{ "resourceType": "StructureDefinition", "id": "nexus-emr-core-documentreference", "extension": [ { "url": "https://fhir.apps.health/StructureDefinition/effective-date", "extension": [ { "url": "paths", "valueString": "date" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "type" }, { "url": "expression", "valueString": "type" }, { "url": "type", "valueCode": "coded" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "category" }, { "url": "expression", "valueString": "category" }, { "url": "type", "valueCode": "coded" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "status" }, { "url": "expression", "valueString": "status" }, { "url": "type", "valueCode": "code" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "date" }, { "url": "expression", "valueString": "date" }, { "url": "type", "valueCode": "dateTime" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "description" }, { "url": "expression", "valueString": "description" }, { "url": "type", "valueCode": "string" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "author" }, { "url": "expression", "valueString": "author.first().display" }, { "url": "type", "valueCode": "string" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "title" }, { "url": "expression", "valueString": "content.first().attachment.title" }, { "url": "type", "valueCode": "string" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "url" }, { "url": "expression", "valueString": "content.first().attachment.url" }, { "url": "type", "valueCode": "string" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/smart-exposed", "extension": [ { "url": "read", "valueString": "documentreference:read" }, { "url": "write", "valueString": "documentreference:write" }, { "url": "delete", "valueString": "documentreference:delete" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/cqf-modelInfo-primaryCodePath", "valueString": "type" } ], "url": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference", "name": "NexusEmrCoreDocumentReference", "title": "DocumentReference Profile", "status": "draft", "description": "Nexus EMR profile for an ATTACHED DOCUMENT -- a clinical document that exists as a file:\nscanned paper, incoming faxes, external consult letters received as PDF, signed consent forms,\npatient-uploaded files. FHIR holds the metadata and clinical context; the bytes live in\ndocument storage and are reached through `content.attachment.url`.\n\nUse `NexusEmrCoreComposition` instead for notes AUTHORED in this EMR -- encounter notes,\nconsult notes, telephone notes -- where the narrative is text the EMR controls and belongs in\nFHIR as XHTML. The two profiles partition the clinical-document space; neither is a fallback\nfor the other.\n\nDocuments are submitted with inline base64 in `content.attachment.data`; the gateway stores\nthem and rewrites the attachment to carry a `url` instead. See the `content` element\ndefinitions for the full round-trip contract, including what a reader should expect back.\n\nAligned with CA-Core+ standards and CII requirements for Canadian healthcare.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "fhircomposition", "uri": "http://hl7.org/fhir/composition", "name": "FHIR Composition" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "xds", "uri": "http://ihe.net/xds", "name": "XDS metadata equivalent" } ], "kind": "resource", "abstract": false, "type": "DocumentReference", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DocumentReference", "derivation": "constraint", "snapshot": { "element": [ { "id": "DocumentReference", "path": "DocumentReference", "short": "An attached document (scan, PDF, fax, Word) with its metadata and clinical context", "definition": "DocumentReference is the metadata wrapper for a document that exists as a FILE -- scanned paper,\nan incoming fax, an external consult letter received as PDF, a signed consent form. It provides\nindexing, discovery, and clinical context; the bytes themselves live in document storage and are\nreached through `content.attachment.url`.\n\nFor notes AUTHORED in this EMR, use `NexusEmrCoreComposition` instead -- narrative belongs in\nFHIR as XHTML, not as an encoded attachment. See the boundary rule at the top of this file.\n\nThe resource captures:\n- Document identification and categorization\n- Clinical context and temporal relevance\n- Authorship and authentication details\n- A pointer to the document content (and, on the way in, the content itself)\n- Relationships to other documents", "comment": "Usually, this is used for documents other than those defined by FHIR.", "min": 0, "max": "*", "base": { "path": "DocumentReference", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "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", "expression": "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()", "xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:security))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "xpath": "exists(f:text/h:div)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "attachment-has-data-or-url", "severity": "error", "human": "Each attachment must have either inline data (base64) or a url (blob storage URI), or both", "expression": "content.all(attachment.data.exists() or attachment.url.exists())", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference" }, { "key": "nexus-documentreference-subject-unless-template", "severity": "error", "human": "A DocumentReference SHALL carry a subject unless it is a form template. A template (an identifier under NamingSystem/nexus-form-template) is the tenant-wide blank of a form type and is about no patient; every other document is about one.", "expression": "subject.exists() or identifier.where(system = 'https://fhir.apps.health/NamingSystem/nexus-form-template').exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference" }, { "key": "nexus-documentreference-field-mapping-only-on-template", "severity": "error", "human": "A field mapping SHALL appear only on a form template (an identifier under NamingSystem/nexus-form-template): it names the fillable fields of the template's file that a chart value pre-fills, and a filed form carries the values themselves", "expression": "extension.where(url = 'https://fhir.apps.health/StructureDefinition/nexus-form-template-field-mapping').exists() implies identifier.where(system = 'https://fhir.apps.health/NamingSystem/nexus-form-template').exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "fhircomposition", "map": "when describing a Composition" }, { "identity": "rim", "map": "Document[classCode=\"DOC\" and moodCode=\"EVN\"]" }, { "identity": "cda", "map": "when describing a CDA" } ] }, { "id": "DocumentReference.id", "path": "DocumentReference.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": true }, { "id": "DocumentReference.meta", "path": "DocumentReference.meta", "short": "Metadata about the resource", "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.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "DocumentReference.meta.id", "path": "DocumentReference.meta.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.meta.extension", "path": "DocumentReference.meta.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.meta.versionId", "path": "DocumentReference.meta.versionId", "short": "Version specific identifier", "definition": "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.", "comment": "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.", "min": 0, "max": "1", "base": { "path": "Meta.versionId", "min": 0, "max": "1" }, "type": [ { "code": "id" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "DocumentReference.meta.lastUpdated", "path": "DocumentReference.meta.lastUpdated", "short": "When the resource version last changed", "definition": "When the resource last changed - e.g. when the version changed.", "comment": "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http.html#read) interaction.", "min": 0, "max": "1", "base": { "path": "Meta.lastUpdated", "min": 0, "max": "1" }, "type": [ { "code": "instant" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "DocumentReference.meta.source", "path": "DocumentReference.meta.source", "short": "Identifies EMR instance & pipeline version the resource came from", "definition": "A URI that identifies the EMR pipeline and version from which this resource originated. This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.", "comment": "In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.", "min": 0, "max": "1", "base": { "path": "Meta.source", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "DocumentReference.meta.profile", "path": "DocumentReference.meta.profile", "short": "Profiles this resource claims to conform to", "definition": "A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).", "comment": "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.", "min": 0, "max": "*", "base": { "path": "Meta.profile", "min": 0, "max": "*" }, "type": [ { "code": "canonical", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/StructureDefinition" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "DocumentReference.meta.security", "path": "DocumentReference.meta.security", "short": "Security Labels applied to this resource", "definition": "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.", "comment": "The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.", "min": 0, "max": "*", "base": { "path": "Meta.security", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "SecurityLabels" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "Security Labels from the Healthcare Privacy and Security Classification System.", "valueSet": "http://hl7.org/fhir/ValueSet/security-labels" } }, { "id": "DocumentReference.meta.tag", "path": "DocumentReference.meta.tag", "short": "Tags applied to this resource", "definition": "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.", "comment": "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.", "min": 0, "max": "*", "base": { "path": "Meta.tag", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Tags" } ], "strength": "example", "description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".", "valueSet": "http://hl7.org/fhir/ValueSet/common-tags" } }, { "id": "DocumentReference.implicitRules", "path": "DocumentReference.implicitRules", "short": "A set of rules under which this content was created", "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.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "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", "isSummary": true }, { "id": "DocumentReference.language", "path": "DocumentReference.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "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).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "preferred", "description": "A human language.", "valueSet": "http://hl7.org/fhir/ValueSet/languages" } }, { "id": "DocumentReference.text", "path": "DocumentReference.text", "short": "Human-readable summary of the document reference", "definition": "A human-readable narrative that contains a summary of the document reference. This narrative should provide key information about the document for human interpretation, including document type, date, and key clinical context.", "comment": "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.