<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="CancerDiagnosticReport" />
  <meta>
    <versionId value="2" />
    <lastUpdated value="2016-11-27T05:25:52.128+00:00" />
  </meta>
  <url value="http://icecoldfhirga.tech/baseDstu3/StructureDefinition/CancerDiagnosticReport" />
  <identifier>
    <system value="http://clinfhir.com" />
    <value value="author" />
  </identifier>
  <name value="CancerDiagnosticReport" />
  <status value="active" />
  <experimental value="true" />
  <publisher value="http://icecoldfhirga.tech/baseDstu3/" />
  <kind value="resource" />
  <abstract value="false" />
  <snapshot>
    <element id="DiagnosticReport">
      <path value="DiagnosticReport" />
      <short value="A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports" />
      <definition value="The findings and interpretation of diagnostic  tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports." />
      <comment value="This is intended to capture a single report, and is not suitable for use in displaying summary information that covers multiple reports.  For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing." />
      <alias value="Report" />
      <alias value="Test" />
      <alias value="Result" />
      <alias value="Results" />
      <alias value="Labs" />
      <alias value="Laboratory" />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="DomainResource" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="ORU -&gt; OBR" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="Observation[classCode=OBS, moodCode=EVN]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="clinical.diagnostics" />
      </mapping>
    </element>
    <element id="DiagnosticReport.id">
      <path value="DiagnosticReport.id" />
      <definition value="Id" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Resource.id" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="id" />
      </type>
    </element>
    <element id="DiagnosticReport.meta">
      <path value="DiagnosticReport.meta" />
      <definition value="The meta element" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Resource.meta" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="Meta" />
      </type>
    </element>
    <element id="DiagnosticReport.text">
      <path value="DiagnosticReport.text" />
      <definition value="Narrative" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="DomainResource.text" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Narrative" />
      </type>
    </element>
    <element id="DiagnosticReport.identifier">
      <path value="DiagnosticReport.identifier" />
      <short value="Id for external references to this report" />
      <definition value="The local ID assigned to the report by the order filler, usually by the Information System of the diagnostic service provider." />
      <requirements value="Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context." />
      <alias value="ReportID" />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Identifier" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="OBR-51" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="id" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="id" />
      </mapping>
    </element>
    <element id="DiagnosticReport.status">
      <path value="DiagnosticReport.status" />
      <short value="registered | partial | final | corrected | appended | cancelled | entered-in-error" />
      <definition value="The status of the diagnostic report as a whole." />
      <comment value="This is labeled as &quot;Is Modifier&quot; because applications need to take appropriate action if a report is withdrawn." />
      <requirements value="Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="code" />
      </type>
      <isModifier value="true" />
      <isSummary value="true" />
      <binding>
        <strength value="required" />
        <description value="The status of the diagnostic report as a whole." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/diagnostic-report-status" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2" />
        <map value="OBR-25 (not 1:1 mapping)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="statusCode  Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type &quot;revise&quot;" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="status" />
      </mapping>
    </element>
    <element id="DiagnosticReport.category">
      <path value="DiagnosticReport.category" />
      <short value="Service category" />
      <definition value="A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes." />
      <comment value="The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code." />
      <alias value="Department" />
      <alias value="Sub-department" />
      <alias value="service" />
      <alias value="discipline" />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <isSummary value="true" />
      <binding>
        <strength value="example" />
        <description value="Codes for diagnostic service sections." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/diagnostic-service-sections" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2" />
        <map value="OBR-24" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code &lt; LabService].code" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="class" />
      </mapping>
    </element>
    <element id="DiagnosticReport.code">
      <path value="DiagnosticReport.code" />
      <short value="Name/Code for this diagnostic report" />
      <definition value="A code or name that describes this diagnostic report." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <isSummary value="true" />
      <binding>
        <strength value="preferred" />
        <description value="Codes that describe Diagnostic Reports." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/report-codes" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2" />
        <map value="OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="code" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="what" />
