MII IG Dokument DE v2025

Dokument (DocumentReference)

Diese Profil beschreibt die Metadaten zu einem klinischen Dokument.

Metadaten

Canonical	Status	Version	Basis
https://www.medizininformatik-initiative.de/fhir/ext/modul-dokument/StructureDefinition/mii-pr-dokument-dokument	draft	2025.0.0-ballot	http://hl7.org/fhir/StructureDefinition/DocumentReference

Inhalt

MII_PR_Dokument_Dokument (DocumentReference)	I		DocumentReference	There are no (further) constraints on this element Element id DocumentReference Short description A reference to a document Definition A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text. Comments Usually, this is used for documents other than those defined by FHIR. Data type DocumentReference Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Event fhircomposition: when describing a Composition rim: Document[classCode="DOC" and moodCode="EVN"] cda: when describing a CDA
id	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	S Σ	0..1	Meta	There are no (further) constraints on this element Element id DocumentReference.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id DocumentReference.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id DocumentReference.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id DocumentReference.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id DocumentReference.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
masterIdentifier	S Σ	0..1	Identifier	Element id DocumentReference.masterIdentifier Short description Versionsspezifische Kennung Definition Versionsspezifische eindeutige Kennung, die dem Dokument durch die Dokumentenquelle zugewiesen wurde Requirements The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.). Comments CDA Document Id extension and root. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier fhircomposition: Composition.identifier v2: TXA-12 rim: .id xds: DocumentEntry.uniqueId cda: ClinicalDocument/id
identifier	S Σ	0..1	Identifier	Element id DocumentReference.identifier Short description Versionsunabhängige Kennung Definition Andere versionsunabhängige Kennung, die dem Dokument (z.B. durch weitere dokumentenverarbeitende Systeme) zugewiesen wurde Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier v2: TXA-16? rim: .id / .setId xds: DocumentEntry.entryUUID
status	S Σ ?!	1..1	codeBinding	Element id DocumentReference.status Short description Status der Dokumentenreferenz Definition Status dieser Dokumentenreferenz (aktuell, überholt oder irrtümlich eingegeben) Comments This is the status of the DocumentReference object, which might be independent from the docStatus element. This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid. Data type code Binding The status of the document reference. DocumentReferenceStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.status w5: FiveWs.status v2: TXA-19 rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete" xds: DocumentEntry.availabilityStatus
docStatus	S Σ	0..1	codeBinding	Element id DocumentReference.docStatus Short description Status des Dokuments Definition Status des zugrunde liegenden Dokuments (vorläufig, final, geändert oder irrtümlich eingegeben) Comments The document that is pointed to might be in various lifecycle states. Data type code Binding Status of the underlying document. CompositionStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.status fhircomposition: Composition.status v2: TXA-17 rim: .statusCode
type	S Σ	0..1	CodeableConceptBinding	Element id DocumentReference.type Short description Art des Dokuments Definition Art des Dokuments auf das verwiesen wird (z.B. Anamnese und Untersuchung, Entlassungsbericht, Verlaufsbericht) Comments Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents. Data type CodeableConcept Binding Precise type of clinical document. DocumentTypeValueSet (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code w5: FiveWs.class fhircomposition: Composition.type v2: TXA-2 rim: ./code xds: DocumentEntry.type cda: ClinicalDocument/code/@code The typeCode should be mapped from the ClinicalDocument/code element to a set of document type codes configured in the affinity domain. One suggested coding system to use for typeCode is LOINC, in which case the mapping step can be omitted.
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.type.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
coding	Σ	0..*	Coding	Element id DocumentReference.type.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Sliced: Unordered, Open, by system(Value) Slice für Art des verwiesenen Dokument Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
KDL	S Σ	0..1	CodingBinding	Element id DocumentReference.type.coding:KDL 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 http://dvmd.de/fhir/ValueSet/kdl (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:KDL.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.type.coding:KDL.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.type.coding:KDL.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:KDL.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.type.coding:KDL.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:KDL.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.type.coding:KDL.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
SCT	S Σ	0..1	CodingBinding	Element id DocumentReference.type.coding:SCT 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 SNOMED_CT (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:SCT.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.type.coding:SCT.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.type.coding:SCT.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:SCT.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.type.coding:SCT.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:SCT.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.type.coding:SCT.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
XDS	S Σ	0..1	CodingBinding	Element id DocumentReference.type.coding:XDS 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 http://ihe-d.de/ValueSets/IHEXDStypeCode (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:XDS.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.type.coding:XDS.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.type.coding:XDS.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:XDS.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.type.coding:XDS.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.coding:XDS.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.type.coding:XDS.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.type.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
category	S Σ	0..*	CodeableConcept	Element id DocumentReference.category Short description Kategorien des Dokuments Alternate names claxs Definition Übergeordnete Kategorie des Dokuments auf das verwiesen wird (z.B. Arztberichte oder Arztdokumentation) Comments Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching. Data type CodeableConcept Binding High-level kind of a clinical document at a macro level. DocumentClassValueSet (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class fhircomposition: Composition.class rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code xds: DocumentEntry.class cda: Derived from a mapping of /ClinicalDocument/code/@code to an Affinity Domain specified coded value to use and coding system. Affinity Domains are encouraged to use the appropriate value for Type of Service, based on the LOINC Type of Service (see Page 53 of the LOINC User's Manual). Must be consistent with /ClinicalDocument/code/@code
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.category.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.category.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
coding	Σ	0..*	Coding	Element id DocumentReference.category.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) Slice für Kategorie des verwiesenen Dokuments Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
SCT	S Σ	0..1	CodingBinding	Element id DocumentReference.category.coding:SCT 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 SNOMED_CT (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.category.coding:SCT.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.category.coding:SCT.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.category.coding:SCT.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.category.coding:SCT.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.category.coding:SCT.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.category.coding:SCT.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.category.coding:SCT.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
XDS	S Σ	0..1	CodingBinding	Element id DocumentReference.category.coding:XDS 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 http://ihe-d.de/ValueSets/IHEXDSclassCode (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.category.coding:XDS.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.category.coding:XDS.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.category.coding:XDS.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.category.coding:XDS.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.category.coding:XDS.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.category.coding:XDS.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.category.coding:XDS.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.category.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
subject	S Σ	0..1	Reference(Patient \| https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient \| https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert)	Element id DocumentReference.subject Short description Verweis auf Patient Definition Patient auf den sich das verwiesene Dokument bezieht Data type Reference(Patient \| https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient \| https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.subject w5: FiveWs.subject[x] fhircomposition: Composition.subject v2: PID-3 (No standard way to define a Practitioner or Group subject in HL7 v2 MDM message) rim: .participation[typeCode="SBJ"].role[typeCode="PAT"] xds: DocumentEntry.patientId cda: ClinicalDocument/recordTarget/ w5: FiveWs.subject
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.subject.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.subject.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
reference	S Σ I	0..1	string	There are no (further) constraints on this element Element id DocumentReference.subject.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id DocumentReference.subject.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id DocumentReference.subject.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.subject.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
date	Σ	0..1	instant	There are no (further) constraints on this element Element id DocumentReference.date Short description When this document reference was created Alternate names indexed Definition When the document reference was created. Comments Referencing/indexing time is used for tracking, organizing versions and searching. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.recorded fhircomposition: Composition.date rim: .availabilityTime[type="TS"]
author	Σ	0..*	Reference(Practitioner \| PractitionerRole \| Organization \| Device \| Patient \| RelatedPerson)	There are no (further) constraints on this element Element id DocumentReference.author Short description Who and/or what authored the document Definition Identifies who is responsible for adding the information to the document. Comments Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant). Data type Reference(Practitioner \| PractitionerRole \| Organization \| Device \| Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor fhircomposition: Composition.author v2: TXA-9 (No standard way to indicate a Device in HL7 v2 MDM message) rim: .participation[typeCode="AUT"].role[classCode="ASSIGNED"] xds: DocumentEntry.author cda: ClinicalDocument/author
authenticator		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id DocumentReference.authenticator Short description Who/what authenticated the document Definition Which person or organization authenticates that this document is valid. Comments Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor w5: FiveWs.witness fhircomposition: Composition.attester v2: TXA-10 rim: .participation[typeCode="AUTHEN"].role[classCode="ASSIGNED"] xds: DocumentEntry.legalAuthenticator cda: ClinicalDocument/legalAuthenticator
custodian		0..1	Reference(Organization)	There are no (further) constraints on this element Element id DocumentReference.custodian Short description Organization which maintains the document Definition Identifies the organization or group who is responsible for ongoing maintenance of and access to the document. Comments Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor fhircomposition: Composition.custodian rim: .participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]
relatesTo	S Σ	0..*	BackboneElement	Element id DocumentReference.relatesTo Short description Beziehung des Dokuments Definition Beziehungen des verwiesenen Dokuments zu anderen Dokumenten Comments This element is labeled as a modifier because documents that append to other documents are incomplete on their own. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.relatesTo rim: .outboundRelationship xds: DocumentEntry Associations
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.relatesTo.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.relatesTo.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.relatesTo.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
code	S Σ	1..1	codeBinding	Element id DocumentReference.relatesTo.code Short description Art der Beziehung Definition Beziehung zu anderen Dokumenten Comments If this document appends another document, then the document cannot be fully understood without also accessing the referenced document. Data type code Binding The type of relationship between documents. DocumentRelationshipType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.relatesTo.code rim: .outboundRelationship.typeCode xds: DocumentEntry Associations type
target	S Σ	1..1	Reference(DocumentReference)	Element id DocumentReference.relatesTo.target Short description Verweis auf Dokument Definition Ziel der Dokumentenbeziehung Data type Reference(DocumentReference) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.relatesTo.target rim: .target[classCode="DOC", moodCode="EVN"].id xds: DocumentEntry Associations reference
description	S Σ	0..1	string	Element id DocumentReference.description Short description Beschreibung des Dokuments Definition Menschenlesbare Beschreibung zum verwiesenen Dokuments Requirements Helps humans to assess whether the document is of interest. Comments What the document is about, a terse summary of the document. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: TXA-25 rim: .outboundRelationship[typeCode="SUBJ"].target.text xds: DocumentEntry.comments