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Act.text?" } ] }, { "id": "DocumentReference.contained", "path": "DocumentReference.contained", "short": "Contained, inline Resources", "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.", "comment": "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.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "DocumentReference.extension", "path": "DocumentReference.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" }, "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "DocumentReference.extension:reviewed", "path": "DocumentReference.extension", "sliceName": "reviewed", "short": "Review acknowledgement, one per reviewer (absent = unreviewed)", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-reviewed" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "DocumentReference.extension:statusReason", "path": "DocumentReference.extension", "sliceName": "statusReason", "short": "Free-text reason the document is superseded or entered in error (absent when current)", "definition": "Why the document is no longer `current`: what replaced a superseded document, or what made an\nentered-in-error one wrong. Written when the status changes and removed when the document is\nmade current again, so a stale reason never sits on an active document. Because the resource is\nupdated in place, each stored version keeps the reason that applied to it -- the store's version\nhistory is the audit of who changed the status, when, from what to what, and why. Optional: a\nstatus change with no reason is a complete record.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-document-status-reason" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "DocumentReference.extension:fieldMapping", "path": "DocumentReference.extension", "sliceName": "fieldMapping", "short": "Fillable fields a chart value pre-fills -- form templates only", "definition": "Which fillable fields of this template's file a chart value pre-fills when a form is started\nfrom it: one rule per field, naming the field as the file names it and the chart value (from\n`CodeSystem/nexus-form-chart-value`) that fills it. Present only on a form template. Absent, or\nnaming no field the file carries, the form opens blank; present, every pre-filled value stays\neditable.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-form-template-field-mapping" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "DocumentReference.modifierExtension", "path": "DocumentReference.modifierExtension", "short": "Extensions that cannot be ignored", "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "DocumentReference.masterIdentifier", "path": "DocumentReference.masterIdentifier", "short": "Master Version Specific Identifier", "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.", "comment": "CDA Document Id extension and root.", "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.).", "min": 0, "max": "1", "base": { "path": "DocumentReference.masterIdentifier", "min": 0, "max": "1" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "fhircomposition", "map": "Composition.identifier" }, { "identity": "v2", "map": "TXA-12" }, { "identity": "rim", "map": ".id" }, { "identity": "xds", "map": "DocumentEntry.uniqueId" }, { "identity": "cda", "map": "ClinicalDocument/id" } ] }, { "id": "DocumentReference.identifier", "path": "DocumentReference.identifier", "short": "Business identifier(s) for document reference", "definition": "Unique business identifiers assigned to this document reference.", "comment": "A source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "min": 0, "max": "*", "base": { "path": "DocumentReference.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "v2", "map": "TXA-16?" }, { "identity": "rim", "map": ".id / .setId" }, { "identity": "xds", "map": "DocumentEntry.entryUUID" } ] }, { "id": "DocumentReference.identifier.id", "path": "DocumentReference.identifier.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.identifier.extension", "path": "DocumentReference.identifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.identifier.use", "path": "DocumentReference.identifier.use", "short": "usual | official | temp | secondary | old (If known)", "definition": "The purpose of this identifier.", "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min": 0, "max": "1", "base": { "path": "Identifier.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierUse" } ], "strength": "required", "description": "Identifies the purpose for this identifier, if known .", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1" }, "mapping": [ { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "DocumentReference.identifier.type", "path": "DocumentReference.identifier.type", "short": "Description of identifier", "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.", "comment": "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.", "requirements": "Allows users to make use of identifiers when the identifier system is not known.", "min": 0, "max": "1", "base": { "path": "Identifier.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type" }, "mapping": [ { "identity": "v2", "map": "CX.5" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "DocumentReference.identifier.system", "path": "DocumentReference.identifier.system", "short": "The namespace for the identifier value", "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.", "comment": "Identifier.system is always case sensitive.", "requirements": "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.", "min": 1, "max": "1", "base": { "path": "Identifier.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "example": [ { "label": "General", "valueUri": "http://www.acme.com/identifiers/patient" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / EI-2-4" }, { "identity": "rim", "map": "II.root or Role.id.root" }, { "identity": "servd", "map": "./IdentifierType" } ] }, { "id": "DocumentReference.identifier.value", "path": "DocumentReference.identifier.value", "short": "The value that is unique", "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.", "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.", "min": 1, "max": "1", "base": { "path": "Identifier.value", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "123456" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.1 / EI.1" }, { "identity": "rim", "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity": "servd", "map": "./Value" } ] }, { "id": "DocumentReference.identifier.period", "path": "DocumentReference.identifier.period", "short": "Time period when id is/was valid for use", "definition": "Time period during which identifier is/was valid for use.", "min": 0, "max": "1", "base": { "path": "Identifier.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.7 + CX.8" }, { "identity": "rim", "map": "Role.effectiveTime or implied by context" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "DocumentReference.identifier.assigner", "path": "DocumentReference.identifier.assigner", "short": "Organization that issued id (may be just text)", "definition": "Organization that issued/manages the identifier.", "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.", "min": 0, "max": "1", "base": { "path": "Identifier.assigner", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity": "rim", "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity": "servd", "map": "./IdentifierIssuingAuthority" } ] }, { "id": "DocumentReference.status", "path": "DocumentReference.status", "short": "Where the document reference is in its lifecycle", "definition": "The status of this document reference. Allowed values:\n- current: The document is active and current\n- superseded: The document has been replaced by a newer version\n- entered-in-error: The document was created in error and should not be used (deleted)\n\nWhen a document is updated, the previous version can be marked as 'superseded' and a new DocumentReference\ncreated with status 'current'. This approach:\n- Maintains immutable document history\n- Provides clear version tracking\n- Enables audit trails\n- Supports document lifecycle management", "comment": "This is the status of the DocumentReference object, which might be independent from the docStatus element.\n\nThis element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.", "min": 1, "max": "1", "base": { "path": "DocumentReference.status", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "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", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DocumentReferenceStatus" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The status of the document reference.", "valueSet": "http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1" }, "mapping": [ { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "v2", "map": "TXA-19" }, { "identity": "rim", "map": "interim: .completionCode=\"IN\" & ./statusCode[isNormalDatatype()]=\"active\"; final: .completionCode=\"AU\" && ./statusCode[isNormalDatatype()]=\"complete\" and not(./inboundRelationship[typeCode=\"SUBJ\" and isNormalActRelationship()]/source[subsumesCode(\"ActClass#CACT\") and moodCode=\"EVN\" and domainMember(\"ReviseDocument\", code) and isNormalAct()]); amended: .completionCode=\"AU\" && ./statusCode[isNormalDatatype()]=\"complete\" and ./inboundRelationship[typeCode=\"SUBJ\" and isNormalActRelationship()]/source[subsumesCode(\"ActClass#CACT\") and moodCode=\"EVN\" and domainMember(\"ReviseDocument\", code) and isNormalAct() and statusCode=\"completed\"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]=\"obsolete\"" }, { "identity": "xds", "map": "DocumentEntry.availabilityStatus" } ] }, { "id": "DocumentReference.docStatus", "path": "DocumentReference.docStatus", "short": "preliminary | final | amended | entered-in-error", "definition": "The status of the underlying document.", "comment": "The document that is pointed to might be in various lifecycle states.", "min": 0, "max": "1", "base": { "path": "DocumentReference.docStatus", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ReferredDocumentStatus" } ], "strength": "required", "description": "Status of the underlying document.", "valueSet": "http://hl7.org/fhir/ValueSet/composition-status|4.0.1" }, "mapping": [ { "identity": "w5", "map": "FiveWs.status" }, { "identity": "fhircomposition", "map": "Composition.status" }, { "identity": "v2", "map": "TXA-17" }, { "identity": "rim", "map": ".statusCode" } ] }, { "id": "DocumentReference.type", "path": "DocumentReference.type", "short": "Precise type of document (use category instead)", "definition": "Specifies the precise type of clinical document referenced (e.g., specific LOINC code for document type). \nWhile this field is supported for backward compatibility with systems expecting it, Nexus EMR strongly \nrecommends using 'category' instead because:\n- Category supports multiple classifications per document\n- Category allows both clinical and administrative taxonomies\n- Type is limited to a single classification\n\nIf used, prefer LOINC codes for interoperability.