Cahier De Liaison
3.0.0 - ci-build

This page is part of the Guide d'implémentation cahier de liaison (v3.0.0-ballot: Release) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

Resource Profile: CdLDocumentReference - Detailed Descriptions

Draft as of 2024-10-30

Definitions for the cdl-document-reference resource profile.

Guidance on how to interpret the contents of this table can be found here

0. DocumentReference
2. DocumentReference.extension:isEmergency
Slice NameisEmergency
ShortL’urgence de la note qui permettra d’identifier la façon avec laquelle elle devra être prise en compte
Control0..*
TypeExtension(CdL_isEmergency) (Extension Type: boolean)
Must Supporttrue
4. DocumentReference.masterIdentifier
ShortIdentifiant de la note attribué par le système initiateur à l’origine de la création de la note
Must Supporttrue
6. DocumentReference.status
ShortLe statut de la note. Les gestionnaires de cahiers de liaison ne supportant pas la suppression de notes peuvent proposer leur désactivation par mise à jour de leurs statuts
Must Supporttrue
8. DocumentReference.docStatus
Control0..0
10. DocumentReference.type
Control1..?
BindingThe codes SHALL be taken from JDV_J23-TypeNoteCahierLiaison-CISIS
(required to https://mos.esante.gouv.fr/NOS/JDV_J23-TypeNoteCahierLiaison-CISIS/FHIR/JDV-J23-TypeNoteCahierLiaison-CISIS)
Must Supporttrue
12. DocumentReference.subject
Control1..?
TypeReference(FR Core Patient Profile)
Must Supporttrue
14. DocumentReference.date
Must Supporttrue
16. DocumentReference.author
ShortAuteur de la note. Il est préférable de privilégier la situation d'exercice (PractitionerRole) dans le cas où l'auteur est un professionnel.
Control1..?
TypeReference(Device, FR Core Related Person Profile, FR Core Patient Profile, AS Practitioner Profile, AS PractitionerRole Profile, AS Organization Profile)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
18. DocumentReference.authenticator
Control0..0
20. DocumentReference.custodian
Control0..0
22. DocumentReference.relatesTo
ShortCet élément peut être utilisé pour lier des notes entre elles (note en réponse à une autre par exemple). Pour ce faire le code « appends » doit être utilisé dans relatesTo.code et relatesTo.reference doit pointer vers la note mère.
24. DocumentReference.description
Must Supporttrue
26. DocumentReference.securityLabel
ShortStatut de visibilité de la note
Control0..1
BindingThe codes SHALL be taken from JDV_J110-StatutVisibiliteDocument-CISIS
(required to https://mos.esante.gouv.fr/NOS/JDV_J110-StatutVisibiliteDocument-CISIS/FHIR/JDV-J110-StatutVisibiliteDocument-CISIS)
Must Supporttrue
28. DocumentReference.content
ShortContenu de la note. Cet élément qui représente le contenu de la note est répétable. Pour une note avec du texte et une photo par exemple, deux instances de l’élément « content » peuvent être présentes : une pour représenter le texte et une pour représenter la photo.
Must Supporttrue
30. DocumentReference.content.attachment
32. DocumentReference.content.attachment.contentType
Must Supporttrue
34. DocumentReference.content.attachment.data
Must Supporttrue
36. DocumentReference.content.attachment.url
Must Supporttrue
38. DocumentReference.content.attachment.title
Must Supporttrue
40. DocumentReference.content.attachment.creation
Must Supporttrue
42. DocumentReference.context
Must Supporttrue

Guidance on how to interpret the contents of this table can be found here

0. DocumentReference
Definition

A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.

ShortA reference to a document
Comments

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

Control0..*
Invariantsdom-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())
2. DocumentReference.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
This element is affected by the following invariants: ele-1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. DocumentReference.extension:isEmergency
Slice NameisEmergency
Definition

Optional Extension Element - found in all resources.

ShortL’urgence de la note qui permettra d’identifier la façon avec laquelle elle devra être prise en compte
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(CdL_isEmergency) (Extension Type: boolean)
Must Supporttrue
Invariantsele-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())
6. DocumentReference.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
This element is affected by the following invariants: ele-1
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Standard StatusNormative (from Trial Use)
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.