securityLabel	S Σ	0..*	CodeableConceptBinding	Element id DocumentReference.securityLabel Short description Vertraulichkeit des Dokuments Definition Grad der Vertraulichkeit/Sicherheit des verwiesenen Dokuments (z. B. uneingeschränkt, gering, mittel, normal oder eingeschränkt) Requirements Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended. Comments The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce. In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects. Data type CodeableConcept Binding Security Labels from the Healthcare Privacy and Security Classification System. All Security Labels (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.confidentiality, Composition.meta.security v2: TXA-18 rim: .confidentialityCode xds: DocumentEntry.confidentialityCode cda: ClinicalDocument/confidentialityCode/@code
content	S Σ	1..*	BackboneElement	Element id DocumentReference.content Short description Inhalt des Dokuments Definition Dokument (Base64-kodierte Daten) oder Verweis (URL) mit relevanten Metadaten zum Anhang Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Bundle(Composition+) rim:* document.text
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
attachment	S Σ	1..1	Attachment	There are no (further) constraints on this element Element id DocumentReference.content.attachment Short description Where to access the document Definition The document or URL of the document along with critical metadata to prove content has integrity. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.language, Composition.title, Composition.date v2: TXA-3 for mime type rim: document.text xds: DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime cda: ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content.attachment.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content.attachment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
contentType	S Σ	0..1	codeBinding	Element id DocumentReference.content.attachment.contentType Short description MIME-Typ zum Inhalt Definition MIME-Typ des Dokumenteninhalts Requirements Processors of the data need to be able to know how to interpret the data. Data type code Binding The mime type of an attachment. Any valid mime type is allowed. Mime Types (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General text/plain; charset=UTF-8, image/png Mappings v2: ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used rim: ./mediaType, ./charset
language	S Σ	0..1	codeBinding	Element id DocumentReference.content.attachment.language Short description Verfassungssprache des Inhalts Definition Verwendete Sprache in dem Dokument Requirements Users need to be able to choose between the languages in a set of attachments. Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General en-AU Mappings rim: ./language
data		0..1	base64Binary	Element id DocumentReference.content.attachment.data Short description Binärdaten zum Inhalt Definition Dokument als Binärdaten Requirements The data needs to able to be transmitted inline. Comments The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: ED.5 rim: ./data
url	S Σ	0..1	url	Element id DocumentReference.content.attachment.url Short description URL zum Inhalt Definition Verweis auf den (lokalen) Ablageort des Dokuments Requirements The data needs to be transmitted by reference. Comments If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data. Data type url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/logo-small.png Mappings v2: RP.1+RP.2 - if they refer to a URL (see v2.6) rim: ./reference/literal
size	Σ	0..1	unsignedInt	There are no (further) constraints on this element Element id DocumentReference.content.attachment.size Short description Number of bytes of content (if url provided) Definition The number of bytes of data that make up this attachment (before base64 encoding, if that is done). Requirements Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all. Comments The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
hash	Σ	0..1	base64Binary	There are no (further) constraints on this element Element id DocumentReference.content.attachment.hash Short description Hash of the data (sha-1, base64ed) Definition The calculated hash of the data using SHA-1. Represented using base64. Requirements Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version). Comments The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature. Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .integrityCheck[parent::ED/integrityCheckAlgorithm="SHA-1"]
title	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.content.attachment.title Short description Label to display in place of the data Definition A label or set of text to display in place of the data. Requirements Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General Official Corporate Logo Mappings rim: ./title/data
creation	S Σ	0..1	dateTime	Element id DocumentReference.content.attachment.creation Short description Erstellungsdatum des Inhalts Definition Datum der Erstellung des Dokumentes Requirements This is often tracked as an integrity issue for use of the attachment. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A (needs data type R3 proposal)
format	S Σ	0..1	CodingBinding	There are no (further) constraints on this element Element id DocumentReference.content.format Short description Format/content rules for the document Definition An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType. Comments Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI. Data type Coding Binding Document Format Codes. DocumentReferenceFormatCodeSet (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.meta.profile rim: document.text xds: DocumentEntry.formatCode cda: derived from the IHE Profile or Implementation Guide templateID
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.content.format.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.content.format.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	Σ	0..1	uri	There are no (further) constraints on this element Element id DocumentReference.content.format.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.content.format.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	0..1	codeBinding	Element id DocumentReference.content.format.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Binding http://ihe-d.de/ValueSets/IHEXDSformatCodeDE (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.content.format.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.content.format.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
context	S Σ	0..1	BackboneElement	Element id DocumentReference.context Short description Erzeugungskontext des Dokuments Definition Klinischer Kontext, in welchem das Dokument erzeugt wurde Comments These values are primarily added to help with searching for interesting/relevant documents. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: outboundRelationship[typeCode="SUBJ"].target[classCode<'ACT']
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
encounter	S	0..*	Reference(Encounter \| https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung)	Element id DocumentReference.context.encounter Short description Verweis auf Einrichtungskontakt Definition Kontakt zur Gesundheitseinrichtung oder die Art der Versorgung, die mit dem Dokumenteninhalt assoziiert ist Data type Reference(Encounter \| https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.context w5: FiveWs.context fhircomposition: Composition.encounter rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.encounter.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.encounter.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
reference	S Σ I	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.encounter.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id DocumentReference.context.encounter.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id DocumentReference.context.encounter.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.encounter.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
event	S	0..*	CodeableConcept	Element id DocumentReference.context.event Short description Dokumentierter Vorgang Definition Handlungen oder Prozeduren, die im Kontext dokumentiert wurden Comments An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation. Data type CodeableConcept Binding This list of codes represents the main clinical acts being documented. v3.ActCode (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.event.code rim: .code xds: DocumentEntry.eventCodeList
period	S Σ	0..1	Period	Element id DocumentReference.context.period Short description Durchführungszeitraum zum Vorgang Definition Zeitraum, in dem die in dem Dokument beschriebene Handlung oder Prozedur durchgeführt wurde Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.event.period rim: .effectiveTime xds: DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime cda: ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/low/ @value --> ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/high/ @value
facilityType	S	0..1	CodeableConcept	Element id DocumentReference.context.facilityType Short description Art der Einrichtung zum Vorgang Definition Art der Einrichtung, in der die Handlung oder Prozedur am Patienten erfolgte Data type CodeableConcept Binding XDS Facility Type. FacilityTypeCodeValueSet (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: usually from a mapping to a local ValueSet rim: .participation[typeCode="LOC"].role[classCode="DSDLOC"].code xds: DocumentEntry.healthcareFacilityTypeCode cda: usually a mapping to a local ValueSet. Must be consistent with /clinicalDocument/code
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
coding	Σ	0..*	Coding	Element id DocumentReference.context.facilityType.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) Slice für IHE XDS-basierte Einrichtungsart Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
SCT	S Σ	0..1	CodingBinding	Element id DocumentReference.context.facilityType.coding:SCT 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 SNOMED_CT (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:SCT.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:SCT.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:SCT.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:SCT.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:SCT.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:SCT.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:SCT.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
XDS	S Σ	0..1	CodingBinding	Element id DocumentReference.context.facilityType.coding:XDS 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 http://ihe-d.de/ValueSets/IHEXDShealthcareFacilityTypeCode (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:XDS.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:XDS.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:XDS.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:XDS.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:XDS.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:XDS.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.coding:XDS.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.facilityType.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
practiceSetting	S	0..1	CodeableConcept	Element id DocumentReference.context.practiceSetting Short description Klinisches Fachgebiet zum Vorgang Definition Klinisches Fachgebiet, in dem Dokumenteninhalt erstellt wurde Requirements This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content. Comments This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC. Data type CodeableConcept Binding Additional details about where the content was created (e.g. clinical specialty). PracticeSettingCodeValueSet (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: usually from a mapping to a local ValueSet rim: .participation[typeCode="LOC"].role[classCode="DSDLOC"].code xds: DocumentEntry.practiceSettingCode cda: usually from a mapping to a local ValueSet
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
coding	Σ	0..*	Coding	Element id DocumentReference.context.practiceSetting.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) Slice für IHE XDS-basierte klinische Fachgebiete Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
SCT	S Σ	0..1	CodingBinding	Element id DocumentReference.context.practiceSetting.coding:SCT 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 SNOMED_CT (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:SCT.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:SCT.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:SCT.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:SCT.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:SCT.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:SCT.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:SCT.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
XDS	S Σ	0..1	CodingBinding	Element id DocumentReference.context.practiceSetting.coding:XDS 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 http://ihe-d.de/ValueSets/IHEXDSpracticeSettingCode (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:XDS.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:XDS.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	S Σ	1..1	uri	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:XDS.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:XDS.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:XDS.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:XDS.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.coding:XDS.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element id DocumentReference.context.practiceSetting.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
sourcePatientInfo		0..1	Reference(Patient)	There are no (further) constraints on this element Element id DocumentReference.context.sourcePatientInfo Short description Patient demographics from source Definition The Patient Information as known when the document was published. May be a reference to a version specific, or contained. Data type Reference(Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.subject rim: .participation[typeCode="SBJ"].role[typeCode="PAT"] xds: DocumentEntry.sourcePatientInfo, DocumentEntry.sourcePatientId cda: ClinicalDocument/recordTarget/
related		0..*	Reference(Resource)	There are no (further) constraints on this element Element id DocumentReference.context.related Short description Related identifiers or resources Definition Related identifiers or resources associated with the DocumentReference. Comments May be identifiers or resources that caused the DocumentReference or referenced Document to be created. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings fhircomposition: Composition.event.detail rim: ./outboundRelationship[typeCode="PERT" and isNormalActRelationship()] / target[isNormalAct] xds: DocumentEntry.referenceIdList cda: ClinicalDocument/relatedDocument