\n\nWhere this code was mapped from a source system's own vocabulary, carry the raw coding alongside the mapped one, flagged `userSelected = true`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "comment": "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.", "min": 0, "max": "1", "base": { "path": "DocumentReference.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DocumentC80Type" } ], "strength": "extensible", "description": "LOINC document type codes", "valueSet": "http://hl7.org/fhir/ValueSet/c80-doc-typecodes" }, "mapping": [ { "identity": "workflow", "map": "Event.code" }, { "identity": "w5", "map": "FiveWs.class" }, { "identity": "fhircomposition", "map": "Composition.type" }, { "identity": "v2", "map": "TXA-2" }, { "identity": "rim", "map": "./code" }, { "identity": "xds", "map": "DocumentEntry.type" }, { "identity": "cda", "map": "ClinicalDocument/code/@code \n\nThe typeCode should be mapped from the ClinicalDocument/code element to a set of document type codes configured in the affinity domain. One suggested coding system to use for typeCode is LOINC, in which case the mapping step can be omitted." } ] }, { "id": "DocumentReference.type.id", "path": "DocumentReference.type.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.type.extension", "path": "DocumentReference.type.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.type.coding", "path": "DocumentReference.type.coding", "slicing": { "discriminator": [ { "type": "pattern", "path": "system" } ], "rules": "open", "description": "Slice by code system" }, "short": "Code defined by a terminology system", "definition": "A reference to a code defined by a terminology system.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "DocumentReference.type.coding:loinc", "path": "DocumentReference.type.coding", "sliceName": "loinc", "short": "LOINC document type code", "definition": "LOINC code for document type when available", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "DocumentReference.type.coding:loinc.id", "path": "DocumentReference.type.coding.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.type.coding:loinc.extension", "path": "DocumentReference.type.coding.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.type.coding:loinc.system", "path": "DocumentReference.type.coding.system", "short": "Identity of the terminology system", "definition": "The identification of the code system that defines the meaning of the symbol in the code.", "comment": "The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.", "requirements": "Need to be unambiguous about the source of the definition of the symbol.", "min": 1, "max": "1", "base": { "path": "Coding.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "fixedUri": "http://loinc.org", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.3" }, { "identity": "rim", "map": "./codeSystem" }, { "identity": "orim", "map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem" } ] }, { "id": "DocumentReference.type.coding:loinc.version", "path": "DocumentReference.type.coding.version", "short": "Version of the system - if relevant", "definition": "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.", "comment": "Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.", "min": 0, "max": "1", "base": { "path": "Coding.version", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.7" }, { "identity": "rim", "map": "./codeSystemVersion" }, { "identity": "orim", "map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion" } ] }, { "id": "DocumentReference.type.coding:loinc.code", "path": "DocumentReference.type.coding.code", "short": "Symbol in syntax defined by the system", "definition": "A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).", "requirements": "Need to refer to a particular code in the system.", "min": 1, "max": "1", "base": { "path": "Coding.code", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.1" }, { "identity": "rim", "map": "./code" }, { "identity": "orim", "map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code" } ] }, { "id": "DocumentReference.type.coding:loinc.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "DocumentReference.type.coding.display", "short": "Representation defined by the system", "definition": "A representation of the meaning of the code in the system, following the rules of the system.", "requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.", "min": 0, "max": "1", "base": { "path": "Coding.display", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.2 - but note this is not well followed" }, { "identity": "rim", "map": "CV.displayName" }, { "identity": "orim", "map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName" } ] }, { "id": "DocumentReference.type.coding:loinc.userSelected", "path": "DocumentReference.type.coding.userSelected", "short": "If this coding was chosen directly by the user", "definition": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).", "comment": "Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.", "requirements": "This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.", "min": 0, "max": "1", "base": { "path": "Coding.userSelected", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "Sometimes implied by being first" }, { "identity": "rim", "map": "CD.codingRationale" }, { "identity": "orim", "map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]" } ] }, { "id": "DocumentReference.type.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "DocumentReference.type.text", "short": "Plain text representation of document type", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "DocumentReference.category", "path": "DocumentReference.category", "short": "Document categorization (preferred over type)", "definition": "High-level categorization of the document. This is the PREFERRED method for document classification in Nexus EMR. \nMultiple categories can be assigned to provide different perspectives on the document's purpose and content.\n\nCommon categories include:\n- Received correspondence (consult letters, discharge summaries from other institutions)\n- Scanned paper and incoming faxes\n- Diagnostic documents (lab or imaging reports delivered as files rather than as DiagnosticReport)\n- Legal and administrative documents (consent forms, advance directives, insurance forms)\n- Patient-supplied documents\n\nNote what is NOT here since the 2026-08-06 narrowing: progress notes and consultation notes\nAUTHORED in this EMR are `NexusEmrCoreComposition`, not DocumentReference. A consult note\n*received* as a PDF is still a DocumentReference -- the distinction is the form the content\narrives in, not the clinical genre.\n\nUse standard terminologies (LOINC, SNOMED CT) for maximum interoperability.", "comment": "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.", "alias": [ "claxs" ], "min": 0, "max": "*", "base": { "path": "DocumentReference.category", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DocumentC80Class" } ], "strength": "example", "description": "High-level kind of a clinical document at a macro level.", "valueSet": "http://hl7.org/fhir/ValueSet/document-classcodes" }, "mapping": [ { "identity": "w5", "map": "FiveWs.class" }, { "identity": "fhircomposition", "map": "Composition.class" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=\"COMP].target[classCode=\"LIST\", moodCode=\"EVN\"].code" }, { "identity": "xds", "map": "DocumentEntry.class" }, { "identity": "cda", "map": "Derived from a mapping of /ClinicalDocument/code/@code to an Affinity Domain specified coded value to use and coding system. Affinity Domains are encouraged to use the appropriate value for Type of Service, based on the LOINC Type of Service (see Page 53 of the LOINC User's Manual). Must be consistent with /ClinicalDocument/code/@code" } ] }, { "id": "DocumentReference.category.id", "path": "DocumentReference.category.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.category.extension", "path": "DocumentReference.category.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.category.coding", "path": "DocumentReference.category.coding", "short": "Code defined by a terminology system", "definition": "A reference to a code defined by a terminology system.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "DocumentReference.category.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "DocumentReference.category.text", "short": "Plain text category description", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "DocumentReference.subject", "path": "DocumentReference.subject", "short": "The patient the document is about", "definition": "The patient that this document pertains to. Required for every document EXCEPT a form template,\nwhich is the tenant-wide blank of a form type and is about no patient; the\n`nexus-documentreference-subject-unless-template` invariant states that rule in evaluable form.\nWhen present it must reference a valid NexusEmrCorePatient resource, and the reference should use\nthe patient's identifier for reliable cross-system identification.\n\nWhile the FHIR standard allows documents about other subjects (Device, Practitioner, Group), Nexus EMR currently \nonly supports patient-centric documents to align with Canadian healthcare requirements.", "comment": "Required unless this is a form template.", "min": 0, "max": "1", "base": { "path": "DocumentReference.subject", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.subject" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "fhircomposition", "map": "Composition.subject" }, { "identity": "v2", "map": "PID-3 (No standard way to define a Practitioner or Group subject in HL7 v2 MDM message)" }, { "identity": "rim", "map": ".participation[typeCode=\"SBJ\"].role[typeCode=\"PAT\"]" }, { "identity": "xds", "map": "DocumentEntry.patientId" }, { "identity": "cda", "map": "ClinicalDocument/recordTarget/" }, { "identity": "w5", "map": "FiveWs.subject" } ] }, { "id": "DocumentReference.date", "path": "DocumentReference.date", "short": "When DocumentReference was created (not document date)", "definition": "When this DocumentReference resource was created in the system. This is NOT necessarily when the document itself \nwas created or when the documented service occurred.