosticReport" />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: TXA-17" />
            <fixedCode value="final" />
        </element>
        <element id="DiagnosticReport.category">
            <path value="DiagnosticReport.category" />
            <short value="Referti di Laboratorio" />
            <definition value="Valore fisso su LAB --&gt; Laboratorio" />
            <fixedCodeableConcept>
                <coding>
                    <code value="LAB" />
                    <display value="Laboratorio" />
                </coding>
            </fixedCodeableConcept>
        </element>
        <element id="DiagnosticReport.code">
            <path value="DiagnosticReport.code" />
            <short value="Codice diagnosticReport" />
        </element>
        <element id="DiagnosticReport.code.coding">
            <path value="DiagnosticReport.code.coding" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="system" />
                </discriminator>
                <rules value="open" />
            </slicing>
        </element>
        <element id="DiagnosticReport.code.coding:LOINC">
            <path value="DiagnosticReport.code.coding" />
            <sliceName value="LOINC" />
            <binding>
                <strength value="required" />
                <valueSet value="https://fhir.siss.regione.lombardia.it/ValueSet/CodificaLOINC" />
            </binding>
        </element>
        <element id="DiagnosticReport.code.coding:TipoDocumento">
            <path value="DiagnosticReport.code.coding" />
            <sliceName value="TipoDocumento" />
            <short value="Tipologia documento." />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: OBX-3.2." />
            <binding>
                <strength value="required" />
                <valueSet value="https://fhir.siss.regione.lombardia.it/ValueSet/TipologiaDocumentoLaboratorio" />
            </binding>
        </element>
        <element id="DiagnosticReport.code.coding:TipoDocumentoInterno">
            <path value="DiagnosticReport.code.coding" />
            <sliceName value="TipoDocumentoInterno" />
            <short value="Tipologia interna di documento." />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: OBX-3.5." />
            <binding>
                <strength value="required" />
                <valueSet value="https://fhir.siss.regione.lombardia.it/ValueSet/TipologiaDocumentoInternoLaboratorio" />
            </binding>
        </element>
        <element id="DiagnosticReport.subject">
            <path value="DiagnosticReport.subject" />
            <short value="Paziente al quale i risultati degli esami fanno riferimento" />
            <definition value="Reference al profilo ReteLabPatientCittadino" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabPatientCittadino" />
            </type>
        </element>
        <element id="DiagnosticReport.issued">
            <path value="DiagnosticReport.issued" />
            <short value="Data e ora di firma del documento" />
            <definition value="Obbligatorio per documenti firmati e/o marcati.\nFormato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR" />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: TXA-22" />
        </element>
        <element id="DiagnosticReport.resultsInterpreter">
            <path value="DiagnosticReport.resultsInterpreter" />
            <short value="Dati dell&#39;operatore che compila e referta" />
            <definition value="Reference al profilo ReteLabPractitionerRoleMedico" />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: TXA-11 e PV1-8" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabPractitionerRoleMedico" />
            </type>
        </element>
        <element id="DiagnosticReport.presentedForm">
            <path value="DiagnosticReport.presentedForm" />
            <short value="Documento Allegato" />
            <definition value="Contenuto da archiviare (documento o link). \nIn questo campo verranno allegati il documento in formato PDF e quello in formato CDA-2." />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: OBX-5" />
            <min value="1" />
            <max value="2" />
        </element>
        <element id="DiagnosticReport.presentedForm.contentType">
            <path value="DiagnosticReport.presentedForm.contentType" />
            <short value="Formato documento" />
            <definition value="tipo fisico del documento (obbligatorio).\n \nValori ammessi:\n - “PDF”\n - “PDF-CDA2”\n - “PDFA3”" />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: OBX-3 CE-6\n\nOBX-5 :\nContenuto da archiviare (documento o link).\nLa compilazione del campo varia in funzione del contenuto:\nDocumento\nOBX-5.2 = multipart\nOBX-5.3 = Octed-stream\nOBX-5.4 = Base64\nOBX-5.5 = documento codificato in Base64" />
        </element>
        <element id="DiagnosticReport.presentedForm.data">
            <path value="DiagnosticReport.presentedForm.data" />
            <short value="Documento codificato in base64" />
            <definition value="Tale campo sar&#224; sempre valorizzato come &quot;Documento codificato in base64&quot;" />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: OBX-5.5" />
        </element>
        <element id="DiagnosticReport.presentedForm.creation">
            <path value="DiagnosticReport.presentedForm.creation" />
            <short value="Data e ora compilazione del documento" />
            <definition value="Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR" />
            <comment value="Corrispondente campo HL7 secondo specifiche regionali: TXA-6" />
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "url": "https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertato",
    "name": "ReteLabDiagnosticReportRefertato",
    "status": "active",
    "date": "2024-01-09T09:49:12.3358619+00:00",
    "description": "Profilo che contiene informazioni relative al referto degli esami di laboratorio.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "DiagnosticReport",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DiagnosticReport",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "DiagnosticReport",
                "path": "DiagnosticReport",
