3. Artifact index

Element id

DocumentReference.category

Short description

ClassCode

Alternate names

claxs

Definition

The code specifying the particular kind of document.

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

DocumentClassValueSet (example)

Binding

High-level kind of a clinical document at a macro level.

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
DocumentEntry-Mapping: DocumentEntry.classCode
ihexds-dataset-2024-20220712: ihexds-dataelement-9

0..1

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

Mappings

rim: n/a

extension

0..*

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

Comments

Data type

Slicing

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

2..*

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

Slicing

Unordered, Open, by $this(Value)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

radiologyStudies

1..1

CodingPattern

Element id

DocumentReference.category.coding:radiologyStudies

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

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Pattern

{
  "system": "http://loinc.org",
  "code": "18726-0"
}

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

images

Σ C

0..1

CodingPattern

Element id

DocumentReference.category.coding:images

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

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: bbs-DocumentReference-1, bbs-DocumentReference-2

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Pattern

{
  "system": "urn:oid:1.3.6.1.4.1.19376.1.2.6.1",
  "code": "IMAGES"
}

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

reports

Σ C

0..1

CodingPattern

Element id

DocumentReference.category.coding:reports

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

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: bbs-DocumentReference-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Pattern

{
  "system": "urn:oid:1.3.6.1.4.1.19376.1.2.6.1",
  "code": "REPORTS"
}

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

text

0..1

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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

subject

S Σ

1..1

Element id

DocumentReference.subject

Short description

Patient / PatientId

Alternate names

Patient

Definition

Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

Data type

Reference(NlcoreHealthcareProviderOrganization)

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
DocumentEntry-Mapping: DocumentEntry.patientId
bbs-dataset-100-alpha2-20240208: bbs-dataelement-132
ihexds-dataset-2024-20220712: ihexds-dataelement-19

date

S Σ

1..1

instant

Element id

DocumentReference.date

Short description

DateTime

Alternate names

indexed, DatumTijd

Definition

Date/time on which the report has been autorised and/or made available.
Date/time on which the radiological examination has been performed on the patient and/or the images have been made.

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"]
bbs-dataset-100-alpha2-20240208: bbs-dataelement-101
bbs-dataset-100-alpha2-20240208: bbs-dataelement-69

author

S Σ

1..*

Element id

DocumentReference.author

Short description

Author

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

Allowed aggregation:contained

Slicing

Unordered, Open, by resolve()(Profile)

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
DocumentEntry-Mapping: DocumentEntry.author
ihexds-dataset-2024-20220712: ihexds-dataelement-2

location

S Σ

1..1

Element id

DocumentReference.author:location

Short description

Location

Alternate names

Locatie

Definition

The healthcare center where the procedure was, is or will be carried out.

Comments

Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

Data type

Reference(NlcoreHealthcareProviderOrganization)

Allowed aggregation:contained

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
DocumentEntry-Mapping: DocumentEntry.author
bbs-dataset-100-alpha2-20240208: bbs-dataelement-185

performer

S Σ

0..1

Reference(NlcoreHealthProfessionalPractitionerRole)

Element id

DocumentReference.author:performer

Short description

Performer

Alternate names

Uitvoerder

Definition

The health professional who carried out or will carry out the procedure. In most cases, only the medical specialty is entered, and not the name of the health professional. In the context of image exchange, the Performing Physician should be conveyed here, and NOT the laboratory technician who makes the images (i.e. the Operator).

Comments

Each occurrence of the zib HealthProfessional is normally represented by two FHIR resources: a PractitionerRole resource (instance of nl-core-HealthProfessional-PractitionerRole) and a Practitioner resource (instance of nl-core-HealthProfessional-Practitioner). The Practitioner resource is referenced from the PractitionerRole instance. For this reason, sending systems should fill the reference to the PractitionerRole instance here, and not the Practitioner resource. Receiving systems can then retrieve the reference to the Practitioner resource from that PractitionerRole instance.