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="mii-pr-dokument-dokument" />
    <url value="https://www.medizininformatik-initiative.de/fhir/ext/modul-dokument/StructureDefinition/mii-pr-dokument-dokument" />
    <version value="2025.0.0-ballot" />
    <name value="MII_PR_Dokument_Dokument" />
    <title value="MII PR Dokument Dokument" />
    <status value="draft" />
    <publisher value="Medizininformatik Initiative" />
    <contact>
        <telecom>
            <system value="url" />
            <value value="https://www.medizininformatik-initiative.de" />
        </telecom>
    </contact>
    <description value="Klinisches Dokument mit zugeh&#246;rigen Metadaten" />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="DocumentReference" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DocumentReference" />
    <derivation value="constraint" />
    <differential>
        <element id="DocumentReference.meta">
            <path value="DocumentReference.meta" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.masterIdentifier">
            <path value="DocumentReference.masterIdentifier" />
            <short value="Versionsspezifische Kennung" />
            <definition value="Versionsspezifische eindeutige Kennung, die dem Dokument durch die Dokumentenquelle zugewiesen wurde" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.identifier">
            <path value="DocumentReference.identifier" />
            <short value="Versionsunabh&#228;ngige Kennung" />
            <definition value="Andere versionsunabh&#228;ngige Kennung, die dem Dokument (z.B. durch weitere dokumentenverarbeitende Systeme) zugewiesen wurde" />
            <max value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.status">
            <path value="DocumentReference.status" />
            <short value="Status der Dokumentenreferenz" />
            <definition value="Status dieser Dokumentenreferenz (aktuell, &#252;berholt oder irrt&#252;mlich eingegeben)" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.docStatus">
            <path value="DocumentReference.docStatus" />
            <short value="Status des Dokuments" />
            <definition value="Status des zugrunde liegenden Dokuments (vorl&#228;ufig, final, ge&#228;ndert oder irrt&#252;mlich eingegeben)" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.type">
            <path value="DocumentReference.type" />
            <short value="Art des Dokuments" />
            <definition value="Art des Dokuments auf das verwiesen wird (z.B. Anamnese und Untersuchung, Entlassungsbericht, Verlaufsbericht)" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.type.coding">
            <path value="DocumentReference.type.coding" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="system" />
                </discriminator>
                <description value="Slice f&#252;r Art des verwiesenen Dokument" />
                <ordered value="false" />
                <rules value="open" />
            </slicing>
        </element>
        <element id="DocumentReference.type.coding:KDL">
            <path value="DocumentReference.type.coding" />
            <sliceName value="KDL" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="http://dvmd.de/fhir/ValueSet/kdl" />
            </binding>
        </element>
        <element id="DocumentReference.type.coding:KDL.system">
            <path value="DocumentReference.type.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.type.coding:KDL.code">
            <path value="DocumentReference.type.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.type.coding:SCT">
            <path value="DocumentReference.type.coding" />
            <sliceName value="SCT" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="http://snomed.info/sct" />
            </binding>
        </element>
        <element id="DocumentReference.type.coding:SCT.system">
            <path value="DocumentReference.type.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.type.coding:SCT.code">
            <path value="DocumentReference.type.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.type.coding:XDS">
            <path value="DocumentReference.type.coding" />
            <sliceName value="XDS" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="http://ihe-d.de/ValueSets/IHEXDStypeCode" />
            </binding>
        </element>
        <element id="DocumentReference.type.coding:XDS.system">
            <path value="DocumentReference.type.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.type.coding:XDS.code">
            <path value="DocumentReference.type.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.category">
            <path value="DocumentReference.category" />
            <short value="Kategorien des Dokuments" />
            <definition value="&#220;bergeordnete Kategorie des Dokuments auf das verwiesen wird (z.B. Arztberichte oder Arztdokumentation)" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.category.coding">
            <path value="DocumentReference.category.coding" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="system" />
                </discriminator>
                <description value="Slice f&#252;r Kategorie des verwiesenen Dokuments" />
                <ordered value="false" />
                <rules value="open" />
            </slicing>
        </element>
        <element id="DocumentReference.category.coding:SCT">
            <path value="DocumentReference.category.coding" />
            <sliceName value="SCT" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="http://snomed.info/sct" />
            </binding>
        </element>
        <element id="DocumentReference.category.coding:SCT.system">
            <path value="DocumentReference.category.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.category.coding:SCT.code">
            <path value="DocumentReference.category.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.category.coding:XDS">
            <path value="DocumentReference.category.coding" />
            <sliceName value="XDS" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="http://ihe-d.de/ValueSets/IHEXDSclassCode" />
            </binding>
        </element>
        <element id="DocumentReference.category.coding:XDS.system">
            <path value="DocumentReference.category.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.category.coding:XDS.code">
            <path value="DocumentReference.category.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.subject">
            <path value="DocumentReference.subject" />
            <short value="Verweis auf Patient" />
            <definition value="Patient auf den sich das verwiesene Dokument bezieht" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.subject.reference">
            <path value="DocumentReference.subject.reference" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.relatesTo">
            <path value="DocumentReference.relatesTo" />
            <short value="Beziehung des Dokuments" />
            <definition value="Beziehungen des verwiesenen Dokuments zu anderen Dokumenten" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.relatesTo.code">
            <path value="DocumentReference.relatesTo.code" />
            <short value="Art der Beziehung" />
            <definition value="Beziehung zu anderen Dokumenten" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.relatesTo.target">
            <path value="DocumentReference.relatesTo.target" />
            <short value="Verweis auf Dokument" />
            <definition value="Ziel der Dokumentenbeziehung" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.description">
            <path value="DocumentReference.description" />
            <short value="Beschreibung des Dokuments" />
            <definition value="Menschenlesbare Beschreibung zum verwiesenen Dokuments" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.securityLabel">
            <path value="DocumentReference.securityLabel" />
            <short value="Vertraulichkeit des Dokuments" />
            <definition value="Grad der Vertraulichkeit/Sicherheit des verwiesenen Dokuments (z. B. uneingeschr&#228;nkt, gering, mittel, normal oder eingeschr&#228;nkt)" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.content">
            <path value="DocumentReference.content" />
            <short value="Inhalt des Dokuments" />
            <definition value="Dokument (Base64-kodierte Daten) oder Verweis (URL) mit relevanten Metadaten zum Anhang" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.content.attachment">
            <path value="DocumentReference.content.attachment" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.content.attachment.contentType">
            <path value="DocumentReference.content.attachment.contentType" />
            <short value="MIME-Typ zum Inhalt" />
            <definition value="MIME-Typ des Dokumenteninhalts" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.content.attachment.language">
            <path value="DocumentReference.content.attachment.language" />
            <short value="Verfassungssprache des Inhalts" />
            <definition value="Verwendete Sprache in dem Dokument" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.content.attachment.data">
            <path value="DocumentReference.content.attachment.data" />
            <short value="Bin&#228;rdaten zum Inhalt" />
            <definition value="Dokument als Bin&#228;rdaten" />
        </element>
        <element id="DocumentReference.content.attachment.url">
            <path value="DocumentReference.content.attachment.url" />
            <short value="URL zum Inhalt" />
            <definition value="Verweis auf den (lokalen) Ablageort des Dokuments" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.content.attachment.creation">
            <path value="DocumentReference.content.attachment.creation" />
            <short value="Erstellungsdatum des Inhalts" />
            <definition value="Datum der Erstellung des Dokumentes" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.content.format">
            <path value="DocumentReference.content.format" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.content.format.code">
            <path value="DocumentReference.content.format.code" />
            <binding>
                <strength value="extensible" />
                <valueSet value="http://ihe-d.de/ValueSets/IHEXDSformatCodeDE" />
            </binding>
        </element>
        <element id="DocumentReference.context">
            <path value="DocumentReference.context" />
            <short value="Erzeugungskontext des Dokuments" />
            <definition value="Klinischer Kontext, in welchem das Dokument erzeugt wurde" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.encounter">
            <path value="DocumentReference.context.encounter" />
            <short value="Verweis auf Einrichtungskontakt" />
            <definition value="Kontakt zur Gesundheitseinrichtung oder die Art der Versorgung, die mit dem Dokumenteninhalt assoziiert ist" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.encounter.reference">
            <path value="DocumentReference.context.encounter.reference" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.event">
            <path value="DocumentReference.context.event" />
            <short value="Dokumentierter Vorgang" />
            <definition value="Handlungen oder Prozeduren, die im Kontext dokumentiert wurden" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.period">
            <path value="DocumentReference.context.period" />
            <short value="Durchf&#252;hrungszeitraum zum Vorgang" />
            <definition value="Zeitraum, in dem die in dem Dokument beschriebene Handlung oder Prozedur durchgef&#252;hrt wurde" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.facilityType">
            <path value="DocumentReference.context.facilityType" />
            <short value="Art der Einrichtung zum Vorgang" />
            <definition value="Art der Einrichtung, in der die Handlung oder Prozedur am Patienten erfolgte" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.facilityType.coding">
            <path value="DocumentReference.context.facilityType.coding" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="system" />
                </discriminator>
                <description value="Slice f&#252;r IHE XDS-basierte Einrichtungsart" />
                <ordered value="false" />
                <rules value="open" />
            </slicing>
        </element>
        <element id="DocumentReference.context.facilityType.coding:SCT">
            <path value="DocumentReference.context.facilityType.coding" />
            <sliceName value="SCT" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="http://snomed.info/sct" />
            </binding>
        </element>
        <element id="DocumentReference.context.facilityType.coding:SCT.system">
            <path value="DocumentReference.context.facilityType.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.facilityType.coding:SCT.code">
            <path value="DocumentReference.context.facilityType.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.facilityType.coding:XDS">
            <path value="DocumentReference.context.facilityType.coding" />
            <sliceName value="XDS" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="http://ihe-d.de/ValueSets/IHEXDShealthcareFacilityTypeCode" />
            </binding>
        </element>
        <element id="DocumentReference.context.facilityType.coding:XDS.system">
            <path value="DocumentReference.context.facilityType.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.facilityType.coding:XDS.code">
            <path value="DocumentReference.context.facilityType.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.practiceSetting">
            <path value="DocumentReference.context.practiceSetting" />
            <short value="Klinisches Fachgebiet zum Vorgang" />
            <definition value="Klinisches Fachgebiet, in dem Dokumenteninhalt erstellt wurde" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.practiceSetting.coding">
            <path value="DocumentReference.context.practiceSetting.coding" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="system" />
                </discriminator>
                <description value="Slice f&#252;r IHE XDS-basierte klinische Fachgebiete" />
                <ordered value="false" />
                <rules value="open" />
            </slicing>
        </element>
        <element id="DocumentReference.context.practiceSetting.coding:SCT">
            <path value="DocumentReference.context.practiceSetting.coding" />
            <sliceName value="SCT" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="http://snomed.info/sct" />
            </binding>
        </element>
        <element id="DocumentReference.context.practiceSetting.coding:SCT.system">
            <path value="DocumentReference.context.practiceSetting.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.practiceSetting.coding:SCT.code">
            <path value="DocumentReference.context.practiceSetting.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.practiceSetting.coding:XDS">
            <path value="DocumentReference.context.practiceSetting.coding" />
            <sliceName value="XDS" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="http://ihe-d.de/ValueSets/IHEXDSpracticeSettingCode" />
            </binding>
        </element>
        <element id="DocumentReference.context.practiceSetting.coding:XDS.system">
            <path value="DocumentReference.context.practiceSetting.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="DocumentReference.context.practiceSetting.coding:XDS.code">
            <path value="DocumentReference.context.practiceSetting.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "mii-pr-dokument-dokument",
    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-dokument/StructureDefinition/mii-pr-dokument-dokument",
    "version": "2025.0.0-ballot",
    "name": "MII_PR_Dokument_Dokument",
    "title": "MII PR Dokument Dokument",
    "status": "draft",
    "publisher": "Medizininformatik Initiative",
    "contact":  [
        {
            "telecom":  [