\n\nTiming relationships:\n- date: When DocumentReference was created (this field)\n- content.attachment.creation: When document was created\n- context.period: When clinical service occurred\n\nExample: A discharge summary for April 10-15 admission might be:\n- Service period: 2025-04-10 to 2025-04-15\n- Document created: 2025-04-15T14:00:00\n- DocumentReference created: 2025-04-16T09:00:00 (next day upload)\n\nThis field is primarily for technical/audit purposes.", "comment": "Referencing/indexing time is used for tracking, organizing versions and searching.", "alias": [ "indexed" ], "min": 0, "max": "1", "base": { "path": "DocumentReference.date", "min": 0, "max": "1" }, "type": [ { "code": "instant" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.occurrence[x]" }, { "identity": "w5", "map": "FiveWs.recorded" }, { "identity": "fhircomposition", "map": "Composition.date" }, { "identity": "rim", "map": ".availabilityTime[type=\"TS\"]" } ] }, { "id": "DocumentReference.author", "path": "DocumentReference.author", "short": "Who wrote the document", "definition": "Identifies who was responsible for writing the document content. Can include multiple authors for collaborative \ndocuments. Note the distinction:\n- Author: Who wrote/created the content\n- Authenticator: Who legally verified/signed the document\n- Custodian: Organization maintaining the document\n\n- in EMRs, you probably want to be using 'authenticator' rather than 'author' here.\n - eg: 'author' may be a medical student, 'authenticator' could be the doc signing off.\n - 'authenticator' is the person who is medically responsible for the content of this document.\n\nAuthors can only be EMR users in this context, referenced as a **Practitioner** (the primary\nprovider identity in this IG) or as a **PractitionerRole** where the clinic/role binding is\npart of the assertion.\n\nOrder matters - list primary author first.", "comment": "Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).", "min": 0, "max": "*", "base": { "path": "DocumentReference.author", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "fhircomposition", "map": "Composition.author" }, { "identity": "v2", "map": "TXA-9 (No standard way to indicate a Device in HL7 v2 MDM message)" }, { "identity": "rim", "map": ".participation[typeCode=\"AUT\"].role[classCode=\"ASSIGNED\"]" }, { "identity": "xds", "map": "DocumentEntry.author" }, { "identity": "cda", "map": "ClinicalDocument/author" } ] }, { "id": "DocumentReference.authenticator", "path": "DocumentReference.authenticator", "short": "Practitioner who verified this document", "definition": "The practitioner who has legally authenticated or verified this document, taking responsibility for its content. \nThis represents medical/legal responsibility rather than authorship. The authenticator:\n- Must have appropriate authority/credentials\n- Takes responsibility for document accuracy\n- May or may not be the document author\n- Should be a single practitioner (not multiple)\n\nTypically the attending physician, consultant, or supervising practitioner.\n\nReferences a **Practitioner** -- the primary provider identity in this IG. A\n**PractitionerRole** reference is also permitted, for the cases where the clinic/role binding\nis part of what is being asserted (e.g. authentication performed in a specific role at a\nspecific organization, which Practitioner cannot express since it has no `organization`).", "comment": "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.", "min": 0, "max": "1", "base": { "path": "DocumentReference.authenticator", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "w5", "map": "FiveWs.witness" }, { "identity": "fhircomposition", "map": "Composition.attester" }, { "identity": "v2", "map": "TXA-10" }, { "identity": "rim", "map": ".participation[typeCode=\"AUTHEN\"].role[classCode=\"ASSIGNED\"]" }, { "identity": "xds", "map": "DocumentEntry.legalAuthenticator" }, { "identity": "cda", "map": "ClinicalDocument/legalAuthenticator" } ] }, { "id": "DocumentReference.custodian", "path": "DocumentReference.custodian", "short": "Organization responsible for document maintenance", "definition": "The organization that is responsible for maintaining the authoritative source of this document and controlling \naccess to it. This is a REQUIRED field that identifies:\n- Who has stewardship of the document\n- Where to direct queries about the document\n- Who is responsible for retention policies\n- Who manages access permissions\n\nTypically the organization that created the document or currently manages the patient's care.\nMust reference a valid NexusEmrCoreOrganization resource.", "comment": "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.", "min": 1, "max": "1", "base": { "path": "DocumentReference.custodian", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "fhircomposition", "map": "Composition.custodian" }, { "identity": "rim", "map": ".participation[typeCode=\"RCV\"].role[classCode=\"CUST\"].scoper[classCode=\"ORG\" and determinerCode=\"INST\"]" } ] }, { "id": "DocumentReference.relatesTo", "path": "DocumentReference.relatesTo", "short": "Relationships to other documents", "definition": "Relationships that this document has with other document references that already exist.", "comment": "This element is labeled as a modifier because documents that append to other documents are incomplete on their own.", "min": 0, "max": "*", "base": { "path": "DocumentReference.relatesTo", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "fhircomposition", "map": "Composition.relatesTo" }, { "identity": "rim", "map": ".outboundRelationship" }, { "identity": "xds", "map": "DocumentEntry Associations" } ] }, { "id": "DocumentReference.relatesTo.id", "path": "DocumentReference.relatesTo.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.relatesTo.extension", "path": "DocumentReference.relatesTo.extension", "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.relatesTo.modifierExtension", "path": "DocumentReference.relatesTo.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "DocumentReference.relatesTo.code", "path": "DocumentReference.relatesTo.code", "short": "replaces | transforms | signs | appends", "definition": "The type of relationship that this document has with anther document.", "comment": "If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.", "min": 1, "max": "1", "base": { "path": "DocumentReference.relatesTo.code", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DocumentRelationshipType" } ], "strength": "required", "description": "The type of relationship between documents.", "valueSet": "http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1" }, "mapping": [ { "identity": "fhircomposition", "map": "Composition.relatesTo.code" }, { "identity": "rim", "map": ".outboundRelationship.typeCode" }, { "identity": "xds", "map": "DocumentEntry Associations type" } ] }, { "id": "DocumentReference.relatesTo.target", "path": "DocumentReference.relatesTo.target", "short": "Target of the relationship", "definition": "The target document of this relationship.", "min": 1, "max": "1", "base": { "path": "DocumentReference.relatesTo.target", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/DocumentReference" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "fhircomposition", "map": "Composition.relatesTo.target" }, { "identity": "rim", "map": ".target[classCode=\"DOC\", moodCode=\"EVN\"].id" }, { "identity": "xds", "map": "DocumentEntry Associations reference" } ] }, { "id": "DocumentReference.description", "path": "DocumentReference.description", "short": "Human-readable description of document content", "definition": "A human-readable description of the document's content and purpose. While optional, this field is strongly \nrecommended as it:\n- Provides quick context without opening the document\n- Improves searchability and discoverability\n- Helps users identify relevant documents quickly\n- Supports accessibility requirements\n\nShould be concise but informative (typically 1-2 sentences).\n\nExamples:\n- \"Complete blood count showing mild anemia, hemoglobin 10.2\"\n- \"Cardiology consultation for chest pain, recommending stress test\"\n- \"Discharge summary following 5-day admission for pneumonia\"", "comment": "What the document is about, a terse summary of the document.", "requirements": "Helps humans to assess whether the document is of interest.", "min": 0, "max": "1", "base": { "path": "DocumentReference.description", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "TXA-25" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=\"SUBJ\"].target.text" }, { "identity": "xds", "map": "DocumentEntry.comments" } ] }, { "id": "DocumentReference.securityLabel", "path": "DocumentReference.securityLabel", "short": "Document security-tags", "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.", "comment": "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. \n\nIn 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.", "requirements": "Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.", "min": 0, "max": "*", "base": { "path": "DocumentReference.securityLabel", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "SecurityLabels" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "Security Labels from the Healthcare Privacy and Security Classification System.", "valueSet": "http://hl7.org/fhir/ValueSet/security-labels" }, "mapping": [ { "identity": "fhircomposition", "map": "Composition.confidentiality, Composition.meta.security" }, { "identity": "v2", "map": "TXA-18" }, { "identity": "rim", "map": ".confidentialityCode" }, { "identity": "xds", "map": "DocumentEntry.confidentialityCode" }, { "identity": "cda", "map": "ClinicalDocument/confidentialityCode/@code" } ] }, { "id": "DocumentReference.content", "path": "DocumentReference.content", "short": "Document attachment(s) -- submitted inline, stored as files, read back by URL", "definition": "The document content and its metadata. Each content element is one attachment. Multiple\nattachments per DocumentReference are supported (a referral letter plus supporting results),\nbut most cases are a single document.\n\nTHE ROUND TRIP -- what a writer sends is not what a reader gets back.\n\nWRITING. Submit the document inline: `contentType` plus base64 in `attachment.data`, with no\n`url`. On create or update the gateway stores the bytes, then rewrites the attachment before\npersisting it: `url` is set to the stored-document address, `size` and `hash` (SHA-1) are\ncomputed and filled in, and `data` is cleared. Writers SHOULD NOT compute `size`, `hash`, or\n`url` themselves.\n\nREADING. Expect `url` and no `data`. Fetch the bytes from the URL (see `content.attachment.url`\nfor the auth contract). Consumers MUST NOT assume `data` is populated.\n\nSENDING BOTH IS A TRAP. The conversion is guarded on `url` being absent. An attachment carrying\nBOTH `data` and a `url` bypasses storage entirely and the base64 is persisted inline in the FHIR\nresource, where it will be echoed on every subsequent read. Send one or the other: `data` to\nupload new content, `url` only to reference something already stored.\n\nSTABLE URLS ACROSS UPDATES. Updating a DocumentReference reuses the existing stored-document\nidentity, so the URL does not churn when metadata changes. (Note this is DocumentReference-only\nbehaviour; `DiagnosticReport.presentedForm` runs through the same middleware but without the\nexisting-document lookup, so its attachments get a fresh URL on each update.)