Alternate Namesextensions, user content
Invariantsele-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())
SlicingThis element introduces a set of slices on DocumentReference.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. DocumentReference.masterIdentifier
    Definition

    Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document.

    ShortIdentifiant de la note attribué par le système initiateur à l’origine de la création de la noteMaster Version Specific Identifier
    Comments

    CDA Document Id extension and root.

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeIdentifier
    Must Supporttrue
    Summarytrue
    Requirements

    The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. DocumentReference.status
    Definition

    The status of this document reference.

    ShortLe statut de la note. Les gestionnaires de cahiers de liaison ne supportant pas la suppression de notes peuvent proposer leur désactivation par mise à jour de leurs statutscurrent | superseded | entered-in-error
    Comments

    This is the status of the DocumentReference object, which might be independent from the docStatus element.

    This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

    Control1..1
    This element is affected by the following invariants: ele-1
    BindingThe codes SHALL be taken from DocumentReferenceStatushttp://hl7.org/fhir/ValueSet/document-reference-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1)

    The status of the document reference.

    Typecode
    Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. DocumentReference.docStatus
    Definition

    The status of the underlying document.

    Shortpreliminary | final | amended | entered-in-error
    Comments

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

    Control0..01
    This element is affected by the following invariants: ele-1
    BindingThe codes SHALL be taken from CompositionStatushttp://hl7.org/fhir/ValueSet/composition-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/composition-status|4.0.1)

    Status of the underlying document.

    Typecode
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. DocumentReference.type
    Definition

    Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

    ShortKind of document (LOINC if possible)
    Comments

    Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.

    Control10..1
    This element is affected by the following invariants: ele-1
    BindingThe codes SHALL be taken from The codes SHOULD be taken from JDV_J23-TypeNoteCahierLiaison-CISIShttp://hl7.org/fhir/ValueSet/c80-doc-typecodes
    (required to https://mos.esante.gouv.fr/NOS/JDV_J23-TypeNoteCahierLiaison-CISIS/FHIR/JDV-J23-TypeNoteCahierLiaison-CISIS)
    TypeCodeableConcept
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. DocumentReference.subject
    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).

    ShortWho/what is the subject of the document
    Comments

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

    Control10..1
    This element is affected by the following invariants: ele-1
    TypeReference(FR Core Patient Profile, Patient, Practitioner, Group, Device)
    Must Supporttrue
    Summarytrue
    Invariantsele-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')))
    18. DocumentReference.date
    Definition

    When the document reference was created.

    ShortWhen this document reference was created
    Comments

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

    Control0..1
    This element is affected by the following invariants: ele-1
    Typeinstant
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Alternate Namesindexed
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. DocumentReference.author
    Definition

    Identifies who is responsible for adding the information to the document.

    ShortAuteur de la note. Il est préférable de privilégier la situation d'exercice (PractitionerRole) dans le cas où l'auteur est un professionnel.Who and/or what authored the document
    Comments

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

    Control10..*
    This element is affected by the following invariants: ele-1
    TypeReference(Device, FR Core Related Person Profile, FR Core Patient Profile, AS Practitioner Profile, AS PractitionerRole Profile, AS Organization Profile, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson)
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Invariantsele-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')))
    22. DocumentReference.authenticator
    Definition

    Which person or organization authenticates that this document is valid.

    ShortWho/what authenticated the document
    Comments

    Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

    Control0..01
    This element is affected by the following invariants: ele-1
    TypeReference(Practitioner, PractitionerRole, Organization)
    Invariantsele-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')))
    24. DocumentReference.custodian
    Definition

    Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

    ShortOrganization which maintains 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.