                {
                    "system": "url",
                    "value": "https://www.medizininformatik-initiative.de"
                }
            ]
        }
    ],
    "description": "Klinisches Dokument mit zugehörigen Metadaten",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "DocumentReference",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DocumentReference",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "DocumentReference.meta",
                "path": "DocumentReference.meta",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.masterIdentifier",
                "path": "DocumentReference.masterIdentifier",
                "short": "Versionsspezifische Kennung",
                "definition": "Versionsspezifische eindeutige Kennung, die dem Dokument durch die Dokumentenquelle zugewiesen wurde",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.identifier",
                "path": "DocumentReference.identifier",
                "short": "Versionsunabhängige Kennung",
                "definition": "Andere versionsunabhängige Kennung, die dem Dokument (z.B. durch weitere dokumentenverarbeitende Systeme) zugewiesen wurde",
                "max": "1",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.status",
                "path": "DocumentReference.status",
                "short": "Status der Dokumentenreferenz",
                "definition": "Status dieser Dokumentenreferenz (aktuell, überholt oder irrtümlich eingegeben)",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.docStatus",
                "path": "DocumentReference.docStatus",
                "short": "Status des Dokuments",
                "definition": "Status des zugrunde liegenden Dokuments (vorläufig, final, geändert oder irrtümlich eingegeben)",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.type",
                "path": "DocumentReference.type",
                "short": "Art des Dokuments",
                "definition": "Art des Dokuments auf das verwiesen wird (z.B. Anamnese und Untersuchung, Entlassungsbericht, Verlaufsbericht)",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.type.coding",
                "path": "DocumentReference.type.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "system"
                        }
                    ],
                    "rules": "open",
                    "description": "Slice für Art des verwiesenen Dokument",
                    "ordered": false
                }
            },
            {
                "id": "DocumentReference.type.coding:KDL",
                "path": "DocumentReference.type.coding",
                "sliceName": "KDL",
                "min": 0,
                "max": "1",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "http://dvmd.de/fhir/ValueSet/kdl"
                }
            },
            {
                "id": "DocumentReference.type.coding:KDL.system",
                "path": "DocumentReference.type.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.type.coding:KDL.code",
                "path": "DocumentReference.type.coding.code",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.type.coding:SCT",
                "path": "DocumentReference.type.coding",
                "sliceName": "SCT",
                "min": 0,
                "max": "1",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "http://snomed.info/sct"
                }
            },
            {
                "id": "DocumentReference.type.coding:SCT.system",
                "path": "DocumentReference.type.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.type.coding:SCT.code",
                "path": "DocumentReference.type.coding.code",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.type.coding:XDS",
                "path": "DocumentReference.type.coding",
                "sliceName": "XDS",
                "min": 0,
                "max": "1",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "http://ihe-d.de/ValueSets/IHEXDStypeCode"
                }
            },
            {
                "id": "DocumentReference.type.coding:XDS.system",
                "path": "DocumentReference.type.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.type.coding:XDS.code",
                "path": "DocumentReference.type.coding.code",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.category",
                "path": "DocumentReference.category",
                "short": "Kategorien des Dokuments",
                "definition": "Übergeordnete Kategorie des Dokuments auf das verwiesen wird (z.B. Arztberichte oder Arztdokumentation)",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.category.coding",
                "path": "DocumentReference.category.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "system"
                        }
                    ],
                    "rules": "open",
                    "description": "Slice für Kategorie des verwiesenen Dokuments",
                    "ordered": false
                }
            },
            {
                "id": "DocumentReference.category.coding:SCT",
                "path": "DocumentReference.category.coding",
                "sliceName": "SCT",
                "min": 0,
                "max": "1",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "http://snomed.info/sct"
                }
            },
            {
                "id": "DocumentReference.category.coding:SCT.system",
                "path": "DocumentReference.category.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.category.coding:SCT.code",
                "path": "DocumentReference.category.coding.code",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.category.coding:XDS",
                "path": "DocumentReference.category.coding",
                "sliceName": "XDS",
                "min": 0,
                "max": "1",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "http://ihe-d.de/ValueSets/IHEXDSclassCode"
                }
            },
            {
                "id": "DocumentReference.category.coding:XDS.system",
                "path": "DocumentReference.category.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.category.coding:XDS.code",
                "path": "DocumentReference.category.coding.code",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.subject",
                "path": "DocumentReference.subject",
                "short": "Verweis auf Patient",
                "definition": "Patient auf den sich das verwiesene Dokument bezieht",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/Patient",
                            "https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient",
                            "https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "DocumentReference.subject.reference",
                "path": "DocumentReference.subject.reference",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.relatesTo",
                "path": "DocumentReference.relatesTo",
                "short": "Beziehung des Dokuments",
                "definition": "Beziehungen des verwiesenen Dokuments zu anderen Dokumenten",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.relatesTo.code",
                "path": "DocumentReference.relatesTo.code",
                "short": "Art der Beziehung",
                "definition": "Beziehung zu anderen Dokumenten",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.relatesTo.target",
                "path": "DocumentReference.relatesTo.target",
                "short": "Verweis auf Dokument",
                "definition": "Ziel der Dokumentenbeziehung",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.description",
                "path": "DocumentReference.description",
                "short": "Beschreibung des Dokuments",
                "definition": "Menschenlesbare Beschreibung zum verwiesenen Dokuments",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.securityLabel",
                "path": "DocumentReference.securityLabel",
                "short": "Vertraulichkeit des Dokuments",
                "definition": "Grad der Vertraulichkeit/Sicherheit des verwiesenen Dokuments (z. B. uneingeschränkt, gering, mittel, normal oder eingeschränkt)",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.content",
                "path": "DocumentReference.content",
                "short": "Inhalt des Dokuments",
                "definition": "Dokument (Base64-kodierte Daten) oder Verweis (URL) mit relevanten Metadaten zum Anhang",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.content.attachment",
                "path": "DocumentReference.content.attachment",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.content.attachment.contentType",
                "path": "DocumentReference.content.attachment.contentType",
                "short": "MIME-Typ zum Inhalt",
                "definition": "MIME-Typ des Dokumenteninhalts",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.content.attachment.language",
                "path": "DocumentReference.content.attachment.language",
                "short": "Verfassungssprache des Inhalts",
                "definition": "Verwendete Sprache in dem Dokument",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.content.attachment.data",
                "path": "DocumentReference.content.attachment.data",
                "short": "Binärdaten zum Inhalt",
                "definition": "Dokument als Binärdaten"
            },
            {
                "id": "DocumentReference.content.attachment.url",
                "path": "DocumentReference.content.attachment.url",
                "short": "URL zum Inhalt",
                "definition": "Verweis auf den (lokalen) Ablageort des Dokuments",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.content.attachment.creation",
                "path": "DocumentReference.content.attachment.creation",
                "short": "Erstellungsdatum des Inhalts",
                "definition": "Datum der Erstellung des Dokumentes",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.content.format",
                "path": "DocumentReference.content.format",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.content.format.code",
                "path": "DocumentReference.content.format.code",
                "binding": {
                    "strength": "extensible",
                    "valueSet": "http://ihe-d.de/ValueSets/IHEXDSformatCodeDE"
                }
            },
            {
                "id": "DocumentReference.context",
                "path": "DocumentReference.context",
                "short": "Erzeugungskontext des Dokuments",
                "definition": "Klinischer Kontext, in welchem das Dokument erzeugt wurde",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.encounter",
                "path": "DocumentReference.context.encounter",
                "short": "Verweis auf Einrichtungskontakt",
                "definition": "Kontakt zur Gesundheitseinrichtung oder die Art der Versorgung, die mit dem Dokumenteninhalt assoziiert ist",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/Encounter",
                            "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.encounter.reference",
                "path": "DocumentReference.context.encounter.reference",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.event",
                "path": "DocumentReference.context.event",
                "short": "Dokumentierter Vorgang",
                "definition": "Handlungen oder Prozeduren, die im Kontext dokumentiert wurden",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.period",
                "path": "DocumentReference.context.period",
                "short": "Durchführungszeitraum zum Vorgang",
                "definition": "Zeitraum, in dem die in dem Dokument beschriebene Handlung oder Prozedur durchgeführt wurde",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.facilityType",
                "path": "DocumentReference.context.facilityType",
                "short": "Art der Einrichtung zum Vorgang",
                "definition": "Art der Einrichtung, in der die Handlung oder Prozedur am Patienten erfolgte",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.facilityType.coding",
                "path": "DocumentReference.context.facilityType.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "system"
                        }
                    ],
                    "rules": "open",
                    "description": "Slice für IHE XDS-basierte Einrichtungsart",
                    "ordered": false
                }
            },
            {
                "id": "DocumentReference.context.facilityType.coding:SCT",
                "path": "DocumentReference.context.facilityType.coding",
                "sliceName": "SCT",
                "min": 0,
                "max": "1",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "http://snomed.info/sct"
                }
            },
            {
                "id": "DocumentReference.context.facilityType.coding:SCT.system",
                "path": "DocumentReference.context.facilityType.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.facilityType.coding:SCT.code",
                "path": "DocumentReference.context.facilityType.coding.code",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.facilityType.coding:XDS",
                "path": "DocumentReference.context.facilityType.coding",
                "sliceName": "XDS",
                "min": 0,
                "max": "1",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "http://ihe-d.de/ValueSets/IHEXDShealthcareFacilityTypeCode"
                }
            },
            {
                "id": "DocumentReference.context.facilityType.coding:XDS.system",
                "path": "DocumentReference.context.facilityType.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.facilityType.coding:XDS.code",
                "path": "DocumentReference.context.facilityType.coding.code",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.practiceSetting",
                "path": "DocumentReference.context.practiceSetting",
                "short": "Klinisches Fachgebiet zum Vorgang",
                "definition": "Klinisches Fachgebiet, in dem Dokumenteninhalt erstellt wurde",
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.practiceSetting.coding",
                "path": "DocumentReference.context.practiceSetting.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "system"
                        }
                    ],
                    "rules": "open",
                    "description": "Slice für IHE XDS-basierte klinische Fachgebiete",
                    "ordered": false
                }
            },
            {
                "id": "DocumentReference.context.practiceSetting.coding:SCT",
                "path": "DocumentReference.context.practiceSetting.coding",
                "sliceName": "SCT",
                "min": 0,
                "max": "1",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "http://snomed.info/sct"
                }
            },
            {
                "id": "DocumentReference.context.practiceSetting.coding:SCT.system",
                "path": "DocumentReference.context.practiceSetting.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.practiceSetting.coding:SCT.code",
                "path": "DocumentReference.context.practiceSetting.coding.code",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.practiceSetting.coding:XDS",
                "path": "DocumentReference.context.practiceSetting.coding",
                "sliceName": "XDS",
                "min": 0,
                "max": "1",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "http://ihe-d.de/ValueSets/IHEXDSpracticeSettingCode"
                }
            },
            {
                "id": "DocumentReference.context.practiceSetting.coding:XDS.system",
                "path": "DocumentReference.context.practiceSetting.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "DocumentReference.context.practiceSetting.coding:XDS.code",
                "path": "DocumentReference.context.practiceSetting.coding.code",
                "min": 1,
                "mustSupport": true
            }
        ]
    }
}