\n\nAt least one of `data` or `url` MUST be present per attachment (invariant\n`attachment-has-data-or-url`) -- which, given the above, means \"inline on the way in, URL on the\nway out.\"", "min": 1, "max": "*", "base": { "path": "DocumentReference.content", "min": 1, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "fhircomposition", "map": "Bundle(Composition+*)" }, { "identity": "rim", "map": "document.text" } ] }, { "id": "DocumentReference.content.id", "path": "DocumentReference.content.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.content.extension", "path": "DocumentReference.content.extension", "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.content.modifierExtension", "path": "DocumentReference.content.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "DocumentReference.content.attachment", "path": "DocumentReference.content.attachment", "short": "The document: MIME type, content (inline on write / URL on read), and file metadata", "definition": "The attachment carrying the document. Required.\n\nProvides MIME type identification, the content itself (inline base64 on write, a stored-file URL\non read -- see `content` for the round trip), a human-readable title, size, hash, and language.\n\n`size` and `hash` are populated by the gateway during storage; writers need not supply them.", "min": 1, "max": "1", "base": { "path": "DocumentReference.content.attachment", "min": 1, "max": "1" }, "type": [ { "code": "Attachment" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "fhircomposition", "map": "Composition.language, \nComposition.title, \nComposition.date" }, { "identity": "v2", "map": "TXA-3 for mime type" }, { "identity": "rim", "map": "document.text" }, { "identity": "xds", "map": "DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime" }, { "identity": "cda", "map": "ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date" } ] }, { "id": "DocumentReference.content.attachment.id", "path": "DocumentReference.content.attachment.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.content.attachment.extension", "path": "DocumentReference.content.attachment.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.content.attachment.contentType", "path": "DocumentReference.content.attachment.contentType", "short": "MIME type (e.g., 'application/pdf')", "definition": "MIME type identifying the document format. This is REQUIRED to ensure proper handling and display of the document. \nCommon values:\n- 'application/pdf' - PDF documents (most common)\n- 'text/plain' - Plain text documents\n- 'text/html' - HTML formatted documents\n- 'text/rtf' - Rich text format\n- 'image/jpeg' - JPEG images (scanned documents)\n- 'image/png' - PNG images\n- 'application/msword' - Microsoft Word\n- 'application/vnd.openxmlformats-officedocument.wordprocessingml.document' - Word DOCX\n\nThe MIME type must accurately reflect the actual content format.", "requirements": "Processors of the data need to be able to know how to interpret the data.", "min": 1, "max": "1", "base": { "path": "Attachment.contentType", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "example": [ { "label": "General", "valueCode": "text/plain; charset=UTF-8, image/png" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MimeType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The mime type of an attachment. Any valid mime type is allowed.", "valueSet": "http://hl7.org/fhir/ValueSet/mimetypes|4.0.1" }, "mapping": [ { "identity": "v2", "map": "ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used" }, { "identity": "rim", "map": "./mediaType, ./charset" } ] }, { "id": "DocumentReference.content.attachment.language", "path": "DocumentReference.content.attachment.language", "short": "Language of document content", "definition": "BCP-47 language tag indicating the human language of the document content. Important for:\n- Multilingual healthcare settings\n- Accessibility requirements\n- Content filtering/searching\n- Translation workflows\n\nCommon values:\n- 'en-CA' - Canadian English\n- 'fr-CA' - Canadian French\n- 'en' - English (generic)\n- 'fr' - French (generic)\n- 'es' - Spanish\n\nExample: A discharge summary in French would have language = 'fr-CA'", "requirements": "Users need to be able to choose between the languages in a set of attachments.", "min": 0, "max": "1", "base": { "path": "Attachment.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "example": [ { "label": "General", "valueCode": "en-AU" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "preferred", "description": "A human language.", "valueSet": "http://hl7.org/fhir/ValueSet/languages" }, "mapping": [ { "identity": "rim", "map": "./language" } ] }, { "id": "DocumentReference.content.attachment.data", "path": "DocumentReference.content.attachment.data", "short": "Base64 document content -- the UPLOAD channel; normally absent on read", "definition": "The document content as base64-encoded binary. This is the upload channel: populate it (with no\n`url`) to submit a new document.\n\nNORMALLY ABSENT ON READ. The gateway clears `data` once the bytes are stored, so a reader gets\n`url` instead. Consumers MUST NOT assume this element is populated, and MUST NOT treat its\nabsence as an empty document.\n\nDo not send `data` and `url` together -- see `content`. That combination skips storage and\npersists the base64 inline permanently.\n\nImplementation notes:\n- Line breaks in the base64 string should be avoided; standard alphabet (A-Z, a-z, 0-9, +, /).\n- Large documents: no explicit size threshold is enforced by the gateway, and the whole body is\n buffered in memory during conversion. Very large inline submissions are a practical risk\n (request-body limits and memory), not a specified one -- prefer keeping documents modest and\n raise it with the platform team rather than assuming a limit exists.\n\nExample encoding (JavaScript):\n```javascript\nconst base64Data = Buffer.from(fileContent).toString('base64');\n```\n\nExample encoding (Python):\n```python\nimport base64\nbase64_data = base64.b64encode(file_content).decode('utf-8')\n```", "comment": "The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.", "requirements": "The data needs to able to be transmitted inline.", "min": 0, "max": "1", "base": { "path": "Attachment.data", "min": 0, "max": "1" }, "type": [ { "code": "base64Binary" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "ED.5" }, { "identity": "rim", "map": "./data" } ] }, { "id": "DocumentReference.content.attachment.url", "path": "DocumentReference.content.attachment.url", "short": "Absolute URL to the stored document -- the READ channel; set by the gateway", "definition": "Where the document bytes can be fetched. This is the read channel, and for gateway-ingested\ndocuments it is written BY the gateway during storage -- clients uploading new content should\nleave it empty and send `data`.\n\nSHAPE. An absolute URL served by the platform's File Storage Service:\n\n https://{host}/fss/api/v1/file/{documentId}\n\nThis is NOT a FHIR `Binary` reference (this platform implements no `Binary` endpoint), and NOT\na pre-signed or SAS blob URL. It is a normal API endpoint.\n\nFETCHING IT. The URL is not self-authorizing. Retrieval requires the caller's own credentials:\na bearer token carrying the file-read permission, and the request resolves within the caller's\ntenant -- a document belonging to another tenant is not found, regardless of the identifier. A\nclient that treats this like a public or signed download link will get a 401, not a document.\nReads are audited.\n\nSTABILITY. The URL is permanent for the life of the document -- no expiry, no rotation -- and\nsurvives updates to the DocumentReference (the gateway reuses the stored-document identity).\nIt may therefore be cached and stored.\n\nSUPPLYING A URL YOURSELF. Permitted, for referencing content already held by the platform, but\nvalidated: the host must be trusted, and an untrusted host is rejected with a 400 and an\nOperationOutcome directing you to upload via `data` instead. Do not point this element at\narbitrary external systems -- content that lives outside the platform should be ingested, not\nlinked.", "comment": "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.", "requirements": "The data needs to be transmitted by reference.", "min": 0, "max": "1", "base": { "path": "Attachment.url", "min": 0, "max": "1" }, "type": [ { "code": "url" } ], "example": [ { "label": "General", "valueUrl": "http://www.acme.com/logo-small.png" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "RP.1+RP.2 - if they refer to a URL (see v2.6)" }, { "identity": "rim", "map": "./reference/literal" } ] }, { "id": "DocumentReference.content.attachment.size", "path": "DocumentReference.content.attachment.size", "short": "Number of bytes of content (if url provided)", "definition": "The number of bytes of data that make up this attachment (before base64 encoding, if that is done).", "comment": "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.", "requirements": "Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.", "min": 0, "max": "1", "base": { "path": "Attachment.size", "min": 0, "max": "1" }, "type": [ { "code": "unsignedInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A (needs data type R3 proposal)" } ] }, { "id": "DocumentReference.content.attachment.hash", "path": "DocumentReference.content.attachment.hash", "short": "Hash of the data (sha-1, base64ed)", "definition": "The calculated hash of the data using SHA-1. Represented using base64.", "comment": "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](provenance-definitions.html#Provenance.signature) for mechanism to protect a resource with a digital signature.", "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).", "min": 0, "max": "1", "base": { "path": "Attachment.hash", "min": 0, "max": "1" }, "type": [ { "code": "base64Binary" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": ".integrityCheck[parent::ED/integrityCheckAlgorithm=\"SHA-1\"]" } ] }, { "id": "DocumentReference.content.attachment.title", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "DocumentReference.content.attachment.title", "short": "Document title for display", "definition": "Human-readable title for the document. While optional, this field is strongly recommended for user experience. \nThe title should be:\n- Descriptive and meaningful\n- Suitable for display in document lists\n- Include relevant context (e.g., date, type)\n- 50-100 characters typically\n\nExamples:\n- \"Discharge Summary - April 15, 2025\"\n- \"CBC Results - Hemoglobin 10.2\"\n- \"Cardiology Referral - Dr. Smith\"\n- \"Chest X-Ray Report - Normal\"", "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.", "min": 0, "max": "1", "base": { "path": "Attachment.title", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "Official Corporate Logo" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "./title/data" } ] }, { "id": "DocumentReference.content.attachment.creation", "path": "DocumentReference.content.attachment.creation", "short": "Date/time