    Control0..01
    This element is affected by the following invariants: ele-1
    TypeReference(Organization)
    Invariantsele-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')))
    26. DocumentReference.relatesTo
    Definition

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

    ShortCet élément peut être utilisé pour lier des notes entre elles (note en réponse à une autre par exemple). Pour ce faire le code « appends » doit être utilisé dans relatesTo.code et relatesTo.reference doit pointer vers la note mère.Relationships to other documents
    Comments

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

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeBackboneElement
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. DocumentReference.relatesTo.modifierExtension
    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).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    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.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-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())
    30. DocumentReference.relatesTo.code
    Definition

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

    Shortreplaces | transforms | signs | appends
    Comments

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

    Control1..1
    This element is affected by the following invariants: ele-1
    BindingThe codes SHALL be taken from DocumentRelationshipTypehttp://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1
    (required to http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1)

    The type of relationship between documents.

    Typecode
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. DocumentReference.relatesTo.target
    Definition

    The target document of this relationship.

    ShortTarget of the relationship
    Comments

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

    Control1..1
    This element is affected by the following invariants: ele-1
    TypeReference(DocumentReference)
    Summarytrue
    Invariantsele-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')))
    34. DocumentReference.description
    Definition

    Human-readable description of the source document.

    ShortHuman-readable description
    Comments

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

    Control0..1
    This element is affected by the following invariants: ele-1
    Typestring
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    Helps humans to assess whether the document is of interest.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    36. DocumentReference.securityLabel
    Definition

    A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.

    ShortStatut de visibilité de la noteDocument security-tags
    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.

    Control0..1*
    This element is affected by the following invariants: ele-1
    BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from JDV_J110-StatutVisibiliteDocument-CISIShttp://hl7.org/fhir/ValueSet/security-labels
    (required to https://mos.esante.gouv.fr/NOS/JDV_J110-StatutVisibiliteDocument-CISIS/FHIR/JDV-J110-StatutVisibiliteDocument-CISIS)
    TypeCodeableConcept
    Must Supporttrue
    Summarytrue
    Requirements

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

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    38. DocumentReference.content
    Definition

    The document and format referenced. There may be multiple content element repetitions, each with a different format.

    ShortContenu de la note. Cet élément qui représente le contenu de la note est répétable. Pour une note avec du texte et une photo par exemple, deux instances de l’élément « content » peuvent être présentes : une pour représenter le texte et une pour représenter la photo.Document referenced
    Control1..*
    This element is affected by the following invariants: ele-1
    TypeBackboneElement
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    40. DocumentReference.content.modifierExtension
    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).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    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.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-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())
    42. DocumentReference.content.attachment
    Definition

    The document or URL of the document along with critical metadata to prove content has integrity.

    ShortWhere to access the document
    Comments

    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".

    Control1..1
    This element is affected by the following invariants: ele-1
    TypeAttachment
    Summarytrue
    Invariantsele-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())
    44. DocumentReference.content.attachment.contentType
    Definition

    Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

    ShortMime type of the content, with charset etc.
    Comments

    Note that FHIR strings SHALL NOT exceed 1MB in size

    Control0..1
    This element is affected by the following invariants: ele-1
    BindingThe codes SHALL be taken from Mime Typeshttp://hl7.org/fhir/ValueSet/mimetypes|4.0.1
    (required to http://hl7.org/fhir/ValueSet/mimetypes|4.0.1)

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

    Typecode
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

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

    Example<br/><b>General</b>:text/plain; charset=UTF-8, image/png
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    46. DocumentReference.content.attachment.data
    Definition

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

    ShortData inline, base64ed
    Comments

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

    Control0..1
    This element is affected by the following invariants: ele-1
    Typebase64Binary
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Requirements

    The data needs to able to be transmitted inline.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    48. DocumentReference.content.attachment.url
    Definition

    A location where the data can be accessed.

    ShortUri where the data can be found
    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.

    Control0..1
    This element is affected by the following invariants: ele-1
    Typeurl
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    The data needs to be transmitted by reference.

    Example<br/><b>General</b>:http://www.acme.com/logo-small.png
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. DocumentReference.content.attachment.title
    Definition

    A label or set of text to display in place of the data.

    ShortLabel to display in place of the data
    Comments

    Note that FHIR strings SHALL NOT exceed 1MB in size

    Control0..1
    This element is affected by the following invariants: ele-1
    Typestring
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    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.

    Example<br/><b>General</b>:Official Corporate Logo
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    52. DocumentReference.content.attachment.creation
    Definition

    The date that the attachment was first created.