MII PR Dokument Dokument

Mapping Datensatz zu FHIR

Suchparameter

Folgende Suchparameter sind für diese Modul relevant, auch in Kombination:

Der Suchparameter "_id" MUSS unterstützt werden:

Beispiele:

GET [base]/DocumentReference?_id=12345

Anwendungshinweise: Weitere Informationen zur Suche nach "_id" finden sich in der FHIR-Basisspezifikation - Abschnitt "Parameters for all resources".

Beispiele

Quelle: GraSCCo Datensatz, DOI (Zenodo): 10.5281/zenodo.6539130

{
    "resourceType": "DocumentReference",
    "id": "UKX-1-E-1-DR-1",
    "meta": {
        "profile":  [
            "https://www.medizininformatik-initiative.de/fhir/ext/modul-dokument/StructureDefinition/mii-pr-dokument-dokument"
        ]
    },
    "type": {
        "coding":  [
            {
                "version": "2024",
                "code": "AD010102",
                "system": "http://dvmd.de/fhir/CodeSystem/kdl",
                "display": "Durchgangsarztbericht"
            },
            {
                "version": "1.4.0",
                "code": "BERI",
                "system": "http://ihe-d.de/CodeSystem/IHEXDStypeCode",
                "display": "Arztberichte"
            }
        ],
        "text": "Durchgangsarztbericht"
    },
    "category":  [
        {
            "coding":  [
                {
                    "version": "1.4.0",
                    "code": "BRI",
                    "system": "http://ihe-d.de/CodeSystems/IHEXDSclassCode",
                    "display": "Brief"
                }
            ],
            "text": "Brief"
        }
    ],
    "securityLabel":  [
        {
            "coding":  [
                {
                    "version": "4.0.1",
                    "code": "L",
                    "system": "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
                    "display": "low"
                }
            ]
        },
        {
            "coding":  [
                {
                    "version": "4.0.1",
                    "code": "HTEST",
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                    "display": "test health data"
                }
            ]
        }
    ],
    "content":  [
        {
            "attachment": {
                "contentType": "text/plain",
                "language": "de_DE",
                "data": "  

Werte Frau Kollegin, werter geehrter Herr Kollege!
Wir berichten über lhre Patientin Beate Albers (* 4.4.1997), die sich vom 19.3. bis zum 7.5.2029 in unserer stat. Behandlung befand.
 
Vorgeschichte Befund
 
•	Verbrennung 1. – 3. Grades, Kopf I Hals,5% v KOF 
•	Handamputation LI
•	Akute Psychose aus dem schizophrenen Formenkreis 
•	Selbstschädigung  
•	Blutungsanamie  
•	Hypokaliämie  
•	Arterieller Hypertonus
•	Symptomatisches Anfallsleiden seit 2007
•	St.p.  Aneurysmablutung  
•	Passagerer Diabetes mellitus  

19.03.2029: Handreplantaticm
25.03.2029:  Revision 
27.03.2029: Nekrosektomie Kopf / Hals
30.03.2029: Jet-Lavage, Debridement und VAG Wechsel linken Hand 
01.04.2029: Jet-Lavage, Debridement und VAG-Wechsel linke Hand 
6.04.2029: Nachdebridement am Kopf, VAG-Wechsel linke Hand
07.04.2029: Weicliteildeckung mit Spalthautsheet und Keratinozytensprühsuspension
15.04.2029: Debridement, Jet Lavage Lind VAC Wechsel linke Hand
23.04.2029 Restdefektdeckung Kopf u. Hals (Sheets), Defektdeckung Handrücken
06.05.2029 K-Draht-Entfernung Ii. Handgelenk

Bei Frau Albers ist psychiatrischerseits eine Wahnvorstellung bekannt. Sie hatte sich zuhause die Ii. Hand selbst amputiert und sich das Haupthaar angezündet. Sie informierte telefonfach eine Freundin, die direkt den Rettungsdienst alarmierte. Lt. Protokoll öffnete die Patientin selbst die Tür und hielt die abgetrennte Hand. Sie wurde darauf umgehend in die Rettungsstelle unseres Zentrums verbracht. Bei Aufnahme zeigte sich klinisch und radiologisch eine komplette Amputation der linken Hand. Beide Ohren sowie insbesondere die re. Hals-/Nackenregion waren ll bis Ill gradig verbrannt. Das Kopf-CT zeigte keinen Nachweis frischer intrakranieller Traumafolgen bei Zustand nach osteoplastischer Trepanation der hinteren Schädelgrube links sowie rechts frontotemporal und nachweisbare  Gefa-Clips links infratentoriell im Bereich der linken A. vertebralis sowie im Bereich der A . cerebri media rechts.

Verlauf
Frau Albers wurde durch die Kollegen der Hand- u. Mikrochirurgischen Abteilung umgehend operativ versorgt. Die Hand konnte in einem die ganze Nacht dauerndem Eingriff replantiert werden. Ein streckseitiger WT-Defekt wurde temporär mit Vacuseal gedeckt. Die verbrannten Areale wurden zunächst antiseptisch mit Lavaseptgelverbänden versorgt. Anschließend wurde Frau Albers intuobiert und beatmet auf die lntensivstation des Brandverletztenzentrums aufgenommen.
Am 25.03.2029 erfolgte eine Wundrevision mil Vacusealwechsel. Das Verbandsregime am Kopf wurde auf ein enzymatisches Debridement mit lruxolsalbe umgestellt. Ein erster debridierender Eingriff erfolgte am 27.03.2029.
Ein erneutes Debridement  erfolgte bei weitgehend  sauberen Wunden am Kopf am 06.04.2029. Daraufhin konnte am 08.04.2029 die Defektdeckung am Kopf mit Keratinozytensprühsuspension und Spalthautsheets vorn linken Überschenkel erfolgen. Insgesamt sahen wir eine problemlose Einheilung der Transplantate. Lediglich am rechten retroauriculären Hals und an kleineren Arealen am Kopf musste im Verlauf am 23.04 2029 nochmals nachtransplantiert werden. Der Kopf mit Gesicht zeigt sich gegenwärtig bis auf kleinere Defekte abgeheilt. Die Entnahmestellen sind gänzlich reepithelisert. Im beharrten Teil des Kopfes sind multiple alopezische Areale verblieben, bei initial drittgradiger Verbrennungstiefe.

Am 23.04.2029 erfolgte ebenfalls die Defektdeckung des mittlerweile sauber granulierenden Defektes am II. Handrücken mittels Spalthautsheet
Die temporare Arthrodese im Handgelenk wurde am 06.05.2029 entfernt. Physio- bzw. ergotherapeutische Behandlung wurde begleitend durchgeführt.

Intensivmedizinischer  Krankheitsverlauf:
Die Patientin wurde vom  20.3.2029 bis zum 27.3.2029  zunächst  kontrolliert und  im weiteren Verlauf unter reduzierter Analgosedierung augmentiert maschinell beatmet. Bei FIüssigkeitseinlagerungen pulmonal und peripher unter der FIüssigkeitstherapie nach Baxter-Parkland Formel induzierten wir eine  forcierte Diurese mit Furosemid. Hierunter war die Oxygenierung im Verlauf suffizient. Die Entwöhnung vom  Respirator gelang problemlos. Frau Albers konnte am 27.3.2029 bei intakten Schutzreflexen extubiert werden . Seitdem  imponiert eine suffiziente Spontanatmung  mit einer peripheren Sauerstoffsättgung von 98%  unter Raumluft.
Nach Beendigung der Analgosedierung imponierte ein mildes Entzugsdelir. das suffizient mit Clonidin behandlet werden konnte. Eine intermittierende psychotische Symptomatik therapierten wir zunächst mit Lorazepam (Tavor®) und Haloperidol (Haldol®). Im weiteren Verlauf wurde diese Medikation einschleichend durch Risperidon (Risperdal®) ersetzt. Die vorbestehende antiepileptische Medikation mit Levothiracetam (Keppra®) führten wir fort. Näheres bitten wir dem psychiatrischen Verlauf zu entnehmen.
Nach Aufnahme strebten wir zunächst eine positive FIüssigkeitsbilanz an Die Diurese war unter FIüssigkeitstherapie unter Anlehnung an die Baxter-Parklandformel qualitativ und quantitativ suffizient. Im weiteren stationären Verlauf wurde eine antiödematöse Therapie mit Furosemid notwendig. Die Retentionsparameter lagen allzeit im Normbereich.
Unter adäquater Volumentherapie zeigte sich die Patientin initial und im Weiteren hämodynamisch stabil. Nach Beendigung der Analgosedierung wurde bei arteriellem Hypertonus eine antihypertensive Therapie mit Metoprolol (Beloc zok mite®) und Ramipril (Delix®) begonnen. Hiermit gelang eine zufriedenstellende Blutdruckeinstellung.
Unter Analgosedierung begannen wir die enterale Ernährung über die einliegende Magensonde. Nach Stimulation führte Frau Albers am 26.3.2029 zum ersten Mal ab. Nach Extubation gelang der orale Kostaufbau problemlos Die Patientin nimmt Wunschkost zu sich.