In rare circumstances, there is only a Practitioner instance, in which case it is that instance which will be referenced here. However, since this should be the exception, the nl-core-HealthProfessional-Practitioner profile is not explicitly mentioned as a target profile.

Data type

Reference(NlcoreHealthProfessionalPractitionerRole)

Allowed aggregation:contained

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
DocumentEntry-Mapping: DocumentEntry.author
bbs-dataset-100-alpha2-20240208: bbs-dataelement-187

authenticator

0..1

Reference(Practitioner | PractitionerRole | Organization | NlcoreHealthProfessionalPractitionerRole | NlcoreHealthcareProviderOrganization)

Element id

DocumentReference.authenticator

Short description

LegalAuthenticator

Definition

Represents a participant who has legally authenticated or attested the document within the author institution.

Comments

Data type

Reference(Practitioner | PractitionerRole | Organization | NlcoreHealthProfessionalPractitionerRole | NlcoreHealthcareProviderOrganization)

Allowed aggregation:contained

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
DocumentEntry-Mapping: DocumentEntry.legalAuthenticator
ihexds-dataset-2024-20220712: ihexds-dataelement-17

custodian

0..1

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

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"]
DocumentEntry-Mapping: not mapped

relatesTo

S Σ

0..*

There are no (further) constraints on this element

Element id

DocumentReference.relatesTo

Short description

Relationships to other documents

Definition

Relationships that this document has with other document references that already exist.

Comments

This element is labeled as a modifier because documents that append to other documents are incomplete on their own.

Data type

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
DocumentEntry-Mapping: DocumentEntry Associations

0..1

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

Mappings

rim: n/a

extension

0..*

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

Comments

Data type

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 ?! C

0..*

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

Data type

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

1..1

codeBinding

There are no (further) constraints on this element

Element id

DocumentReference.relatesTo.code

Short description

replaces | transforms | signs | appends

Definition

The type of relationship that this document has with anther document.

Comments

If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

Data type

DocumentRelationshipType (required)

Binding

The type of relationship between documents.

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
DocumentEntry-Mapping: DocumentEntry Associations.type

target

1..1

Reference(DocumentReference)

There are no (further) constraints on this element

Element id

DocumentReference.relatesTo.target

Short description

Target of the relationship

Definition

The target document of this relationship.

Data type

Reference(DocumentReference)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

fhircomposition: Composition.relatesTo.target
rim: .target[classCode="DOC", moodCode="EVN"].id
xds: DocumentEntry Associations reference
DocumentEntry-Mapping: DocumentEntry Associations.reference

description

0..1

Element id

DocumentReference.description

Short description

Comments

Definition

Comments associated with the document.

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

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
DocumentEntry-Mapping: DocumentEntry.comments
ihexds-dataset-2024-20220712: ihexds-dataelement-4

securityLabel

S Σ

1..*

CodeableConceptBinding

Element id

DocumentReference.securityLabel

Short description

ConfidentialityCode

Definition

The code specifying the level of confidentiality of the document.

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

ConfidentialityCodes (extensible)

Binding

Security Labels from the Healthcare Privacy and Security Classification System.

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
DocumentEntry-Mapping: DocumentEntry.confidentialityCode
ihexds-dataset-2024-20220712: ihexds-dataelement-10

content

1..1

There are no (further) constraints on this element

Element id

DocumentReference.content

Short description

Document referenced

Definition

The document and format referenced.

Data type

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

0..1

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

Mappings

rim: n/a

extension

0..*

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

Comments

Data type

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 ?! C

0..*

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

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

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

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

0..1

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

Mappings

rim: n/a

extension

0..*

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

Comments

Data type

Slicing

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

1..1

codeBinding

Element id

DocumentReference.content.attachment.contentType

Short description

MimeType

Definition

MIME type of the document.

Requirements

Processors of the data need to be able to know how to interpret the data.

Data type

Binding

The mime type of an attachment. Any valid mime type is allowed.