    ShortDate attachment was first created
    Control0..1
    This element is affected by the following invariants: ele-1
    TypedateTime
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

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

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    54. DocumentReference.context
    Definition

    The clinical context in which the document was prepared.

    ShortClinical context of document
    Comments

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

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeBackboneElement
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    56. DocumentReference.context.modifierExtension
    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).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    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.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-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())

    Guidance on how to interpret the contents of this table can be found here

    0. DocumentReference
    Definition

    A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.

    ShortA reference to a document
    Comments

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

    Control0..*
    Invariantsdom-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())
    2. DocumentReference.id
    Definition

    The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

    ShortLogical id of this artifact
    Comments

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

    Control0..1
    Typeid
    Summarytrue
    4. DocumentReference.meta
    Definition

    The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

    ShortMetadata about the resource
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeMeta
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    6. DocumentReference.implicitRules
    Definition

    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

    ShortA set of rules under which this content was created
    Comments

    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

    Control0..1
    This element is affected by the following invariants: ele-1
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. DocumentReference.language
    Definition

    The base language in which the resource is written.

    ShortLanguage of the resource content
    Comments

    Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

    Control0..1
    This element is affected by the following invariants: ele-1
    BindingThe codes SHOULD be taken from CommonLanguages
    (preferred to http://hl7.org/fhir/ValueSet/languages)

    A human language.

    Additional BindingsPurpose
    AllLanguagesMax Binding
    Typecode
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. DocumentReference.text
    Definition

    A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

    ShortText summary of the resource, for human interpretation
    Comments

    Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeNarrative
    Alternate Namesnarrative, html, xhtml, display
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. DocumentReference.contained
    Definition

    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

    ShortContained, inline Resources
    Comments

    This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

    Control0..*
    TypeResource
    Alternate Namesinline resources, anonymous resources, contained resources
    14. DocumentReference.extension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension
    Standard StatusNormative (from Trial Use)
    Alternate Namesextensions, user content
    Invariantsele-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())
    SlicingThis element introduces a set of slices on DocumentReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 16. DocumentReference.extension:isEmergency
      Slice NameisEmergency
      Definition

      Optional Extension Element - found in all resources.

      ShortL’urgence de la note qui permettra d’identifier la façon avec laquelle elle devra être prise en compte
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(CdL_isEmergency) (Extension Type: boolean)
      Must Supporttrue
      Invariantsele-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())
      18. DocumentReference.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

      ShortExtensions that cannot be ignored
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Standard StatusNormative (from Trial Use)
      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.

      Alternate Namesextensions, user content
      Invariantsele-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())
      SlicingThis element introduces a set of slices on DocumentReference.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 20. DocumentReference.masterIdentifier
        Definition

        Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document.

        ShortIdentifiant de la note attribué par le système initiateur à l’origine de la création de la note
        Comments

        CDA Document Id extension and root.

        Control0..1
        This element is affected by the following invariants: ele-1
        TypeIdentifier
        Must Supporttrue
        Summarytrue
        Requirements

        The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. DocumentReference.identifier
        Definition

        Other identifiers associated with the document, including version independent identifiers.

        ShortOther identifiers for the document
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeIdentifier
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. DocumentReference.status
        Definition

        The status of this document reference.

        ShortLe statut de la note. Les gestionnaires de cahiers de liaison ne supportant pas la suppression de notes peuvent proposer leur désactivation par mise à jour de leurs statuts
        Comments

        This is the status of the DocumentReference object, which might be independent from the docStatus element.

        This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

        Control1..1
        This element is affected by the following invariants: ele-1
        BindingThe codes SHALL be taken from DocumentReferenceStatus
        (required to http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1)

        The status of the document reference.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. DocumentReference.docStatus
        Definition

        The status of the underlying document.

        Shortpreliminary | final | amended | entered-in-error
        Comments

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

        Control0..0
        This element is affected by the following invariants: ele-1
        BindingThe codes SHALL be taken from CompositionStatus
        (required to http://hl7.org/fhir/ValueSet/composition-status|4.0.1)

        Status of the underlying document.