      </mapping>
    </element>
    <element id="DiagnosticReport.subject">
      <path value="DiagnosticReport.subject" />
      <short value="The subject of the report, usually, but not always, the patient" />
      <definition value="The subject of the report. Usually, but not always, this is a patient. However diagnostic services also perform analyses on specimens collected from a variety of other sources." />
      <requirements value="SHALL know the subject context." />
      <alias value="Patient" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Patient" />
      </type>
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Group" />
      </type>
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Device" />
      </type>
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Location" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="PID-3 (no HL7 v2 mapping for Group or Device)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="participation[typeCode=SBJ]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="who.focus" />
      </mapping>
    </element>
    <element id="DiagnosticReport.encounter">
      <path value="DiagnosticReport.encounter" />
      <short value="Health care event when test ordered" />
      <definition value="The link to the health care event (encounter) when the order was made." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="PV1-19" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="context" />
      </mapping>
    </element>
    <element id="DiagnosticReport.effective[x]">
      <path value="DiagnosticReport.effective[x]" />
      <short value="Clinically Relevant time/time-period for report" />
      <definition value="The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself." />
      <comment value="If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic." />
      <requirements value="Need to know where in the patient history to file/present this report." />
      <alias value="Observation time" />
      <alias value="Effective Time" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="dateTime" />
      </type>
      <type>
        <code value="Period" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="OBR-7" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="effectiveTime" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="when.done" />
      </mapping>
    </element>
    <element id="DiagnosticReport.issued">
      <path value="DiagnosticReport.issued" />
      <short value="DateTime this version was released" />
      <definition value="The date and time that this version of the report was released from the source diagnostic service." />
      <comment value="May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report." />
      <requirements value="Clinicians need to be able to check the date that the report was released." />
      <alias value="Date Created" />
      <alias value="Date published" />
      <alias value="Date Issued" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="instant" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="OBR-22" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="participation[typeCode=VRF or AUT].time" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="when.recorded" />
      </mapping>
    </element>
    <element id="DiagnosticReport.performer">
      <path value="DiagnosticReport.performer" />
      <short value="Responsible Diagnostic Service" />
      <definition value="The diagnostic service that is responsible for issuing the report." />
      <comment value="This is not necessarily the source of the atomic data items. It is the entity that takes responsibility for the clinical report." />
      <requirements value="Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis." />
      <alias value="Laboratory" />
      <alias value="Service" />
      <alias value="Practitioner" />
      <alias value="Department" />
      <alias value="Company" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
      </type>
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Organization" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="PRT-8 (where this PRT-4-Participation = &quot;PO&quot;)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="participation[typeCode=AUT].role[classCode=ASSIGN].scoper" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="who.witness" />
      </mapping>
    </element>
    <element id="DiagnosticReport.request">
      <path value="DiagnosticReport.request" />
      <short value="What was requested" />
      <definition value="Details concerning a test or procedure requested." />
      <comment value="Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports." />
      <requirements value="Need to be able to track completion of requests based on reports issued and also to report what diagnostic tests were requested (not always the same as what is delivered)." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/DiagnosticOrder" />
      </type>
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/ProcedureRequest" />
      </type>
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/ReferralRequest" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="ORC? OBR-2/3?" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="outboundRelationship[typeCode=FLFS].target" />
      </mapping>
    </element>
    <element id="DiagnosticReport.specimen">
      <path value="DiagnosticReport.specimen" />
      <short value="Specimens this report is based on" />
      <definition value="Details about the specimens on which this diagnostic report is based." />
      <comment value="If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per Observation or group." />
      <requirements value="Need to be able to report information about the collected specimens on which the report is based." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Specimen" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="SPM" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="participation[typeCode=SBJ]" />