document was created", "definition": "The date/time when the document was originally created (not when the DocumentReference was created). \nUseful for:\n- Distinguishing between multiple versions\n- Understanding document timeline\n- Sorting documents chronologically\n- Audit trail purposes\n\nFormat: FHIR dateTime (e.g., \"2025-04-20T10:00:00-06:00\")", "requirements": "This is often tracked as an integrity issue for use of the attachment.", "min": 0, "max": "1", "base": { "path": "Attachment.creation", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A (needs data type R3 proposal)" } ] }, { "id": "DocumentReference.content.format", "path": "DocumentReference.content.format", "short": "Format/content rules for the document", "definition": "An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.", "comment": "Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.", "min": 0, "max": "1", "base": { "path": "DocumentReference.content.format", "min": 0, "max": "1" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DocumentFormat" } ], "strength": "preferred", "description": "Document Format Codes.", "valueSet": "http://hl7.org/fhir/ValueSet/formatcodes" }, "mapping": [ { "identity": "fhircomposition", "map": "Composition.meta.profile" }, { "identity": "rim", "map": "document.text" }, { "identity": "xds", "map": "DocumentEntry.formatCode" }, { "identity": "cda", "map": "derived from the IHE Profile or Implementation Guide templateID" } ] }, { "id": "DocumentReference.context", "path": "DocumentReference.context", "short": "Clinical context of document", "definition": "The clinical context in which the document was prepared.", "comment": "These values are primarily added to help with searching for interesting/relevant documents.", "min": 0, "max": "1", "base": { "path": "DocumentReference.context", "min": 0, "max": "1" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "outboundRelationship[typeCode=\"SUBJ\"].target[classCode<'ACT']" } ] }, { "id": "DocumentReference.context.id", "path": "DocumentReference.context.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.context.extension", "path": "DocumentReference.context.extension", "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.context.modifierExtension", "path": "DocumentReference.context.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "DocumentReference.context.encounter", "path": "DocumentReference.context.encounter", "short": "Related clinical encounter(s)", "definition": "Encounter(s) related to the document content. Links the document to specific clinical visits, admissions, or \nother healthcare interactions. Multiple encounters can be referenced if the document spans multiple visits.\n\nExamples:\n- Discharge summary → Inpatient admission encounter\n- Consultation note → Outpatient consultation encounter\n- Operative report → Surgical encounter\n- Progress note → Daily hospital round encounter\n\nProviding encounter context enables:\n- Grouping documents by visit\n- Understanding care continuity\n- Encounter-based searches\n- Billing/administrative workflows", "min": 0, "max": "*", "base": { "path": "DocumentReference.context.encounter", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-encounter" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.context" }, { "identity": "w5", "map": "FiveWs.context" }, { "identity": "fhircomposition", "map": "Composition.encounter" }, { "identity": "rim", "map": "unique(highest(./outboundRelationship[typeCode=\"SUBJ\" and isNormalActRelationship()], priorityNumber)/target[moodCode=\"EVN\" and classCode=(\"ENC\", \"PCPR\") and isNormalAct])" } ] }, { "id": "DocumentReference.context.event", "path": "DocumentReference.context.event", "short": "Main clinical acts documented", "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.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "DocumentReference.context.event", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DocumentEventType" } ], "strength": "example", "description": "This list of codes represents the main clinical acts being documented.", "valueSet": "http://terminology.hl7.org/ValueSet/v3-ActCode" }, "mapping": [ { "identity": "fhircomposition", "map": "Composition.event.code" }, { "identity": "rim", "map": ".code" }, { "identity": "xds", "map": "DocumentEntry.eventCodeList" } ] }, { "id": "DocumentReference.context.period", "path": "DocumentReference.context.period", "short": "Time period of documented service. Only 'start' expected", "definition": "The time period over which the service described by the document was provided. This represents the clinical \nrelevance timeframe, not when the document was created. Critical for understanding temporal context.\n\nExamples:\n- Discharge summary: Admission to discharge dates\n- Consultation note: Consultation appointment time\n- Progress note: Specific day of care\n- Procedure report: Surgery start to end time\n\nIf only a point in time is relevant, use 'start' only.\nFor ongoing care, 'end' may be absent.", "min": 0, "max": "1", "base": { "path": "DocumentReference.context.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "fhircomposition", "map": "Composition.event.period" }, { "identity": "rim", "map": ".effectiveTime" }, { "identity": "xds", "map": "DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime" }, { "identity": "cda", "map": "ClinicalDocument/documentationOf/\nserviceEvent/effectiveTime/low/\n@value --> ClinicalDocument/documentationOf/\nserviceEvent/effectiveTime/high/\n@value" } ] }, { "id": "DocumentReference.context.period.id", "path": "DocumentReference.context.period.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.context.period.extension", "path": "DocumentReference.context.period.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DocumentReference.context.period.start", "path": "DocumentReference.context.period.start", "short": "Starting time with inclusive boundary", "definition": "The start of the period. The boundary is inclusive.", "comment": "If the low element is missing, the meaning is that the low boundary is not known.", "min": 1, "max": "1", "base": { "path": "Period.start", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "condition": [ "per-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "DR.1" }, { "identity": "rim", "map": "./low" } ] }, { "id": "DocumentReference.context.period.end", "path": "DocumentReference.context.period.end", "short": "End time with inclusive boundary, if not ongoing", "definition": "The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.", "comment": "The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.", "min": 0, "max": "1", "base": { "path": "Period.end", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "meaningWhenMissing": "If the end of the period is missing, it means that the period is ongoing", "condition": [ "per-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "DR.2" }, { "identity": "rim", "map": "./high" } ] }, { "id": "DocumentReference.context.facilityType", "path": "DocumentReference.context.facilityType", "short": "Kind of facility where patient was seen", "definition": "The kind of facility where the patient was seen.", "min": 0, "max": "1", "base": { "path": "DocumentReference.context.facilityType", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DocumentC80FacilityType" } ], "strength": "example", "description": "XDS Facility Type.", "valueSet": "http://hl7.org/fhir/ValueSet/c80-facilitycodes" }, "mapping": [ { "identity": "fhircomposition", "map": "usually from a mapping to a local ValueSet" }, { "identity": "rim", "map": ".participation[typeCode=\"LOC\"].role[classCode=\"DSDLOC\"].code" }, { "identity": "xds", "map": "DocumentEntry.healthcareFacilityTypeCode" }, { "identity": "cda", "map": "usually a mapping to a local ValueSet. Must be consistent with /clinicalDocument/code" } ] }, { "id": "DocumentReference.context.practiceSetting", "path": "DocumentReference.context.practiceSetting", "short": "Additional details about where the content was created (e.g. clinical specialty)", "definition": "This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.", "comment": "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.", "requirements": "This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.", "min": 0, "max": "1", "base": { "path": "DocumentReference.context.practiceSetting", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DocumentC80PracticeSetting" } ], "strength": "example", "description": "Additional details about where the content was created (e.g. clinical specialty).", "valueSet": "http://hl7.org/fhir/ValueSet/c80-practice-codes" }, "mapping": [ { "identity": "fhircomposition", "map": "usually from a mapping to a local ValueSet" }, { "identity": "rim", "map": ".participation[typeCode=\"LOC\"].role[classCode=\"DSDLOC\"].code" }, { "identity": "xds", "map": "DocumentEntry.practiceSettingCode" }, { "identity": "cda", "map": "usually from a mapping to a local ValueSet" } ] }, { "id": "DocumentReference.context.sourcePatientInfo", "path": "DocumentReference.context.sourcePatientInfo", "short": "Patient demographics from source", "definition": "The Patient Information as known when the document was published. May be a reference to a version specific, or contained.", "min": 0, "max": "1", "base": { "path": "DocumentReference.context.sourcePatientInfo", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "fhircomposition", "map": "Composition.subject" }, { "identity": "rim", "map": ".participation[typeCode=\"SBJ\"].role[typeCode=\"PAT\"]" }, { "identity": "xds", "map": "DocumentEntry.sourcePatientInfo, DocumentEntry.sourcePatientId" }, { "identity": "cda", "map": "ClinicalDocument/recordTarget/" } ] }, { "id": "DocumentReference.context.related", "path": "DocumentReference.context.related", "short": "What this document was assembled from or sent with -- the packet, and its host", "definition": "Other resources this document is related to. For a rendered outbound artifact this is the BACK\nPOINTER: the attachment packet whose members it renders, and the host that packet travelled with\n(a letter's `Composition`, a referral's `ServiceRequest`).\n\nThe FORWARD link is on the host and is the one to navigate: a letter names its packet in one\n`Composition.section.entry`, a referral in `ServiceRequest.supportingInfo`. This element exists so\na reader that starts from the document can get back, not so the relationship can be discovered by\nsearch -- `related` is not a declared search parameter on this server.", "comment": "May be identifiers or resources that caused the DocumentReference or referenced Document to be created.", "min": 0, "max": "*", "base": { "path": "DocumentReference.context.related", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "fhircomposition", "map": "Composition.event.detail" }, { "identity": "rim", "map": "./outboundRelationship[typeCode=\"PERT\" and isNormalActRelationship()] / target[isNormalAct]" }, { "identity": "xds", "map": "DocumentEntry.referenceIdList" }, { "identity": "cda", "map": "ClinicalDocument/relatedDocument" } ] } ] }, "differential": { "element": [ { "id": "DocumentReference", "path": "DocumentReference", "short": "An attached document (scan, PDF, fax, Word) with its metadata and clinical context", "definition": "DocumentReference is the metadata wrapper for a document that exists as a FILE -- scanned paper,\nan incoming fax, an external consult letter received as PDF, a signed consent form. It provides\nindexing, discovery, and clinical context; the bytes themselves live in document storage and are\nreached through `content.attachment.url`.