        Typecode
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. DocumentReference.type
        Definition

        Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

        ShortKind of document (LOINC if possible)
        Comments

        Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.

        Control1..1
        This element is affected by the following invariants: ele-1
        BindingThe codes SHALL be taken from JDV_J23-TypeNoteCahierLiaison-CISIS
        (required to https://mos.esante.gouv.fr/NOS/JDV_J23-TypeNoteCahierLiaison-CISIS/FHIR/JDV-J23-TypeNoteCahierLiaison-CISIS)
        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. DocumentReference.category
        Definition

        A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

        ShortCategorization 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.

        Control0..*
        This element is affected by the following invariants: ele-1
        BindingFor example codes, see DocumentClassValueSet
        (example to http://hl7.org/fhir/ValueSet/document-classcodes)

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

        TypeCodeableConcept
        Summarytrue
        Alternate Namesclaxs
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. DocumentReference.subject
        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).

        ShortWho/what is the subject of the document
        Comments

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

        Control1..1
        This element is affected by the following invariants: ele-1
        TypeReference(FR Core Patient Profile)
        Must Supporttrue
        Summarytrue
        Invariantsele-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')))
        34. DocumentReference.date
        Definition

        When the document reference was created.

        ShortWhen this document reference was created
        Comments

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

        Control0..1
        This element is affected by the following invariants: ele-1
        Typeinstant
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Alternate Namesindexed
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. DocumentReference.author
        Definition

        Identifies who is responsible for adding the information to the document.

        ShortAuteur de la note. Il est préférable de privilégier la situation d'exercice (PractitionerRole) dans le cas où l'auteur est un professionnel.
        Comments

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

        Control1..*
        This element is affected by the following invariants: ele-1
        TypeReference(Device, FR Core Related Person Profile, FR Core Patient Profile, AS Practitioner Profile, AS PractitionerRole Profile, AS Organization Profile)
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summarytrue
        Invariantsele-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')))
        38. DocumentReference.authenticator
        Definition

        Which person or organization authenticates that this document is valid.

        ShortWho/what authenticated the document
        Comments

        Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

        Control0..0
        This element is affected by the following invariants: ele-1
        TypeReference(Practitioner, PractitionerRole, Organization)
        Invariantsele-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')))
        40. DocumentReference.custodian
        Definition

        Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

        ShortOrganization which maintains 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.

        Control0..0
        This element is affected by the following invariants: ele-1
        TypeReference(Organization)
        Invariantsele-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')))
        42. DocumentReference.relatesTo
        Definition

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

        ShortCet élément peut être utilisé pour lier des notes entre elles (note en réponse à une autre par exemple). Pour ce faire le code « appends » doit être utilisé dans relatesTo.code et relatesTo.reference doit pointer vers la note mère.
        Comments

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

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeBackboneElement
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. DocumentReference.relatesTo.id
        Definition

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

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        XML FormatIn the XML format, this property is represented as an attribute.
        46. DocumentReference.relatesTo.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension
        Standard StatusNormative (from Trial Use)
        Alternate Namesextensions, user content
        Invariantsele-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())
        SlicingThis element introduces a set of slices on DocumentReference.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 48. DocumentReference.relatesTo.modifierExtension
          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).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          This element is affected by the following invariants: ele-1
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-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())
          50. DocumentReference.relatesTo.code
          Definition

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

          Shortreplaces | transforms | signs | appends
          Comments

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

          Control1..1
          This element is affected by the following invariants: ele-1
          BindingThe codes SHALL be taken from DocumentRelationshipType
          (required to http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1)

          The type of relationship between documents.

          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. DocumentReference.relatesTo.target
          Definition

          The target document of this relationship.

          ShortTarget of the relationship
          Comments

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

          Control1..1
          This element is affected by the following invariants: ele-1
          TypeReference(DocumentReference)
          Summarytrue
          Invariantsele-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')))
          54. DocumentReference.description
          Definition

          Human-readable description of the source document.

          ShortHuman-readable description
          Comments

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

          Control0..1
          This element is affected by the following invariants: ele-1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Helps humans to assess whether the document is of interest.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. DocumentReference.securityLabel
          Definition

          A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.