Mime Types (required)

Additional bindings

MimetypeXDS (extensible)

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
DocumentEntry-Mapping: DocumentEntry.mimeType
ihexds-dataset-2024-20220712: ihexds-dataelement-18

language

S Σ

1..1

codeBinding

Element id

DocumentReference.content.attachment.language

Short description

LanguageCode

Definition

Specifies the human language of character data in the document. Using codes from IETF RFC 3066.

Requirements

Users need to be able to choose between the languages in a set of attachments.

Data type

Binding

A human language.

Taal (extensible)

Binding extensions

maxValueSet	AllLanguages

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
DocumentEntry-Mapping: DocumentEntry.languageCode
ihexds-dataset-2024-20220712: ihexds-dataelement-16

data

0..0

There are no (further) constraints on this element

Element id

DocumentReference.content.attachment.data

Short description

Data inline, base64ed

Definition

The actual data of the attachment - a sequence of bytes, base64 encoded.

Requirements

The data needs to able to be transmitted inline.

Comments

The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

Data type

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

1..1

url

Element id

DocumentReference.content.attachment.url

Short description

URI

Definition

The URI for the document.

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
DocumentEntry-Mapping: DocumentEntry.repositoryUniqueId or DocuemntEntry.URI
ihexds-dataset-2024-20220712: ihexds-dataelement-30

size

0..1

unsignedInt

Element id

DocumentReference.content.attachment.size

Short description

Size

Definition

Size in bytes of the document.

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)
DocumentEntry-Mapping: DocumentEntry.size
ihexds-dataset-2024-20220712: ihexds-dataelement-24

hash

0..1

Element id

DocumentReference.content.attachment.hash

Short description

Hash

Definition

Hash of the document itself.

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

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"]
DocumentEntry-Mapping: DocumentEntry.hash
ihexds-dataset-2024-20220712: ihexds-dataelement-14

title

1..1

Element id

DocumentReference.content.attachment.title

Short description

ReportTitle / ImageTitle / Title

Alternate names

VerslagTitel, BeeldTitel

Definition

The title of the report.
The title of the image.
The title of the document.

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

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
DocumentEntry-Mapping: DocumentEntry.title
bbs-medmij-dataset-100-beta1-20250807: bbs-medmij-dataelement-2
bbs-medmij-dataset-100-beta1-20250807: bbs-medmij-dataelement-1
ihexds-dataset-2024-20220712: ihexds-dataelement-27

creation

S Σ

1..1

Element id

DocumentReference.content.attachment.creation

Short description

DateTime / CreationTime

Alternate names

DatumTijd

Definition

Date/time on which the report has been autorised and/or made available.
Date/time on which the radiological examination has been performed on the patient and/or the images have been made.
The time the author created the document. Shall have a single value.

Requirements

This is often tracked as an integrity issue for use of the attachment.

Data type

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)
DocumentEntry-Mapping: DocumentEntry.creationTime
bbs-dataset-100-alpha2-20240208: bbs-dataelement-101
bbs-dataset-100-alpha2-20240208: bbs-dataelement-69
ihexds-dataset-2024-20220712: ihexds-dataelement-11

format

S Σ

1..1

CodingBinding

Element id

DocumentReference.content.format

Short description

FormatCode

Definition

Code globally uniquely specifying the format of the document.

Comments

Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

Data type

Binding

FormatCodes (extensible)

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
DocumentEntry-Mapping: DocumentEntry.formatCode
ihexds-dataset-2024-20220712: ihexds-dataelement-13

context

1..1

There are no (further) constraints on this element

Element id

DocumentReference.context

Short description

Clinical context of document

Definition

The clinical context in which the document was prepared.

Comments

These values are primarily added to help with searching for interesting/relevant documents.

Data type

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']

0..1

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

Mappings

rim: n/a

extension

0..*

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

Comments

Data type

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 ?! C

0..*

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

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

encounter

0..*

Reference(Encounter | EpisodeOfCare | NlcoreEncounter)

Element id

DocumentReference.context.encounter

Short description

ReferenceIdList

Definition

A list of identifiers that apply to the document. Identifiers may be Accession Numbers, Order Numbers, Referral Request Identifiers, XDS Workflow Instance Identifiers, etc.