\n\nFor notes AUTHORED in this EMR, use `NexusEmrCoreComposition` instead -- narrative belongs in\nFHIR as XHTML, not as an encoded attachment. See the boundary rule at the top of this file.\n\nThe resource captures:\n- Document identification and categorization\n- Clinical context and temporal relevance\n- Authorship and authentication details\n- A pointer to the document content (and, on the way in, the content itself)\n- Relationships to other documents", "constraint": [ { "key": "attachment-has-data-or-url", "severity": "error", "human": "Each attachment must have either inline data (base64) or a url (blob storage URI), or both", "expression": "content.all(attachment.data.exists() or attachment.url.exists())", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference" }, { "key": "nexus-documentreference-subject-unless-template", "severity": "error", "human": "A DocumentReference SHALL carry a subject unless it is a form template. A template (an identifier under NamingSystem/nexus-form-template) is the tenant-wide blank of a form type and is about no patient; every other document is about one.", "expression": "subject.exists() or identifier.where(system = 'https://fhir.apps.health/NamingSystem/nexus-form-template').exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference" }, { "key": "nexus-documentreference-field-mapping-only-on-template", "severity": "error", "human": "A field mapping SHALL appear only on a form template (an identifier under NamingSystem/nexus-form-template): it names the fillable fields of the template's file that a chart value pre-fills, and a filed form carries the values themselves", "expression": "extension.where(url = 'https://fhir.apps.health/StructureDefinition/nexus-form-template-field-mapping').exists() implies identifier.where(system = 'https://fhir.apps.health/NamingSystem/nexus-form-template').exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference" } ] }, { "id": "DocumentReference.meta.source", "path": "DocumentReference.meta.source", "short": "Identifies EMR instance & pipeline version the resource came from", "definition": "A URI that identifies the EMR pipeline and version from which this resource originated. This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.", "mustSupport": true }, { "id": "DocumentReference.text", "path": "DocumentReference.text", "short": "Human-readable summary of the document reference", "definition": "A human-readable narrative that contains a summary of the document reference. This narrative should provide key information about the document for human interpretation, including document type, date, and key clinical context.", "mustSupport": true }, { "id": "DocumentReference.extension", "path": "DocumentReference.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" } }, { "id": "DocumentReference.extension:reviewed", "path": "DocumentReference.extension", "sliceName": "reviewed", "short": "Review acknowledgement, one per reviewer (absent = unreviewed)", "min": 0, "max": "*", "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-reviewed" ] } ], "mustSupport": true }, { "id": "DocumentReference.extension:statusReason", "path": "DocumentReference.extension", "sliceName": "statusReason", "short": "Free-text reason the document is superseded or entered in error (absent when current)", "definition": "Why the document is no longer `current`: what replaced a superseded document, or what made an\nentered-in-error one wrong. Written when the status changes and removed when the document is\nmade current again, so a stale reason never sits on an active document. Because the resource is\nupdated in place, each stored version keeps the reason that applied to it -- the store's version\nhistory is the audit of who changed the status, when, from what to what, and why. Optional: a\nstatus change with no reason is a complete record.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-document-status-reason" ] } ], "mustSupport": true }, { "id": "DocumentReference.extension:fieldMapping", "path": "DocumentReference.extension", "sliceName": "fieldMapping", "short": "Fillable fields a chart value pre-fills -- form templates only", "definition": "Which fillable fields of this template's file a chart value pre-fills when a form is started\nfrom it: one rule per field, naming the field as the file names it and the chart value (from\n`CodeSystem/nexus-form-chart-value`) that fills it. Present only on a form template. Absent, or\nnaming no field the file carries, the form opens blank; present, every pre-filled value stays\neditable.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-form-template-field-mapping" ] } ], "mustSupport": true }, { "id": "DocumentReference.identifier", "path": "DocumentReference.identifier", "short": "Business identifier(s) for document reference", "definition": "Unique business identifiers assigned to this document reference.", "comment": "A source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html)." }, { "id": "DocumentReference.identifier.system", "path": "DocumentReference.identifier.system", "min": 1 }, { "id": "DocumentReference.identifier.value", "path": "DocumentReference.identifier.value", "min": 1 }, { "id": "DocumentReference.status", "path": "DocumentReference.status", "short": "Where the document reference is in its lifecycle", "definition": "The status of this document reference. Allowed values:\n- current: The document is active and current\n- superseded: The document has been replaced by a newer version\n- entered-in-error: The document was created in error and should not be used (deleted)\n\nWhen a document is updated, the previous version can be marked as 'superseded' and a new DocumentReference\ncreated with status 'current'. This approach:\n- Maintains immutable document history\n- Provides clear version tracking\n- Enables audit trails\n- Supports document lifecycle management", "mustSupport": true }, { "id": "DocumentReference.type", "path": "DocumentReference.type", "short": "Precise type of document (use category instead)", "definition": "Specifies the precise type of clinical document referenced (e.g., specific LOINC code for document type). \nWhile this field is supported for backward compatibility with systems expecting it, Nexus EMR strongly \nrecommends using 'category' instead because:\n- Category supports multiple classifications per document\n- Category allows both clinical and administrative taxonomies\n- Type is limited to a single classification\n\nIf used, prefer LOINC codes for interoperability.\n\nWhere this code was mapped from a source system's own vocabulary, carry the raw coding alongside the mapped one, flagged `userSelected = true`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DocumentC80Type" } ], "strength": "extensible", "description": "LOINC document type codes", "valueSet": "http://hl7.org/fhir/ValueSet/c80-doc-typecodes" } }, { "id": "DocumentReference.type.coding", "path": "DocumentReference.type.coding", "slicing": { "discriminator": [ { "type": "pattern", "path": "system" } ], "rules": "open", "description": "Slice by code system" } }, { "id": "DocumentReference.type.coding:loinc", "path": "DocumentReference.type.coding", "sliceName": "loinc", "short": "LOINC document type code", "definition": "LOINC code for document type when available", "min": 0, "max": "1", "mustSupport": true }, { "id": "DocumentReference.type.coding:loinc.system", "path": "DocumentReference.type.coding.system", "min": 1, "fixedUri": "http://loinc.org" }, { "id": "DocumentReference.type.coding:loinc.code", "path": "DocumentReference.type.coding.code", "min": 1 }, { "id": "DocumentReference.type.text", "path": "DocumentReference.type.text", "short": "Plain text representation of document type" }, { "id": "DocumentReference.category", "path": "DocumentReference.category", "short": "Document categorization (preferred over type)", "definition": "High-level categorization of the document. This is the PREFERRED method for document classification in Nexus EMR. \nMultiple categories can be assigned to provide different perspectives on the document's purpose and content.\n\nCommon categories include:\n- Received correspondence (consult letters, discharge summaries from other institutions)\n- Scanned paper and incoming faxes\n- Diagnostic documents (lab or imaging reports delivered as files rather than as DiagnosticReport)\n- Legal and administrative documents (consent forms, advance directives, insurance forms)\n- Patient-supplied documents\n\nNote what is NOT here since the 2026-08-06 narrowing: progress notes and consultation notes\nAUTHORED in this EMR are `NexusEmrCoreComposition`, not DocumentReference. A consult note\n*received* as a PDF is still a DocumentReference -- the distinction is the form the content\narrives in, not the clinical genre.\n\nUse standard terminologies (LOINC, SNOMED CT) for maximum interoperability.", "mustSupport": true }, { "id": "DocumentReference.category.text", "path": "DocumentReference.category.text", "short": "Plain text category description", "mustSupport": true }, { "id": "DocumentReference.subject", "path": "DocumentReference.subject", "short": "The patient the document is about", "definition": "The patient that this document pertains to. Required for every document EXCEPT a form template,\nwhich is the tenant-wide blank of a form type and is about no patient; the\n`nexus-documentreference-subject-unless-template` invariant states that rule in evaluable form.\nWhen present it must reference a valid NexusEmrCorePatient resource, and the reference should use\nthe patient's identifier for reliable cross-system identification.\n\nWhile the FHIR standard allows documents about other subjects (Device, Practitioner, Group), Nexus EMR currently \nonly supports patient-centric documents to align with Canadian healthcare requirements.", "comment": "Required unless this is a form template.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" ] } ], "mustSupport": true }, { "id": "DocumentReference.date", "path": "DocumentReference.date", "short": "When DocumentReference was created (not document date)", "definition": "When this DocumentReference resource was created in the system. This is NOT necessarily when the document itself \nwas created or when the documented service occurred.