                "short": "Profilo che contiene informazioni relative al referto degli esami di laboratorio.",
                "definition": "Questo profilo può essere presente nei seguenti flussi: \"Notifica refertato da LS a LR\""
            },
            {
                "id": "DiagnosticReport.extension",
                "path": "DiagnosticReport.extension",
                "min": 1
            },
            {
                "id": "DiagnosticReport.extension:refertoPadre",
                "path": "DiagnosticReport.extension",
                "sliceName": "refertoPadre",
                "short": "Referto Padre",
                "definition": "Se la naturaDCE è: \n- 02: integrativo\n- 03: sostitutivo \n- 04: annullativo\n\n è necessario indicare in quest'attributo o il link logico o l'identificativo del documento padre.\nPuò essere di diversi tipi, e si riconosce dal system: \n- id documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocTestuale\n- id documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/IdentificativoDocStrutturato\n- link documento testuale: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocTestuale\n- link documento strutturato: https://fhir.siss.regione.lombardia.it/CodeSystem/LinkDocStrutturato",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertoPadre"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "DiagnosticReport.extension:refertoPadre.value[x]",
                "path": "DiagnosticReport.extension.value[x]",
                "definition": "Link logico al repository o identificativo del documento padre."
            },
            {
                "id": "DiagnosticReport.extension:naturaDCE",
                "path": "DiagnosticReport.extension",
                "sliceName": "naturaDCE",
                "short": "Indica la natura del DCE da archiviare",
                "definition": "Può assumere i seguenti valori:\n- 01: standard\n- 02: integrativo\n- 03: sostitutivo \n- 04: annullativo",
                "min": 1,
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportRefertatoNaturaDCE"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "DiagnosticReport.extension:tipologiaDCE",
                "path": "DiagnosticReport.extension",
                "sliceName": "tipologiaDCE",
                "short": "Tipologia referto",
                "definition": "Corrispondente campo HL7 secondo specifiche regionali: OBX-3.3",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportTipologiaDCE"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "DiagnosticReport.extension:noteDocumento",
                "path": "DiagnosticReport.extension",
                "sliceName": "noteDocumento",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabDiagnosticReportNote"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "DiagnosticReport.identifier",
                "path": "DiagnosticReport.identifier",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "system"
                        }
                    ],
                    "rules": "open"
                },
                "short": "Identificativo univoco del referto",
                "definition": "Identificativo univoco del referto: \n1. identificativo del documento testuale \n2. identificativo del documento strutturato\n\nDevono essere presenti entrambi gli identificativi: uno per il documento PDF e l'altro per il documento CDA-2",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: TXA-12",
                "min": 2,
                "max": "2"
            },
            {
                "id": "DiagnosticReport.identifier:IdentificativoDocumentoTestuale",
                "path": "DiagnosticReport.identifier",
                "sliceName": "IdentificativoDocumentoTestuale",
                "short": "Codice identificativo del documento testuale",
                "definition": "Identificativo del documento testuale (max 64)",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: TXA-12, EI-1",
                "min": 1,
                "max": "1"
            },
            {
                "id": "DiagnosticReport.identifier:IdentificativoDocumentoTestuale.system",
                "path": "DiagnosticReport.identifier.system",
                "fixedUri": "https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoTestuale"
            },
            {
                "id": "DiagnosticReport.identifier:IdentificativoDocumentoTestuale.value",
                "path": "DiagnosticReport.identifier.value",
                "short": "Identificativo documento testuale"
            },
            {
                "id": "DiagnosticReport.identifier:IdentificativoDocumentoStrutturato",
                "path": "DiagnosticReport.identifier",
                "sliceName": "IdentificativoDocumentoStrutturato",
                "min": 1,
                "max": "1"
            },
            {
                "id": "DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.system",
                "path": "DiagnosticReport.identifier.system",
                "fixedUri": "https://fhir.siss.regione.lombardia.it/sid/codiceIdentificativoDocumentoStrutturato"
            },
            {
                "id": "DiagnosticReport.identifier:IdentificativoDocumentoStrutturato.value",
                "path": "DiagnosticReport.identifier.value",
                "short": "Identificativo documento strutturato"
            },
            {
                "id": "DiagnosticReport.basedOn",
                "path": "DiagnosticReport.basedOn",
                "short": "Richiesta di esame di laboratorio di cui si riportano i risultati",
                "definition": "Reference al profilo ReteLabServiceRequestRichiestaEsamiLab",
                "min": 1,
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabServiceRequestRichiestaEsamiLab"
                        ]
                    }
                ]
            },
            {
                "id": "DiagnosticReport.status",
                "path": "DiagnosticReport.status",
                "short": "Stato del DiagnosticReport",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: TXA-17",
                "fixedCode": "final"
            },
            {
                "id": "DiagnosticReport.category",
                "path": "DiagnosticReport.category",
                "short": "Referti di Laboratorio",