          ShortStatut de visibilité de la note
          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.

          Control0..1
          This element is affected by the following invariants: ele-1
          BindingThe codes SHALL be taken from JDV_J110-StatutVisibiliteDocument-CISIS
          (required to https://mos.esante.gouv.fr/NOS/JDV_J110-StatutVisibiliteDocument-CISIS/FHIR/JDV-J110-StatutVisibiliteDocument-CISIS)
          TypeCodeableConcept
          Must Supporttrue
          Summarytrue
          Requirements

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

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. DocumentReference.content
          Definition

          The document and format referenced. There may be multiple content element repetitions, each with a different format.

          ShortContenu de la note. Cet élément qui représente le contenu de la note est répétable. Pour une note avec du texte et une photo par exemple, deux instances de l’élément « content » peuvent être présentes : une pour représenter le texte et une pour représenter la photo.
          Control1..*
          This element is affected by the following invariants: ele-1
          TypeBackboneElement
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          60. DocumentReference.content.id
          Definition

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

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          XML FormatIn the XML format, this property is represented as an attribute.
          62. DocumentReference.content.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          This element is affected by the following invariants: ele-1
          TypeExtension
          Standard StatusNormative (from Trial Use)
          Alternate Namesextensions, user content
          Invariantsele-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())
          SlicingThis element introduces a set of slices on DocumentReference.content.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 64. DocumentReference.content.modifierExtension
            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).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            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.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-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())
            66. DocumentReference.content.attachment
            Definition

            The document or URL of the document along with critical metadata to prove content has integrity.

            ShortWhere to access the document
            Comments

            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".

            Control1..1
            This element is affected by the following invariants: ele-1
            TypeAttachment
            Summarytrue
            Invariantsele-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())
            68. DocumentReference.content.attachment.id
            Definition

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

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            XML FormatIn the XML format, this property is represented as an attribute.
            70. DocumentReference.content.attachment.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension
            Standard StatusNormative (from Trial Use)
            Alternate Namesextensions, user content
            Invariantsele-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())
            SlicingThis element introduces a set of slices on DocumentReference.content.attachment.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 72. DocumentReference.content.attachment.contentType
              Definition

              Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

              ShortMime type of the content, with charset etc.
              Comments

              Note that FHIR strings SHALL NOT exceed 1MB in size

              Control0..1
              This element is affected by the following invariants: ele-1
              BindingThe codes SHALL be taken from Mime Types
              (required to http://hl7.org/fhir/ValueSet/mimetypes|4.0.1)

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

              Typecode
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

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

              Example<br/><b>General</b>:text/plain; charset=UTF-8, image/png
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. DocumentReference.content.attachment.language
              Definition

              The human language of the content. The value can be any valid value according to BCP 47.

              ShortHuman language of the content (BCP-47)
              Comments

              Note that FHIR strings SHALL NOT exceed 1MB in size

              Control0..1
              This element is affected by the following invariants: ele-1
              BindingThe codes SHOULD be taken from CommonLanguages
              (preferred to http://hl7.org/fhir/ValueSet/languages)

              A human language.

              Additional BindingsPurpose
              AllLanguagesMax Binding
              Typecode
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

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

              Example<br/><b>General</b>:en-AU
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              76. DocumentReference.content.attachment.data
              Definition

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

              ShortData inline, base64ed
              Comments

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

              Control0..1
              This element is affected by the following invariants: ele-1
              Typebase64Binary
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Requirements

              The data needs to able to be transmitted inline.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              78. DocumentReference.content.attachment.url
              Definition

              A location where the data can be accessed.

              ShortUri where the data can be found
              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.

              Control0..1
              This element is affected by the following invariants: ele-1
              Typeurl
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              The data needs to be transmitted by reference.

              Example<br/><b>General</b>:http://www.acme.com/logo-small.png
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              80. DocumentReference.content.attachment.size
              Definition

              The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

              ShortNumber of bytes of content (if url provided)
              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.

              Control0..1
              This element is affected by the following invariants: ele-1
              TypeunsignedInt
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              82. DocumentReference.content.attachment.hash
              Definition

              The calculated hash of the data using SHA-1. Represented using base64.

