StructureDefinition-UKCore-DocumentReference

Usually, this is used for documents other than those defined by FHIR.

• dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources
  contained.contained.empty()
• dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
  contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
• dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
  contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
• dom-6:A resource should have narrative for robust management
  text.`div`.exists()
• dom-5:If a resource is contained in another resource, it SHALL NOT have a security label
  contained.meta.security.empty()

• rim:Entity. Role, or Act
• workflow:Event
• fhircomposition:when describing a Composition
• rim:Document[classCode="DOC" and moodCode="EVN"]
• cda:when describing a CDA

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

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

• rim:n/a
• rim:N/A

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.

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

• rim:n/a

A human language.

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).

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

• rim:n/a

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.

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

• rim:n/a
• rim:N/A
• rim:Act.text?

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.

• rim:Entity. Role, or Act
• rim:N/A

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.

• 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()

• rim:n/a
• rim:N/A

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.

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.

• 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()

• rim:n/a
• rim:N/A

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.).

CDA Document Id extension and root.

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

• rim:n/a
• v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
• rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
• servd:Identifier
• workflow:Event.identifier
• w5:FiveWs.identifier
• fhircomposition:Composition.identifier
• v2:TXA-12
• rim:.id
• xds:DocumentEntry.uniqueId
• cda:ClinicalDocument/id

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

• rim:n/a
• v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
• rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
• servd:Identifier
• workflow:Event.identifier
• w5:FiveWs.identifier
• v2:TXA-16?
• rim:.id / .setId
• xds:DocumentEntry.entryUUID

The status of the document reference.

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.

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

• rim:n/a
• 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

Status of the underlying document.

The document that is pointed to might be in various lifecycle states.

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

• rim:n/a
• w5:FiveWs.status
• fhircomposition:Composition.status
• v2:TXA-17
• rim:.statusCode

SNOMED CT UK Document Type

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.

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

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• 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.

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

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.

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

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• 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

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ref-1:SHALL have a contained resource if a local reference is provided
  reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• workflow:Event.subject
• w5:FiveWs.subject[x]
• 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

Referencing/indexing time is used for tracking, organizing versions and searching.

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

• rim:n/a
• workflow:Event.occurrence[x]
• w5:FiveWs.recorded
• fhircomposition:Composition.date
• rim:.availabilityTime[type="TS"]

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

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ref-1:SHALL have a contained resource if a local reference is provided
  reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• 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

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ref-1:SHALL have a contained resource if a local reference is provided
  reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• workflow:Event.performer.actor
• w5:FiveWs.witness
• fhircomposition:Composition.attester
• v2:TXA-10
• rim:.participation[typeCode="AUTHEN"].role[classCode="ASSIGNED"]
• xds:DocumentEntry.legalAuthenticator
• cda:ClinicalDocument/legalAuthenticator

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ref-1:SHALL have a contained resource if a local reference is provided
  reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• workflow:Event.performer.actor
• fhircomposition:Composition.custodian
• rim:.participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]

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

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

• rim:n/a
• fhircomposition:Composition.relatesTo
• rim:.outboundRelationship
• xds:DocumentEntry Associations

• rim:n/a

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.

• 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()

• rim:n/a
• rim:N/A

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.

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.

• 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()

• rim:n/a
• rim:N/A

The type of relationship between documents.

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

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

• rim:n/a
• fhircomposition:Composition.relatesTo.code
• rim:.outboundRelationship.typeCode
• xds:DocumentEntry Associations type

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ref-1:SHALL have a contained resource if a local reference is provided
  reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• fhircomposition:Composition.relatesTo.target
• rim:.target[classCode="DOC", moodCode="EVN"].id
• xds:DocumentEntry Associations reference

Helps humans to assess whether the document is of interest.

What the document is about, a terse summary of the document.

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

• rim:n/a
• v2:TXA-25
• rim:.outboundRelationship[typeCode="SUBJ"].target.text
• xds:DocumentEntry.comments

Security Labels from the Healthcare Privacy and Security Classification System.

Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

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.

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

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• fhircomposition:Composition.confidentiality, Composition.meta.security
• v2:TXA-18
• rim:.confidentialityCode
• xds:DocumentEntry.confidentialityCode
• cda:ClinicalDocument/confidentialityCode/@code

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

• rim:n/a
• fhircomposition:Bundle(Composition+*)
• rim:document.text

• rim:n/a

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.

• 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()

• rim:n/a
• rim:N/A

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.

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.

• 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()

• rim:n/a
• rim:N/A

When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• att-1:If the Attachment has data, it SHALL have a contentType
  data.empty() or contentType.exists()

• rim:n/a
• v2:ED/RP
• rim:ED
• 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

Document Format Codes.

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

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

• rim:n/a
• v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
• rim:CV
• orim:fhir:Coding rdfs:subClassOf dt:CDCoding
• fhircomposition:Composition.meta.profile
• rim:document.text
• xds:DocumentEntry.formatCode
• cda:derived from the IHE Profile or Implementation Guide templateID

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

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

• rim:n/a
• rim:outboundRelationship[typeCode="SUBJ"].target[classCode<'ACT']

• rim:n/a

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.

• 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()

• rim:n/a
• rim:N/A

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.

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.

• 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()

• rim:n/a
• rim:N/A

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ref-1:SHALL have a contained resource if a local reference is provided
  reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• 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])

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

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.

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

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• fhircomposition:Composition.event.code
• rim:.code
• xds:DocumentEntry.eventCodeList

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• per-1:If present, start SHALL have a lower value than end
  start.hasValue().not() or end.hasValue().not() or (start <= end)

• rim:n/a
• v2:DR
• rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
• fhircomposition:Composition.event.period
• rim:.effectiveTime
• xds:DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime
• cda:ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/low/ @value --> ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/high/ @value

XDS Facility Type.

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.

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

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• 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

UK Core Care setting type of the document

This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

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.

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

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• 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

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ref-1:SHALL have a contained resource if a local reference is provided
  reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• fhircomposition:Composition.subject
• rim:.participation[typeCode="SBJ"].role[typeCode="PAT"]
• xds:DocumentEntry.sourcePatientInfo, DocumentEntry.sourcePatientId
• cda:ClinicalDocument/recordTarget/

May be identifiers or resources that caused the DocumentReference or referenced Document to be created.

• ele-1:All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ref-1:SHALL have a contained resource if a local reference is provided
  reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• fhircomposition:Composition.event.detail
• rim:./outboundRelationship[typeCode="PERT" and isNormalActRelationship()] / target[isNormalAct]
• xds:DocumentEntry.referenceIdList
• cda:ClinicalDocument/relatedDocument