                "definition": "Valore fisso su LAB --> Laboratorio",
                "fixedCodeableConcept": {
                    "coding":  [
                        {
                            "code": "LAB",
                            "display": "Laboratorio"
                        }
                    ]
                }
            },
            {
                "id": "DiagnosticReport.code",
                "path": "DiagnosticReport.code",
                "short": "Codice diagnosticReport"
            },
            {
                "id": "DiagnosticReport.code.coding",
                "path": "DiagnosticReport.code.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "system"
                        }
                    ],
                    "rules": "open"
                }
            },
            {
                "id": "DiagnosticReport.code.coding:LOINC",
                "path": "DiagnosticReport.code.coding",
                "sliceName": "LOINC",
                "binding": {
                    "strength": "required",
                    "valueSet": "https://fhir.siss.regione.lombardia.it/ValueSet/CodificaLOINC"
                }
            },
            {
                "id": "DiagnosticReport.code.coding:TipoDocumento",
                "path": "DiagnosticReport.code.coding",
                "sliceName": "TipoDocumento",
                "short": "Tipologia documento.",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: OBX-3.2.",
                "binding": {
                    "strength": "required",
                    "valueSet": "https://fhir.siss.regione.lombardia.it/ValueSet/TipologiaDocumentoLaboratorio"
                }
            },
            {
                "id": "DiagnosticReport.code.coding:TipoDocumentoInterno",
                "path": "DiagnosticReport.code.coding",
                "sliceName": "TipoDocumentoInterno",
                "short": "Tipologia interna di documento.",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: OBX-3.5.",
                "binding": {
                    "strength": "required",
                    "valueSet": "https://fhir.siss.regione.lombardia.it/ValueSet/TipologiaDocumentoInternoLaboratorio"
                }
            },
            {
                "id": "DiagnosticReport.subject",
                "path": "DiagnosticReport.subject",
                "short": "Paziente al quale i risultati degli esami fanno riferimento",
                "definition": "Reference al profilo ReteLabPatientCittadino",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabPatientCittadino"
                        ]
                    }
                ]
            },
            {
                "id": "DiagnosticReport.issued",
                "path": "DiagnosticReport.issued",
                "short": "Data e ora di firma del documento",
                "definition": "Obbligatorio per documenti firmati e/o marcati.\nFormato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: TXA-22"
            },
            {
                "id": "DiagnosticReport.resultsInterpreter",
                "path": "DiagnosticReport.resultsInterpreter",
                "short": "Dati dell'operatore che compila e referta",
                "definition": "Reference al profilo ReteLabPractitionerRoleMedico",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: TXA-11 e PV1-8",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.siss.regione.lombardia.it/StructureDefinition/ReteLabPractitionerRoleMedico"
                        ]
                    }
                ]
            },
            {
                "id": "DiagnosticReport.presentedForm",
                "path": "DiagnosticReport.presentedForm",
                "short": "Documento Allegato",
                "definition": "Contenuto da archiviare (documento o link). \nIn questo campo verranno allegati il documento in formato PDF e quello in formato CDA-2.",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: OBX-5",
                "min": 1,
                "max": "2"
            },
            {
                "id": "DiagnosticReport.presentedForm.contentType",
                "path": "DiagnosticReport.presentedForm.contentType",
                "short": "Formato documento",
                "definition": "tipo fisico del documento (obbligatorio).\n \nValori ammessi:\n - “PDF”\n - “PDF-CDA2”\n - “PDFA3”",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: OBX-3 CE-6\n\nOBX-5 :\nContenuto da archiviare (documento o link).\nLa compilazione del campo varia in funzione del contenuto:\nDocumento\nOBX-5.2 = multipart\nOBX-5.3 = Octed-stream\nOBX-5.4 = Base64\nOBX-5.5 = documento codificato in Base64"
            },
            {
                "id": "DiagnosticReport.presentedForm.data",
                "path": "DiagnosticReport.presentedForm.data",
                "short": "Documento codificato in base64",
                "definition": "Tale campo sarà sempre valorizzato come \"Documento codificato in base64\"",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: OBX-5.5"
            },
            {
                "id": "DiagnosticReport.presentedForm.creation",
                "path": "DiagnosticReport.presentedForm.creation",
                "short": "Data e ora compilazione del documento",
                "definition": "Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR",
                "comment": "Corrispondente campo HL7 secondo specifiche regionali: TXA-6"
            }
        ]
    }
}

Esempi

DiagnosticReport 123456

ValueSet

Nella seguente tabella sono elencati i value set relativi al profilo ReteLabDiagnosticReportRefertato:

Nome	Descrizione	Riferimento al dettaglio della codifica
Tipologia Documento	Codifica della tipologia di documento secondo le specifiche SISS	La codifica è definita dal ValueSet Tipologia Documento SISS
Tipologia Documento Interno	Codifica della tipologia di documento interno secondo le specifiche SISS	La codifica è definita dal ValueSet Tipologia documento interno
Tipologia Documento LOINC	Codifica della tipologia di documento secondo la codifica loinc	La codifica è definita dal ValueSet Codifica LOINC
Tipologia DCE	Codifica della tipologia di referto	La codifica è definita dal ValueSet Tipologia DCE