Psychiatrischer Verlauf
Fremdanamnestisch war von der Freundin und der ambulant behandelnden Ärztin für Psychiatrie und Psychotherapie zu erfahren, dass die Patientin bereits seit Anfang des Jahres akut psychotisch gewesen sei. Sie hatte die letzte antipsychotische Erhaltungsmedikation von 2 mg abgesetzt, die ambulant behandelnde Psychiaterin Frau Dr. Siewert wusste davon. Trotz häufiger telefonischer Kontakte mit der behandelnden Ärztin ließ sie sich nicht zu einer weiteren medikamentösen Therapie motivieren. Noch am Tag der Selbstverletzung war die besorgte Freundin mit ihr beim Sozialpsychiatrischen Dienst vorstellig gewesen. Da Frau Albers zu einer freiwilligen stationären Aufnahme nicht bereit war und keine Unterbringungsgründe vorlagen, war eine Vorstellung bei der ambulanten Psychiaterin vorgesehen. Auf dem Weg dorthin sei Frau Albers aus dem Taxi gesprungen und hatte sich zuhause o.g. Verletzungen zugefügt. Sie teilte dies telefonisch der Freundin mit, die daraufhin die Feuerwehr alarmierte.
Initial fanden  sich erhebliche Denkstörungen. lnhaltlich klang Wahnerleben an, Gott zu sein. Sie erinnerte sich daran, sich die linke Hand mit dem Brotmesser abgeschnitten zu haben. Dies sei geschehen um das Böse in der Welt zu Sühnen. Sie war zunächst noch erheblich inadäquat, spuckte permanent, geordnete Gespräche mit ihr waren nur schwer möglich. Unter einer Sedierung mit Tavor und nach Umstellung auf Haloperidol sistierte diese Symptomatik zunehmend, so dass wir die antipsychotische Medikation in Absprache mit ihr auf eine Dosis von 6 mg Risperdal umstellten. Das Tavor bat sie auszuschleichen.
Darunter war sie im Verlauf weitgehend distanziert von psychotischem Erleben, ruhig, gut im Kontakt und bedauerte, was sie sich da angetan hatte und nachdem sie zunächst eine stationäre psychiatrische Verlegung ablehnte, willigte sie nach einem motivierenden Gespräch schließlich ein, sich freiwillig in lhre Abteilung verlegen zu lassen. Sie war sehr interessiert an der Therapie, verfügte hier auch aus der Vorgeschichte über gute Kenntnisse z.B. über die Rezeptorwirkung der Medikamente. Im Affekt blieb sie insgesamt eher distanziert zur Dramatik ihrer Selbstverletzung.
Ziel der Verlegung soll die weitere Belastungserprobung unter zunehmender Konfrontation milder Außenwelt im Anschluss an die stationäre intensivmedizinische Behandlung sein. Darüber hinaus ist eine sozialpsychiatrische Einbettung in ein ambulantes Setting nach dieser schweren Selbstverletzung angestrebt sowie die therapeutische Begleitung bei der Bewältigung der Folgeschaden im Alltag.
Procedere: Wir verlegen Frau Albers, die in Ihrem Hause vorbekannt ist, am 14.05.2029 in lhre weitere stationäre fachpsychiatrische Behandlung.
Durch die Orthopädiemechanik unseres Hauses wurde eine teils flexible Orthese angefertigt. Diese muss bis auf Weiteres getragen werden. Wir bitten bei per Patientin 1 x tgl. eine ergo- und physiotherapeutische Beübung der Iinken Hand durchzuführen. Hierbei sollten die Fingergelenke und das Handgelenk belastungsfrei in allen Ebenen therapiert werden. Die Übungen sollten aktiv und passiv aus der Orthese heraus erfolgen.  
Die Transplantat· und Entnahmeareale sollten tgl. mehrfach mit fettenden Salben (z.B. Panthenol) gepflegt werden. Restdefekte, die ggf. etwas nässen können mit Betaisodona – Lsg. behandelt werden.  
Aus plastisch- u. handchirurgischer Sicht werden mittel- bis langfristig noch mehrere korrigierende Eingriffe 1otwendig sein. Hierzu zählen beispielsweise operative Sehnen- und Gelenklösungen zur Verbesserung der Beweglichkeit der Hand sowie Korrektureingriffe im Bereich der Narben insbesondere im Kopf-/Halsbereich und der haarlosen Kopfareale. Wir werden Frau Albers hierzu in Kooperation mit den Handchirurgen an unsere Sprechstunde anbinden.
Medikamente bei Entlassunq:
 Enoxaparin (Clexane®) 0,4 ml 
Pantoprazol (Pantozol®) 40 mg 
Ramipril (Detix®) 2.5 mg
Metoprolol (Beloc zok mite®) 47,5 mg
Levothir c.etarn (Keppra®) 1500mg 
Risperidon {Risperdaf®) 2 mg
Ibuprofen .600mg
Thiamin (Vil. B1) 100 mg + Pyridoxin (Vit. 8) 100 mg (Neurorathiopharrn®) 
Es konnen bioaquivalente Generika (weiter-) verordnet werden.

Mit freundlichen kollegialen Grüßen
 
Dr.med. Bernwart Schulze  

",
                "size": 10092,
                "title": "Albers.txt",
                "creation": "02/26/2024 08:34:21"
            }
        }
    ],
    "context": {
        "encounter":  [
            {
                "reference": "Encounter/UKX-1-E-1"
            }
        ]
    },
    "status": "current",
    "docStatus": "final",
    "subject": {
        "reference": "Patient/UKX-1"
    },
    "date": "01/21/2025 12:39:02",
    "description": "GraSSCO Standardbrief"
}

<DocumentReference xmlns="http://hl7.org/fhir">
    <id value="UKX-1-E-1-DR-1" />
    <meta>
        <profile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-dokument/StructureDefinition/mii-pr-dokument-dokument" />
    </meta>
    <status value="current" />
    <docStatus value="final" />
    <type>
        <coding>
            <system value="http://dvmd.de/fhir/CodeSystem/kdl" />
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            <code value="AD010102" />
            <display value="Durchgangsarztbericht" />
        </coding>
        <coding>
            <system value="http://ihe-d.de/CodeSystem/IHEXDStypeCode" />
            <version value="1.4.0" />
            <code value="BERI" />
            <display value="Arztberichte" />
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    </type>
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            <system value="http://ihe-d.de/CodeSystems/IHEXDSclassCode" />
            <version value="1.4.0" />
            <code value="BRI" />
            <display value="Brief" />
        </coding>
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            <data value="  

Werte Frau Kollegin, werter geehrter Herr Kollege!
Wir berichten über lhre Patientin Beate Albers (* 4.4.1997), die sich vom 19.3. bis zum 7.5.2029 in unserer stat. Behandlung befand.
 
Vorgeschichte Befund
 
•	Verbrennung 1. – 3. Grades, Kopf I Hals,5% v KOF 
•	Handamputation LI
•	Akute Psychose aus dem schizophrenen Formenkreis 
•	Selbstschädigung  
•	Blutungsanamie  
•	Hypokaliämie  
•	Arterieller Hypertonus
•	Symptomatisches Anfallsleiden seit 2007
•	St.p.  Aneurysmablutung  
•	Passagerer Diabetes mellitus  

19.03.2029: Handreplantaticm
25.03.2029:  Revision 
27.03.2029: Nekrosektomie Kopf / Hals
30.03.2029: Jet-Lavage, Debridement und VAG Wechsel linken Hand 
01.04.2029: Jet-Lavage, Debridement und VAG-Wechsel linke Hand 
6.04.2029: Nachdebridement am Kopf, VAG-Wechsel linke Hand
07.04.2029: Weicliteildeckung mit Spalthautsheet und Keratinozytensprühsuspension
15.04.2029: Debridement, Jet Lavage Lind VAC Wechsel linke Hand
23.04.2029 Restdefektdeckung Kopf u. Hals (Sheets), Defektdeckung Handrücken
06.05.2029 K-Draht-Entfernung Ii. Handgelenk

Bei Frau Albers ist psychiatrischerseits eine Wahnvorstellung bekannt. Sie hatte sich zuhause die Ii. Hand selbst amputiert und sich das Haupthaar angezündet. Sie informierte telefonfach eine Freundin, die direkt den Rettungsdienst alarmierte. Lt. Protokoll öffnete die Patientin selbst die Tür und hielt die abgetrennte Hand. Sie wurde darauf umgehend in die Rettungsstelle unseres Zentrums verbracht. Bei Aufnahme zeigte sich klinisch und radiologisch eine komplette Amputation der linken Hand. Beide Ohren sowie insbesondere die re. Hals-/Nackenregion waren ll bis Ill gradig verbrannt. Das Kopf-CT zeigte keinen Nachweis frischer intrakranieller Traumafolgen bei Zustand nach osteoplastischer Trepanation der hinteren Schädelgrube links sowie rechts frontotemporal und nachweisbare  Gefa-Clips links infratentoriell im Bereich der linken A. vertebralis sowie im Bereich der A . cerebri media rechts.