      </mapping>
    </element>
    <element id="DiagnosticReport.result">
      <path value="DiagnosticReport.result" />
      <short value="Observations - simple, or complex nested groups" />
      <definition value="Observations that are part of this diagnostic report. Observations can be simple name/value pairs (e.g. &quot;atomic&quot; results), or they can be grouping observations that include references to other members of the group (e.g. &quot;panels&quot;)." />
      <requirements value="Need to support individual results, or report groups of results, where the result grouping is arbitrary, but meaningful. This structure is recursive - observations can contain observations." />
      <alias value="Data" />
      <alias value="Atomic Value" />
      <alias value="Result" />
      <alias value="Atomic result" />
      <alias value="Data" />
      <alias value="Test" />
      <alias value="Analyte" />
      <alias value="Battery" />
      <alias value="Organizer" />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="OBXs" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="outboundRelationship[typeCode=COMP].target" />
      </mapping>
    </element>
    <element id="DiagnosticReport.imagingStudy">
      <path value="DiagnosticReport.imagingStudy" />
      <short value="Reference to full details of imaging associated with the diagnostic report" />
      <definition value="One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images." />
      <comment value="ImagingStudy and ImageObjectStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However each caters to different types of displays for different types of purposes. Neither, either, or both may be provided." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/ImagingStudy" />
      </type>
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/ImagingObjectSelection" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value="outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]" />
      </mapping>
    </element>
    <element id="DiagnosticReport.image">
      <path value="DiagnosticReport.image" />
      <short value="Key images associated with this report" />
      <definition value="A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest)." />
      <requirements value="Many diagnostic services include images in the report as part of their service." />
      <alias value="DICOM" />
      <alias value="Slides" />
      <alias value="Scans" />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="OBX?" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="outboundRelationship[typeCode=COMP].target" />
      </mapping>
    </element>
    <element id="DiagnosticReport.image.comment">
      <path value="DiagnosticReport.image.comment" />
      <short value="Comment about the image (e.g. explanation)" />
      <definition value="A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features." />
      <comment value="The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion." />
      <requirements value="The provider of the report should make a comment about each image included in the report." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value=".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code=&quot;annotation&quot;].value" />
      </mapping>
    </element>
    <element id="DiagnosticReport.image.link">
      <path value="DiagnosticReport.image.link" />
      <short value="Reference to the image source" />
      <definition value="Reference to the image source." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Media" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value=".value.reference" />
      </mapping>
    </element>
    <element id="DiagnosticReport.conclusion">
      <path value="DiagnosticReport.conclusion" />
      <short value="Clinical Interpretation of test results" />
      <definition value="Concise and clinically contextualized narrative interpretation of the diagnostic report." />
      <comment value="Typically, a report is either [all data, no narrative (e.g. Core lab)] or [a mix of data with some concluding narrative (e.g. Structured Pathology Report, Bone Density)], or [all narrative (e.g. typical imaging report, histopathology)]. In all of these cases, the narrative goes in &quot;text&quot;." />
      <requirements value="Need to be able to provide a conclusion that is not lost among the basic result data." />
      <alias value="Report" />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="OBX" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="inboundRelationship[typeCode=&quot;SPRT&quot;].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)" />
      </mapping>
    </element>
    <element id="DiagnosticReport.codedDiagnosis">
      <path value="DiagnosticReport.codedDiagnosis" />
      <short value="Codes for the conclusion" />
      <definition value="Codes for the conclusion." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <strength value="example" />
        <description value="Diagnoses codes provided as adjuncts to the report." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/clinical-findings" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2" />
        <map value="OBX" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)" />
      </mapping>
    </element>
    <element id="DiagnosticReport.presentedForm">
      <path value="DiagnosticReport.presentedForm" />
      <short value="Entire report as issued" />
      <definition value="Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent." />
      <comment value="&quot;application/pdf&quot; is recommended as the most reliable and interoperable in this context." />
      <requirements value="Gives Laboratory the ability to provide its own fully formatted report for clinical fidelity." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Attachment" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="OBX" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="text (type=ED)" />
      </mapping>
    </element>
  </snapshot>
</StructureDefinition>