              ShortHash of the data (sha-1, base64ed)
              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.

              Control0..1
              This element is affected by the following invariants: ele-1
              Typebase64Binary
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              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).

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              84. DocumentReference.content.attachment.title
              Definition

              A label or set of text to display in place of the data.

              ShortLabel to display in place of the data
              Comments

              Note that FHIR strings SHALL NOT exceed 1MB in size

              Control0..1
              This element is affected by the following invariants: ele-1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              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.

              Example<br/><b>General</b>:Official Corporate Logo
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              86. DocumentReference.content.attachment.creation
              Definition

              The date that the attachment was first created.

              ShortDate attachment was first created
              Control0..1
              This element is affected by the following invariants: ele-1
              TypedateTime
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              88. DocumentReference.content.format
              Definition

              An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

              ShortFormat/content rules for the document
              Comments

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

              Control0..1
              This element is affected by the following invariants: ele-1
              BindingThe codes SHOULD be taken from DocumentReferenceFormatCodeSet
              (preferred to http://hl7.org/fhir/ValueSet/formatcodes)

              Document Format Codes.

              TypeCoding
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              90. DocumentReference.context
              Definition

              The clinical context in which the document was prepared.

              ShortClinical context of document
              Comments

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

              Control0..1
              This element is affected by the following invariants: ele-1
              TypeBackboneElement
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              92. DocumentReference.context.id
              Definition

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

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              XML FormatIn the XML format, this property is represented as an attribute.
              94. DocumentReference.context.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension
              Standard StatusNormative (from Trial Use)
              Alternate Namesextensions, user content
              Invariantsele-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())
              SlicingThis element introduces a set of slices on DocumentReference.context.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 96. DocumentReference.context.modifierExtension
                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).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                This element is affected by the following invariants: ele-1
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                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.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-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())
                98. DocumentReference.context.encounter
                Definition

                Describes the clinical encounter or type of care that the document content is associated with.

                ShortContext of the document content
                Comments

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

                Control0..*
                This element is affected by the following invariants: ele-1
                TypeReference(Encounter, EpisodeOfCare)
                Invariantsele-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')))
                100. DocumentReference.context.event
                Definition

                This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.

                ShortMain clinical acts 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.

                Control0..*
                This element is affected by the following invariants: ele-1
                BindingFor example codes, see v3 Code System ActCode
                (example to http://terminology.hl7.org/ValueSet/v3-ActCode)

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

                TypeCodeableConcept
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                102. DocumentReference.context.period
                Definition

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

                ShortTime of service that is being documented
                Comments

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

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

                Control0..1
                This element is affected by the following invariants: ele-1
                TypePeriod
                Summarytrue
                Invariantsele-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))
                104. DocumentReference.context.facilityType
                Definition

                The kind of facility where the patient was seen.

                ShortKind of facility where patient was seen
                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.

                Control0..1
                This element is affected by the following invariants: ele-1
                BindingFor example codes, see FacilityTypeCodeValueSet
                (example to http://hl7.org/fhir/ValueSet/c80-facilitycodes)

                XDS Facility Type.

                TypeCodeableConcept
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                106. DocumentReference.context.practiceSetting
                Definition

                This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.

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

                Control0..1
                This element is affected by the following invariants: ele-1
                BindingFor example codes, see PracticeSettingCodeValueSet
                (example to http://hl7.org/fhir/ValueSet/c80-practice-codes)

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

                TypeCodeableConcept
                Requirements

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                108. DocumentReference.context.sourcePatientInfo
                Definition

                The Patient Information as known when the document was published. May be a reference to a version specific, or contained.

                ShortPatient demographics from source
                Comments

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

                Control0..1
                This element is affected by the following invariants: ele-1
                TypeReference(Patient)
                Invariantsele-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')))
                110. DocumentReference.context.related
                Definition

                Related identifiers or resources associated with the DocumentReference.

                ShortRelated identifiers or resources
                Comments

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

                Control0..*
                This element is affected by the following invariants: ele-1
                TypeReference(Resource)
                Invariantsele-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')))