Verlauf
Frau Albers wurde durch die Kollegen der Hand- u. Mikrochirurgischen Abteilung umgehend operativ versorgt. Die Hand konnte in einem die ganze Nacht dauerndem Eingriff replantiert werden. Ein streckseitiger WT-Defekt wurde temporär mit Vacuseal gedeckt. Die verbrannten Areale wurden zunächst antiseptisch mit Lavaseptgelverbänden versorgt. Anschließend wurde Frau Albers intuobiert und beatmet auf die lntensivstation des Brandverletztenzentrums aufgenommen.
Am 25.03.2029 erfolgte eine Wundrevision mil Vacusealwechsel. Das Verbandsregime am Kopf wurde auf ein enzymatisches Debridement mit lruxolsalbe umgestellt. Ein erster debridierender Eingriff erfolgte am 27.03.2029.
Ein erneutes Debridement  erfolgte bei weitgehend  sauberen Wunden am Kopf am 06.04.2029. Daraufhin konnte am 08.04.2029 die Defektdeckung am Kopf mit Keratinozytensprühsuspension und Spalthautsheets vorn linken Überschenkel erfolgen. Insgesamt sahen wir eine problemlose Einheilung der Transplantate. Lediglich am rechten retroauriculären Hals und an kleineren Arealen am Kopf musste im Verlauf am 23.04 2029 nochmals nachtransplantiert werden. Der Kopf mit Gesicht zeigt sich gegenwärtig bis auf kleinere Defekte abgeheilt. Die Entnahmestellen sind gänzlich reepithelisert. Im beharrten Teil des Kopfes sind multiple alopezische Areale verblieben, bei initial drittgradiger Verbrennungstiefe.

Am 23.04.2029 erfolgte ebenfalls die Defektdeckung des mittlerweile sauber granulierenden Defektes am II. Handrücken mittels Spalthautsheet
Die temporare Arthrodese im Handgelenk wurde am 06.05.2029 entfernt. Physio- bzw. ergotherapeutische Behandlung wurde begleitend durchgeführt.

Intensivmedizinischer  Krankheitsverlauf:
Die Patientin wurde vom  20.3.2029 bis zum 27.3.2029  zunächst  kontrolliert und  im weiteren Verlauf unter reduzierter Analgosedierung augmentiert maschinell beatmet. Bei FIüssigkeitseinlagerungen pulmonal und peripher unter der FIüssigkeitstherapie nach Baxter-Parkland Formel induzierten wir eine  forcierte Diurese mit Furosemid. Hierunter war die Oxygenierung im Verlauf suffizient. Die Entwöhnung vom  Respirator gelang problemlos. Frau Albers konnte am 27.3.2029 bei intakten Schutzreflexen extubiert werden . Seitdem  imponiert eine suffiziente Spontanatmung  mit einer peripheren Sauerstoffsättgung von 98%  unter Raumluft.
Nach Beendigung der Analgosedierung imponierte ein mildes Entzugsdelir. das suffizient mit Clonidin behandlet werden konnte. Eine intermittierende psychotische Symptomatik therapierten wir zunächst mit Lorazepam (Tavor®) und Haloperidol (Haldol®). Im weiteren Verlauf wurde diese Medikation einschleichend durch Risperidon (Risperdal®) ersetzt. Die vorbestehende antiepileptische Medikation mit Levothiracetam (Keppra®) führten wir fort. Näheres bitten wir dem psychiatrischen Verlauf zu entnehmen.
Nach Aufnahme strebten wir zunächst eine positive FIüssigkeitsbilanz an Die Diurese war unter FIüssigkeitstherapie unter Anlehnung an die Baxter-Parklandformel qualitativ und quantitativ suffizient. Im weiteren stationären Verlauf wurde eine antiödematöse Therapie mit Furosemid notwendig. Die Retentionsparameter lagen allzeit im Normbereich.
Unter adäquater Volumentherapie zeigte sich die Patientin initial und im Weiteren hämodynamisch stabil. Nach Beendigung der Analgosedierung wurde bei arteriellem Hypertonus eine antihypertensive Therapie mit Metoprolol (Beloc zok mite®) und Ramipril (Delix®) begonnen. Hiermit gelang eine zufriedenstellende Blutdruckeinstellung.
Unter Analgosedierung begannen wir die enterale Ernährung über die einliegende Magensonde. Nach Stimulation führte Frau Albers am 26.3.2029 zum ersten Mal ab. Nach Extubation gelang der orale Kostaufbau problemlos Die Patientin nimmt Wunschkost zu sich.

Psychiatrischer Verlauf
Fremdanamnestisch war von der Freundin und der ambulant behandelnden Ärztin für Psychiatrie und Psychotherapie zu erfahren, dass die Patientin bereits seit Anfang des Jahres akut psychotisch gewesen sei. Sie hatte die letzte antipsychotische Erhaltungsmedikation von 2 mg abgesetzt, die ambulant behandelnde Psychiaterin Frau Dr. Siewert wusste davon. Trotz häufiger telefonischer Kontakte mit der behandelnden Ärztin ließ sie sich nicht zu einer weiteren medikamentösen Therapie motivieren. Noch am Tag der Selbstverletzung war die besorgte Freundin mit ihr beim Sozialpsychiatrischen Dienst vorstellig gewesen. Da Frau Albers zu einer freiwilligen stationären Aufnahme nicht bereit war und keine Unterbringungsgründe vorlagen, war eine Vorstellung bei der ambulanten Psychiaterin vorgesehen. Auf dem Weg dorthin sei Frau Albers aus dem Taxi gesprungen und hatte sich zuhause o.g. Verletzungen zugefügt. Sie teilte dies telefonisch der Freundin mit, die daraufhin die Feuerwehr alarmierte.
Initial fanden  sich erhebliche Denkstörungen. lnhaltlich klang Wahnerleben an, Gott zu sein. Sie erinnerte sich daran, sich die linke Hand mit dem Brotmesser abgeschnitten zu haben. Dies sei geschehen um das Böse in der Welt zu Sühnen. Sie war zunächst noch erheblich inadäquat, spuckte permanent, geordnete Gespräche mit ihr waren nur schwer möglich. Unter einer Sedierung mit Tavor und nach Umstellung auf Haloperidol sistierte diese Symptomatik zunehmend, so dass wir die antipsychotische Medikation in Absprache mit ihr auf eine Dosis von 6 mg Risperdal umstellten. Das Tavor bat sie auszuschleichen.
Darunter war sie im Verlauf weitgehend distanziert von psychotischem Erleben, ruhig, gut im Kontakt und bedauerte, was sie sich da angetan hatte und nachdem sie zunächst eine stationäre psychiatrische Verlegung ablehnte, willigte sie nach einem motivierenden Gespräch schließlich ein, sich freiwillig in lhre Abteilung verlegen zu lassen. Sie war sehr interessiert an der Therapie, verfügte hier auch aus der Vorgeschichte über gute Kenntnisse z.B. über die Rezeptorwirkung der Medikamente. Im Affekt blieb sie insgesamt eher distanziert zur Dramatik ihrer Selbstverletzung.
Ziel der Verlegung soll die weitere Belastungserprobung unter zunehmender Konfrontation milder Außenwelt im Anschluss an die stationäre intensivmedizinische Behandlung sein. Darüber hinaus ist eine sozialpsychiatrische Einbettung in ein ambulantes Setting nach dieser schweren Selbstverletzung angestrebt sowie die therapeutische Begleitung bei der Bewältigung der Folgeschaden im Alltag.
Procedere: Wir verlegen Frau Albers, die in Ihrem Hause vorbekannt ist, am 14.05.2029 in lhre weitere stationäre fachpsychiatrische Behandlung.
Durch die Orthopädiemechanik unseres Hauses wurde eine teils flexible Orthese angefertigt. Diese muss bis auf Weiteres getragen werden. Wir bitten bei per Patientin 1 x tgl. eine ergo- und physiotherapeutische Beübung der Iinken Hand durchzuführen. Hierbei sollten die Fingergelenke und das Handgelenk belastungsfrei in allen Ebenen therapiert werden. Die Übungen sollten aktiv und passiv aus der Orthese heraus erfolgen.  
Die Transplantat· und Entnahmeareale sollten tgl. mehrfach mit fettenden Salben (z.B. Panthenol) gepflegt werden. Restdefekte, die ggf. etwas nässen können mit Betaisodona – Lsg. behandelt werden.  
Aus plastisch- u. handchirurgischer Sicht werden mittel- bis langfristig noch mehrere korrigierende Eingriffe 1otwendig sein. Hierzu zählen beispielsweise operative Sehnen- und Gelenklösungen zur Verbesserung der Beweglichkeit der Hand sowie Korrektureingriffe im Bereich der Narben insbesondere im Kopf-/Halsbereich und der haarlosen Kopfareale. Wir werden Frau Albers hierzu in Kooperation mit den Handchirurgen an unsere Sprechstunde anbinden.
Medikamente bei Entlassunq:
 Enoxaparin (Clexane®) 0,4 ml 
Pantoprazol (Pantozol®) 40 mg 
Ramipril (Detix®) 2.5 mg
Metoprolol (Beloc zok mite®) 47,5 mg
Levothir c.etarn (Keppra®) 1500mg 
Risperidon {Risperdaf®) 2 mg
Ibuprofen .600mg
Thiamin (Vil. B1) 100 mg + Pyridoxin (Vit. 8) 100 mg (Neurorathiopharrn®) 
Es konnen bioaquivalente Generika (weiter-) verordnet werden.

Mit freundlichen kollegialen Grüßen
 
Dr.med. Bernwart Schulze  

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Werte Frau Kollegin, werter geehrter Herr Kollege!

Wir berichten über lhre Patientin Beate Albers (* 4.4.1997), die sich vom 19.3. bis zum 7.5.2029 in unserer stat. Behandlung befand.

Vorgeschichte Befund

• Verbrennung 1. – 3. Grades, Kopf I Hals,5% v KOF • Handamputation LI • Akute Psychose aus dem schizophrenen Formenkreis • Selbstschädigung • Blutungsanamie • Hypokaliämie • Arterieller Hypertonus • Symptomatisches Anfallsleiden seit 2007 • St.p. Aneurysmablutung • Passagerer Diabetes mellitus

19.03.2029: Handreplantaticm 25.03.2029: Revision 27.03.2029: Nekrosektomie Kopf / Hals 30.03.2029: Jet-Lavage, Debridement und VAG Wechsel linken Hand 01.04.2029: Jet-Lavage, Debridement und VAG-Wechsel linke Hand 6.04.2029: Nachdebridement am Kopf, VAG-Wechsel linke Hand 07.04.2029: Weicliteildeckung mit Spalthautsheet und Keratinozytensprühsuspension 15.04.2029: Debridement, Jet Lavage Lind VAC Wechsel linke Hand 23.04.2029 Restdefektdeckung Kopf u. Hals (Sheets), Defektdeckung Handrücken 06.05.2029 K-Draht-Entfernung Ii. Handgelenk

Bei Frau Albers ist psychiatrischerseits eine Wahnvorstellung bekannt. Sie hatte sich zuhause die Ii. Hand selbst amputiert und sich das Haupthaar angezündet. Sie informierte telefonfach eine Freundin, die direkt den Rettungsdienst alarmierte. Lt. Protokoll öffnete die Patientin selbst die Tür und hielt die abgetrennte Hand. Sie wurde darauf umgehend in die Rettungsstelle unseres Zentrums verbracht. Bei Aufnahme zeigte sich klinisch und radiologisch eine komplette Amputation der linken Hand. Beide Ohren sowie insbesondere die re. Hals-/Nackenregion waren ll bis Ill gradig verbrannt. Das Kopf-CT zeigte keinen Nachweis frischer intrakranieller Traumafolgen bei Zustand nach osteoplastischer Trepanation der hinteren Schädelgrube links sowie rechts frontotemporal und nachweisbare Gefa-Clips links infratentoriell im Bereich der linken A. vertebralis sowie im Bereich der A . cerebri media rechts.

