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DocumentReference Profile

Canonical../StructureDefinition/nexus-emr-core-documentreference
Statusdraft · 1.26.0
BaseDocumentReference (constraint)
CQL primary code pathtype — what this means
SourceFSH · JSON

Nexus EMR profile for an ATTACHED DOCUMENT -- a clinical document that exists as a file: scanned paper, incoming faxes, external consult letters received as PDF, signed consent forms, patient-uploaded files. FHIR holds the metadata and clinical context; the bytes live in document storage and are reached through content.attachment.url.

Examples

Allergy Consult Letter (challenge refuted) · Anemia Consultation Document · Cardiology Consult Letter (received) · Consent Withdrawal Evidence Document · Hrm discharge summary 20260618 · WSIB Form 8 (filed) · WSIB Form 8 Template (with field mapping)

Allergy Consult Letter (challenge refuted)

The letter recording that a graded oral challenge refuted the previously reported penicillin allergy. It is the source the chart-update suggestion cites when proposing that the recorded allergy be marked entered-in-error. It also carries a comment thread -- two resource-note extension repeats in the Task Note turn shape, one from a practitioner reference and one from an authorString author, read oldest first by time

DocumentReference/allergy-consult-20260817 — claims conformance to DocumentReference Profile

{
  "resourceType": "DocumentReference",
  "id": "allergy-consult-20260817",
  "meta": {
    "profile": [
      "../StructureDefinition/nexus-emr-core-documentreference"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns="http://www.w3.org/1999/xhtml"><p>Allergy consultation letter for Avery Linwood, received 17 August 2026. A graded oral challenge to amoxicillin was completed without reaction and the previously recorded penicillin allergy is refuted.</p><p>This letter is the source the chart-update suggestion cites when it proposes marking the recorded penicillin allergy <code>entered-in-error</code>. The passage quoted in that citation is reproduced in <code>description</code> below, so the quote can be checked against the document it is attributed to.</p><p><code>author</code> is deliberately absent: the letter was written by an allergist outside this practice.</p><p>The document also carries its comment thread: two repeats of the resource-note extension, each one Task Note turn -- the first authored by a practitioner reference, the second by an <code>authorString</code> author with no resource of their own -- read oldest first by <code>time</code>.</p></div>"
  },
  "extension": [
    {
      "url": "../StructureDefinition/nexus-emr-resource-note",
      "valueAnnotation": {
        "authorReference": {
          "reference": "Practitioner/dr-emil-navarro",
          "display": "Dr. Emil Navarro"
        },
        "time": "2026-08-19T14:12:00Z",
        "text": "Challenge result verified with the allergist's office before removing the allergy — chart updated the same day."
      }
    },
    {
      "url": "../StructureDefinition/nexus-emr-resource-note",
      "valueAnnotation": {
        "authorString": "Rae Okafor (front desk)",
        "time": "2026-08-19T15:40:00Z",
        "text": "Original paper letter filed in the physical chart; this scan is the working copy."
      }
    }
  ],
  "status": "current",
  "type": {
    "coding": [
      {
        "system": "http://loinc.org",
        "code": "11488-4",
        "display": "Consult Note"
      }
    ],
    "text": "Consult Note"
  },
  "category": [
    {
      "text": "Allergy and immunology"
    }
  ],
  "subject": {
    "reference": "Patient/nexus-emr-patient-attachment-example",
    "display": "Avery Linwood"
  },
  "date": "2026-08-17T15:05:00-04:00",
  "description": "Graded oral challenge to amoxicillin completed without reaction. The previously reported penicillin allergy is refuted; please remove it from the chart.",
  "custodian": {
    "reference": "Organization/cedarbrook-clinic"
  },
  "content": [
    {
      "attachment": {
        "contentType": "application/pdf",
        "language": "en-CA",
        "title": "Allergy Consult Letter - August 17, 2026",
        "creation": "2026-08-17T15:05:00-04:00",
        "size": 243,
        "data": "JVBERi0xLjQKJeLjz9MKMSAwIG9iago8PAovVHlwZSAvQ2F0YWxvZwovUGFnZXMgMiAwIFIKPj4KZW5kb2JqCjIgMCBvYmoKPDwKL1R5cGUgL1BhZ2VzCi9LaWRzIFszIDAgUl0KL0NvdW50IDEKPD4KZW5kb2JqCjMgMCBvYmoKPDwKL1R5cGUgL1BhZ2UKL1BhcmVudCAyIDAgUgovTWVkaWFCb3ggWzAgMCA2MTIgNzkyXQovUmVzb3VyY2VzIDw8L0ZvbnQgPDwvRjEgNCAwIFI+Pj4+Ci9Db250ZW50cyA1IDAgUgo+PgplbmRvYmoK"
      }
    }
  ]
}

Referenced by: Suggested-Resource Task - Retire a Chart Entry