Comments

Only Encounters on the ReferenceIdList are conveyed here, while other identifiers on that list are conveyed via .context.related.

Data type

Reference(Encounter | EpisodeOfCare | NlcoreEncounter)

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])
DocumentEntry-Mapping: DocumentEntry.referenceIdList with CXi encoding for urn:ihe:iti:xds:2015:encounterId
ihexds-dataset-2024-20220712: ihexds-dataelement-117

event

0..*

Element id

DocumentReference.context.event

Short description

EventCodeList

Definition

This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented.

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

Slicing

Unordered, Open, by $this(Value)

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
DocumentEntry-Mapping: DocumentEntry.eventCodeList
ihexds-dataset-2024-20220712: ihexds-dataelement-12

procedureAnatomicalLocation

0..1

NlcoreAnatomicalLocationBinding

Element id

DocumentReference.context.event:procedureAnatomicalLocation

Short description

ProcedureAnatomicalLocation / Location

Alternate names

Locatie, nl-core-AnatomicalLocation, VerrichtingAnatomischeLocatie

Definition

Anatomical location which is the focus of the procedure.

The value set is proposed by IHE MCWG and also suggested for the EU (Xt-EHR). The used value set is a subset of the value set defined in zib2020.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Data type

NlcoreAnatomicalLocation

Binding

This list of codes represents the main clinical acts being documented.

AnatomicalRegion (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

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
DocumentEntry-Mapping: DocumentEntry.eventCodeList
rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
zib-anatomicallocation-v1.0-2020EN: NL-CM:20.7.4
bbs-dataset-100-alpha2-20240208: bbs-dataelement-178
bbs-dataset-100-alpha2-20240208: bbs-dataelement-179

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.event:procedureAnatomicalLocation.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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

DocumentReference.context.event:procedureAnatomicalLocation.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Extension(CodeableConcept)

Slicing

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

laterality

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.event:procedureAnatomicalLocation.extension:laterality

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

Extension(CodeableConcept)

Extension URL

http://nictiz.nl/fhir/StructureDefinition/ext-AnatomicalLocation.Laterality

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.event:procedureAnatomicalLocation.extension:laterality.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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

DocumentReference.context.event:procedureAnatomicalLocation.extension:laterality.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

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

url

1..1

uriFixed Value

There are no (further) constraints on this element

Element id

DocumentReference.context.event:procedureAnatomicalLocation.extension:laterality.url

Short description

identifies the meaning of the extension

Definition

Source of the definition for the extension code - a logical name or a URL.

Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Data type

LateraliteitCodelijst (required)

Fixed value

http://nictiz.nl/fhir/StructureDefinition/ext-AnatomicalLocation.Laterality

Mappings

rim: N/A

value[x]

0..1

Binding

Element id

DocumentReference.context.event:procedureAnatomicalLocation.extension:laterality.value[x]

Short description

Laterality

Alternate names

Lateraliteit

Definition

Laterality adds information about body site to the anatomic location, e.g. left.

Binding

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A
zib-anatomicallocation-v1.0-2020EN: NL-CM:20.7.3
bbs-dataset-100-alpha2-20240208: bbs-dataelement-180

valueCodeableConcept

There are no (further) constraints on this element

Data type

coding

0..*

There are no (further) constraints on this element

Element id

DocumentReference.context.event:procedureAnatomicalLocation.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

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

text

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.event:procedureAnatomicalLocation.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

modality

0..*

CodeableConceptBinding

Element id

DocumentReference.context.event:modality

Short description

Modality

Alternate names

Modaliteit

Definition

Type of medical imaging device, process or method that originally acquired or produced the data used to create the image or series of images, such as a CT scanner or MRI machine.

Comments

For an image or series of images the modalities SHALL be specified.