Verlauf Frau Albers wurde durch die Kollegen der Hand- u. Mikrochirurgischen Abteilung umgehend operativ versorgt. Die Hand konnte in einem die ganze Nacht dauerndem Eingriff replantiert werden. Ein streckseitiger WT-Defekt wurde temporär mit Vacuseal gedeckt. Die verbrannten Areale wurden zunächst antiseptisch mit Lavaseptgelverbänden versorgt. Anschließend wurde Frau Albers intuobiert und beatmet auf die lntensivstation des Brandverletztenzentrums aufgenommen. Am 25.03.2029 erfolgte eine Wundrevision mil Vacusealwechsel. Das Verbandsregime am Kopf wurde auf ein enzymatisches Debridement mit lruxolsalbe umgestellt. Ein erster debridierender Eingriff erfolgte am 27.03.2029. Ein erneutes Debridement erfolgte bei weitgehend sauberen Wunden am Kopf am 06.04.2029. Daraufhin konnte am 08.04.2029 die Defektdeckung am Kopf mit Keratinozytensprühsuspension und Spalthautsheets vorn linken Überschenkel erfolgen. Insgesamt sahen wir eine problemlose Einheilung der Transplantate. Lediglich am rechten retroauriculären Hals und an kleineren Arealen am Kopf musste im Verlauf am 23.04 2029 nochmals nachtransplantiert werden. Der Kopf mit Gesicht zeigt sich gegenwärtig bis auf kleinere Defekte abgeheilt. Die Entnahmestellen sind gänzlich reepithelisert. Im beharrten Teil des Kopfes sind multiple alopezische Areale verblieben, bei initial drittgradiger Verbrennungstiefe.

Am 23.04.2029 erfolgte ebenfalls die Defektdeckung des mittlerweile sauber granulierenden Defektes am II. Handrücken mittels Spalthautsheet Die temporare Arthrodese im Handgelenk wurde am 06.05.2029 entfernt. Physio- bzw. ergotherapeutische Behandlung wurde begleitend durchgeführt.

Intensivmedizinischer Krankheitsverlauf: Die Patientin wurde vom 20.3.2029 bis zum 27.3.2029 zunächst kontrolliert und im weiteren Verlauf unter reduzierter Analgosedierung augmentiert maschinell beatmet. Bei FIüssigkeitseinlagerungen pulmonal und peripher unter der FIüssigkeitstherapie nach Baxter-Parkland Formel induzierten wir eine forcierte Diurese mit Furosemid. Hierunter war die Oxygenierung im Verlauf suffizient. Die Entwöhnung vom Respirator gelang problemlos. Frau Albers konnte am 27.3.2029 bei intakten Schutzreflexen extubiert werden . Seitdem imponiert eine suffiziente Spontanatmung mit einer peripheren Sauerstoffsättgung von 98% unter Raumluft. Nach Beendigung der Analgosedierung imponierte ein mildes Entzugsdelir. das suffizient mit Clonidin behandlet werden konnte. Eine intermittierende psychotische Symptomatik therapierten wir zunächst mit Lorazepam (Tavor®) und Haloperidol (Haldol®). Im weiteren Verlauf wurde diese Medikation einschleichend durch Risperidon (Risperdal®) ersetzt. Die vorbestehende antiepileptische Medikation mit Levothiracetam (Keppra®) führten wir fort. Näheres bitten wir dem psychiatrischen Verlauf zu entnehmen. Nach Aufnahme strebten wir zunächst eine positive FIüssigkeitsbilanz an Die Diurese war unter FIüssigkeitstherapie unter Anlehnung an die Baxter-Parklandformel qualitativ und quantitativ suffizient. Im weiteren stationären Verlauf wurde eine antiödematöse Therapie mit Furosemid notwendig. Die Retentionsparameter lagen allzeit im Normbereich. Unter adäquater Volumentherapie zeigte sich die Patientin initial und im Weiteren hämodynamisch stabil. Nach Beendigung der Analgosedierung wurde bei arteriellem Hypertonus eine antihypertensive Therapie mit Metoprolol (Beloc zok mite®) und Ramipril (Delix®) begonnen. Hiermit gelang eine zufriedenstellende Blutdruckeinstellung. Unter Analgosedierung begannen wir die enterale Ernährung über die einliegende Magensonde. Nach Stimulation führte Frau Albers am 26.3.2029 zum ersten Mal ab. Nach Extubation gelang der orale Kostaufbau problemlos Die Patientin nimmt Wunschkost zu sich.

Psychiatrischer Verlauf Fremdanamnestisch war von der Freundin und der ambulant behandelnden Ärztin für Psychiatrie und Psychotherapie zu erfahren, dass die Patientin bereits seit Anfang des Jahres akut psychotisch gewesen sei. Sie hatte die letzte antipsychotische Erhaltungsmedikation von 2 mg abgesetzt, die ambulant behandelnde Psychiaterin Frau Dr. Siewert wusste davon. Trotz häufiger telefonischer Kontakte mit der behandelnden Ärztin ließ sie sich nicht zu einer weiteren medikamentösen Therapie motivieren. Noch am Tag der Selbstverletzung war die besorgte Freundin mit ihr beim Sozialpsychiatrischen Dienst vorstellig gewesen. Da Frau Albers zu einer freiwilligen stationären Aufnahme nicht bereit war und keine Unterbringungsgründe vorlagen, war eine Vorstellung bei der ambulanten Psychiaterin vorgesehen. Auf dem Weg dorthin sei Frau Albers aus dem Taxi gesprungen und hatte sich zuhause o.g. Verletzungen zugefügt. Sie teilte dies telefonisch der Freundin mit, die daraufhin die Feuerwehr alarmierte. Initial fanden sich erhebliche Denkstörungen. lnhaltlich klang Wahnerleben an, Gott zu sein. Sie erinnerte sich daran, sich die linke Hand mit dem Brotmesser abgeschnitten zu haben. Dies sei geschehen um das Böse in der Welt zu Sühnen. Sie war zunächst noch erheblich inadäquat, spuckte permanent, geordnete Gespräche mit ihr waren nur schwer möglich. Unter einer Sedierung mit Tavor und nach Umstellung auf Haloperidol sistierte diese Symptomatik zunehmend, so dass wir die antipsychotische Medikation in Absprache mit ihr auf eine Dosis von 6 mg Risperdal umstellten. Das Tavor bat sie auszuschleichen. Darunter war sie im Verlauf weitgehend distanziert von psychotischem Erleben, ruhig, gut im Kontakt und bedauerte, was sie sich da angetan hatte und nachdem sie zunächst eine stationäre psychiatrische Verlegung ablehnte, willigte sie nach einem motivierenden Gespräch schließlich ein, sich freiwillig in lhre Abteilung verlegen zu lassen. Sie war sehr interessiert an der Therapie, verfügte hier auch aus der Vorgeschichte über gute Kenntnisse z.B. über die Rezeptorwirkung der Medikamente. Im Affekt blieb sie insgesamt eher distanziert zur Dramatik ihrer Selbstverletzung. Ziel der Verlegung soll die weitere Belastungserprobung unter zunehmender Konfrontation milder Außenwelt im Anschluss an die stationäre intensivmedizinische Behandlung sein. Darüber hinaus ist eine sozialpsychiatrische Einbettung in ein ambulantes Setting nach dieser schweren Selbstverletzung angestrebt sowie die therapeutische Begleitung bei der Bewältigung der Folgeschaden im Alltag. Procedere: Wir verlegen Frau Albers, die in Ihrem Hause vorbekannt ist, am 14.05.2029 in lhre weitere stationäre fachpsychiatrische Behandlung. Durch die Orthopädiemechanik unseres Hauses wurde eine teils flexible Orthese angefertigt. Diese muss bis auf Weiteres getragen werden. Wir bitten bei per Patientin 1 x tgl. eine ergo- und physiotherapeutische Beübung der Iinken Hand durchzuführen. Hierbei sollten die Fingergelenke und das Handgelenk belastungsfrei in allen Ebenen therapiert werden. Die Übungen sollten aktiv und passiv aus der Orthese heraus erfolgen.
Die Transplantat· und Entnahmeareale sollten tgl. mehrfach mit fettenden Salben (z.B. Panthenol) gepflegt werden. Restdefekte, die ggf. etwas nässen können mit Betaisodona – Lsg. behandelt werden.
Aus plastisch- u. handchirurgischer Sicht werden mittel- bis langfristig noch mehrere korrigierende Eingriffe 1otwendig sein. Hierzu zählen beispielsweise operative Sehnen- und Gelenklösungen zur Verbesserung der Beweglichkeit der Hand sowie Korrektureingriffe im Bereich der Narben insbesondere im Kopf-/Halsbereich und der haarlosen Kopfareale. Wir werden Frau Albers hierzu in Kooperation mit den Handchirurgen an unsere Sprechstunde anbinden. Medikamente bei Entlassunq: Enoxaparin (Clexane®) 0,4 ml Pantoprazol (Pantozol®) 40 mg Ramipril (Detix®) 2.5 mg Metoprolol (Beloc zok mite®) 47,5 mg Levothir c.etarn (Keppra®) 1500mg Risperidon {Risperdaf®) 2 mg Ibuprofen .600mg Thiamin (Vil. B1) 100 mg + Pyridoxin (Vit. 8) 100 mg (Neurorathiopharrn®) Es konnen bioaquivalente Generika (weiter-) verordnet werden.

Mit freundlichen kollegialen Grüßen

Dr.med. Bernwart Schulze