Data type

Binding

This list of codes represents the main clinical acts being documented.

Modalities (required)

Conditions

The cardinality or value of this element may be affected by these constraints: bbs-DocumentReference-2

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
DocumentEntry-Mapping: DocumentEntry.eventCodeList
bbs-medmij-dataset-100-beta1-20250807: bbs-medmij-dataelement-5

period

S Σ

1..1

There are no (further) constraints on this element

Element id

DocumentReference.context.period

Short description

Time of service that is being documented

Definition

The time period over which the service that is described by the document was provided.

Data type

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

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.period.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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

DocumentReference.context.period.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

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

start

Σ C

1..1

Element id

DocumentReference.context.period.start

Short description

ProcedureStartDate / ServiceStartTime

Alternate names

VerrichtingStartDatum

Definition

Date/time on which the radiological examination has been performed on the patient and/or the images have been made. In practice the time is the instance on which the first image has been taken.
The start time the service being documented took place.

Comments

If the low element is missing, the meaning is that the low boundary is not known.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: per-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: DR.1
rim: ./low
DocumentEntry-Mapping: DocumetEntry.serviceStartTime
bbs-dataset-100-alpha2-20240208: bbs-dataelement-174
ihexds-dataset-2024-20220712: ihexds-dataelement-22

end

Σ C

0..1

Element id

DocumentReference.context.period.end

Short description

ProcedureEndDate / ServiceStopTime

Alternate names

VerrichtingEindDatum

Definition

The end date (and if possible end time) of the procedure. A ‘vague’ date, such as only the year, is permitted. The element offers the option to indicate the end of the period of a series of related procedures. The end date element is only used for a procedures that takes some time and is then always applied. If the procedure still continues, the value is left empty. For instantaneous or very short lasting procedures the element is omitted.
The stop time the service being documented took place.

Comments

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

Meaning when missing

If the end of the period is missing, it means that the period is ongoing

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: per-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: DR.2
rim: ./high
DocumentEntry-Mapping: DocumentEntry.serviceStopTime
bbs-dataset-100-alpha2-20240208: bbs-dataelement-175
ihexds-dataset-2024-20220712: ihexds-dataelement-23

facilityType

1..1

CodeableConceptBinding

Element id

DocumentReference.context.facilityType

Short description

OrganizationType / HealthcareFacilityTypeCode

Alternate names

OrganisatieType

Definition

The type of healthcare provider, such as general hospital, or nursing home. If this field is filled in and an AGB code is used for the HealthcareProviderIdentificationNumber, the type must match the type implicitly contained in the AGB code.
This code represents the type of organizational setting of the clinical encounter during which the documented act occurred.

Data type

OrganisatieTypeCodelijst (extensible)

Binding

XDS Facility Type.

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
DocumentEntry-Mapping: DocumentEntry.healthcareFacilityTypeCode
bbs-dataset-100-alpha2-20240208: bbs-dataelement-546
ihexds-dataset-2024-20220712: ihexds-dataelement-31

practiceSetting

1..1

CodeableConceptBinding

Element id

DocumentReference.context.practiceSetting

Short description

DepartmentSpecialty / PracticeSettingCode

Alternate names

AfdelingSpecialisme

Definition

The specialty of the healthcare provider’s department. The departmental specialty can be filled in if further indication of the healthcare provider is needed. This refers to the recognized medical specialties as stated in the BIG Act. The bound value set is the value set that has been proposed by IHE MCWG to the EU (Xt-EHR) for national and international exchange.
The code specifying the clinical specialty where the act that resulted in the document was performed (e.g. Family Practice, Laboratory, Radiology).

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

PracticeSettingCodeMCWG (required)

Binding

Additional details about where the content was created (e.g. clinical specialty).

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
DocumentEntry-Mapping: DocumentEntry.practiceSettingCode
bbs-dataset-100-alpha2-20240208: bbs-dataelement-524
ihexds-dataset-2024-20220712: ihexds-dataelement-20

sourcePatientInfo

1..1

Element id

DocumentReference.context.sourcePatientInfo

Short description

SourcePatientId / SourcePatientInfo

Definition

The sourcePatientId represents the subject of care medical record Identifier (e.g. Patient Id) in the local patient Identifier Domain of the Document Source.
The sourcePatientInfo contains demographic information of the patient to whose medical record this document belongs.

Data type

Allowed aggregation:contained

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/
ihexds-dataset-2024-20220712: ihexds-dataelement-25
ihexds-dataset-2024-20220712: ihexds-dataelement-26

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.sourcePatientInfo.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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

DocumentReference.context.sourcePatientInfo.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.sourcePatientInfo.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

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A
DocumentEntry-Mapping: DocumentEntry.sourcePatientInfo

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

DocumentReference.context.sourcePatientInfo.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

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

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.sourcePatientInfo.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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier
DocumentEntry-Mapping: DocumentEntry.sourcePatientId

display

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.sourcePatientInfo.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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

0..*

Element id

DocumentReference.context.related

Short description

ReferenceIdList

Definition

A list of identifiers that apply to the document. Identifiers may be Accession Numbers, Order Numbers, Referral Request Identifiers, XDS Workflow Instance Identifiers, etc.

For Imaging (Reports), use the Accession Number with Assigning Authority, Order Number with Assigning Authority and StudyUID, as proposed by the IHE MCWG to support linking the Images and Reports together.

Comments

Encounters on the ReferenceIdList are conveyed via .context.encounter.

Data type

Slicing

Unordered, Open, by identifier.type(Value)

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
DocumentEntry-Mapping: DocumentEntry.referenceIdList using CXi encoding for type when possible
ihexds-dataset-2024-20220712: ihexds-dataelement-117

accessionNumber

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber

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

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
DocumentEntry-Mapping: DocumentEntry.referenceIdList using CXi encoding for type when possible

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.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.

Comments

Data type

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

1..1

Element id

DocumentReference.context.related:accessionNumber.identifier

Short description

AccessionNumber

Alternate names

AccessionNumber

Definition

A locally unique record number in the RIS that identifies the imaging procedure request.

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier
bbs-medmij-dataset-100-beta1-20250807: bbs-medmij-dataelement-3

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.identifier.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data type

Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

type

1..1

CodeableConceptBindingPattern

Element id

DocumentReference.context.related:accessionNumber.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Data type

Identifier Type Codes (extensible)

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Pattern

{
  "coding": [
    {
      "system": "urn:ietf:rfc:3986",
      "code": "urn:ihe:iti:xds:2013:accession"
    }
  ]
}

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

1..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Data type

Reference(Organization | NlcoreHealthcareProviderOrganization)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

Element id

DocumentReference.context.related:accessionNumber.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Issuer of Accession Number.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data type

Reference(Organization | NlcoreHealthcareProviderOrganization)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:accessionNumber.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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

studyInstanceUID

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID

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

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
DocumentEntry-Mapping: DocumentEntry.referenceIdList using CXi encoding for type when possible

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.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.

Comments

Data type

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

1..1

Element id

DocumentReference.context.related:studyInstanceUID.identifier

Short description

StudyInstanceUID

Alternate names

StudyInstanceUID

Definition

The globally unique DICOM identifier of the imaging study upon which the imaging report is based, assigned by the modality or PACS.

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier
bbs-medmij-dataset-100-beta1-20250807: bbs-medmij-dataelement-4

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.identifier.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data type

Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

type

1..1

CodeableConceptBindingPattern

Element id

DocumentReference.context.related:studyInstanceUID.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data type

Identifier Type Codes (extensible)

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Pattern

{
  "coding": [
    {
      "system": "urn:ietf:rfc:3986",
      "code": "urn:ihe:iti:xds:2016:studyInstanceUID"
    }
  ]
}

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

1..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

DocumentReference.context.related:studyInstanceUID.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