\n\nTiming relationships:\n- date: When DocumentReference was created (this field)\n- content.attachment.creation: When document was created\n- context.period: When clinical service occurred\n\nExample: A discharge summary for April 10-15 admission might be:\n- Service period: 2025-04-10 to 2025-04-15\n- Document created: 2025-04-15T14:00:00\n- DocumentReference created: 2025-04-16T09:00:00 (next day upload)\n\nThis field is primarily for technical/audit purposes.", "mustSupport": true }, { "id": "DocumentReference.author", "path": "DocumentReference.author", "short": "Who wrote the document", "definition": "Identifies who was responsible for writing the document content. Can include multiple authors for collaborative \ndocuments. Note the distinction:\n- Author: Who wrote/created the content\n- Authenticator: Who legally verified/signed the document\n- Custodian: Organization maintaining the document\n\n- in EMRs, you probably want to be using 'authenticator' rather than 'author' here.\n - eg: 'author' may be a medical student, 'authenticator' could be the doc signing off.\n - 'authenticator' is the person who is medically responsible for the content of this document.\n\nAuthors can only be EMR users in this context, referenced as a **Practitioner** (the primary\nprovider identity in this IG) or as a **PractitionerRole** where the clinic/role binding is\npart of the assertion.\n\nOrder matters - list primary author first.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner" ] } ], "mustSupport": true }, { "id": "DocumentReference.authenticator", "path": "DocumentReference.authenticator", "short": "Practitioner who verified this document", "definition": "The practitioner who has legally authenticated or verified this document, taking responsibility for its content. \nThis represents medical/legal responsibility rather than authorship. The authenticator:\n- Must have appropriate authority/credentials\n- Takes responsibility for document accuracy\n- May or may not be the document author\n- Should be a single practitioner (not multiple)\n\nTypically the attending physician, consultant, or supervising practitioner.\n\nReferences a **Practitioner** -- the primary provider identity in this IG. A\n**PractitionerRole** reference is also permitted, for the cases where the clinic/role binding\nis part of what is being asserted (e.g. authentication performed in a specific role at a\nspecific organization, which Practitioner cannot express since it has no `organization`).", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner" ] } ], "mustSupport": true }, { "id": "DocumentReference.custodian", "path": "DocumentReference.custodian", "short": "Organization responsible for document maintenance", "definition": "The organization that is responsible for maintaining the authoritative source of this document and controlling \naccess to it. This is a REQUIRED field that identifies:\n- Who has stewardship of the document\n- Where to direct queries about the document\n- Who is responsible for retention policies\n- Who manages access permissions\n\nTypically the organization that created the document or currently manages the patient's care.\nMust reference a valid NexusEmrCoreOrganization resource.", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-organization" ] } ], "mustSupport": true }, { "id": "DocumentReference.description", "path": "DocumentReference.description", "short": "Human-readable description of document content", "definition": "A human-readable description of the document's content and purpose. While optional, this field is strongly \nrecommended as it:\n- Provides quick context without opening the document\n- Improves searchability and discoverability\n- Helps users identify relevant documents quickly\n- Supports accessibility requirements\n\nShould be concise but informative (typically 1-2 sentences).\n\nExamples:\n- \"Complete blood count showing mild anemia, hemoglobin 10.2\"\n- \"Cardiology consultation for chest pain, recommending stress test\"\n- \"Discharge summary following 5-day admission for pneumonia\"", "mustSupport": true }, { "id": "DocumentReference.content", "path": "DocumentReference.content", "short": "Document attachment(s) -- submitted inline, stored as files, read back by URL", "definition": "The document content and its metadata. Each content element is one attachment. Multiple\nattachments per DocumentReference are supported (a referral letter plus supporting results),\nbut most cases are a single document.\n\nTHE ROUND TRIP -- what a writer sends is not what a reader gets back.\n\nWRITING. Submit the document inline: `contentType` plus base64 in `attachment.data`, with no\n`url`. On create or update the gateway stores the bytes, then rewrites the attachment before\npersisting it: `url` is set to the stored-document address, `size` and `hash` (SHA-1) are\ncomputed and filled in, and `data` is cleared. Writers SHOULD NOT compute `size`, `hash`, or\n`url` themselves.\n\nREADING. Expect `url` and no `data`. Fetch the bytes from the URL (see `content.attachment.url`\nfor the auth contract). Consumers MUST NOT assume `data` is populated.\n\nSENDING BOTH IS A TRAP. The conversion is guarded on `url` being absent. An attachment carrying\nBOTH `data` and a `url` bypasses storage entirely and the base64 is persisted inline in the FHIR\nresource, where it will be echoed on every subsequent read. Send one or the other: `data` to\nupload new content, `url` only to reference something already stored.\n\nSTABLE URLS ACROSS UPDATES. Updating a DocumentReference reuses the existing stored-document\nidentity, so the URL does not churn when metadata changes. (Note this is DocumentReference-only\nbehaviour; `DiagnosticReport.presentedForm` runs through the same middleware but without the\nexisting-document lookup, so its attachments get a fresh URL on each update.)\n\nAt least one of `data` or `url` MUST be present per attachment (invariant\n`attachment-has-data-or-url`) -- which, given the above, means \"inline on the way in, URL on the\nway out.\"", "mustSupport": true }, { "id": "DocumentReference.content.attachment", "path": "DocumentReference.content.attachment", "short": "The document: MIME type, content (inline on write / URL on read), and file metadata", "definition": "The attachment carrying the document. Required.\n\nProvides MIME type identification, the content itself (inline base64 on write, a stored-file URL\non read -- see `content` for the round trip), a human-readable title, size, hash, and language.\n\n`size` and `hash` are populated by the gateway during storage; writers need not supply them.", "mustSupport": true }, { "id": "DocumentReference.content.attachment.contentType", "path": "DocumentReference.content.attachment.contentType", "short": "MIME type (e.g., 'application/pdf')", "definition": "MIME type identifying the document format. This is REQUIRED to ensure proper handling and display of the document. \nCommon values:\n- 'application/pdf' - PDF documents (most common)\n- 'text/plain' - Plain text documents\n- 'text/html' - HTML formatted documents\n- 'text/rtf' - Rich text format\n- 'image/jpeg' - JPEG images (scanned documents)\n- 'image/png' - PNG images\n- 'application/msword' - Microsoft Word\n- 'application/vnd.openxmlformats-officedocument.wordprocessingml.document' - Word DOCX\n\nThe MIME type must accurately reflect the actual content format.", "min": 1, "mustSupport": true }, { "id": "DocumentReference.content.attachment.language", "path": "DocumentReference.content.attachment.language", "short": "Language of document content", "definition": "BCP-47 language tag indicating the human language of the document content. Important for:\n- Multilingual healthcare settings\n- Accessibility requirements\n- Content filtering/searching\n- Translation workflows\n\nCommon values:\n- 'en-CA' - Canadian English\n- 'fr-CA' - Canadian French\n- 'en' - English (generic)\n- 'fr' - French (generic)\n- 'es' - Spanish\n\nExample: A discharge summary in French would have language = 'fr-CA'" }, { "id": "DocumentReference.content.attachment.data", "path": "DocumentReference.content.attachment.data", "short": "Base64 document content -- the UPLOAD channel; normally absent on read", "definition": "The document content as base64-encoded binary. This is the upload channel: populate it (with no\n`url`) to submit a new document.\n\nNORMALLY ABSENT ON READ. The gateway clears `data` once the bytes are stored, so a reader gets\n`url` instead. Consumers MUST NOT assume this element is populated, and MUST NOT treat its\nabsence as an empty document.\n\nDo not send `data` and `url` together -- see `content`. That combination skips storage and\npersists the base64 inline permanently.\n\nImplementation notes:\n- Line breaks in the base64 string should be avoided; standard alphabet (A-Z, a-z, 0-9, +, /).\n- Large documents: no explicit size threshold is enforced by the gateway, and the whole body is\n buffered in memory during conversion. Very large inline submissions are a practical risk\n (request-body limits and memory), not a specified one -- prefer keeping documents modest and\n raise it with the platform team rather than assuming a limit exists.\n\nExample encoding (JavaScript):\n```javascript\nconst base64Data = Buffer.from(fileContent).toString('base64');\n```\n\nExample encoding (Python):\n```python\nimport base64\nbase64_data = base64.b64encode(file_content).decode('utf-8')\n```", "mustSupport": true }, { "id": "DocumentReference.content.attachment.url", "path": "DocumentReference.content.attachment.url", "short": "Absolute URL to the stored document -- the READ channel; set by the gateway", "definition": "Where the document bytes can be fetched. This is the read channel, and for gateway-ingested\ndocuments it is written BY the gateway during storage -- clients uploading new content should\nleave it empty and send `data`.\n\nSHAPE. An absolute URL served by the platform's File Storage Service:\n\n https://{host}/fss/api/v1/file/{documentId}\n\nThis is NOT a FHIR `Binary` reference (this platform implements no `Binary` endpoint), and NOT\na pre-signed or SAS blob URL. It is a normal API endpoint.\n\nFETCHING IT. The URL is not self-authorizing. Retrieval requires the caller's own credentials:\na bearer token carrying the file-read permission, and the request resolves within the caller's\ntenant -- a document belonging to another tenant is not found, regardless of the identifier. A\nclient that treats this like a public or signed download link will get a 401, not a document.\nReads are audited.\n\nSTABILITY. The URL is permanent for the life of the document -- no expiry, no rotation -- and\nsurvives updates to the DocumentReference (the gateway reuses the stored-document identity).\nIt may therefore be cached and stored.\n\nSUPPLYING A URL YOURSELF. Permitted, for referencing content already held by the platform, but\nvalidated: the host must be trusted, and an untrusted host is rejected with a 400 and an\nOperationOutcome directing you to upload via `data` instead. Do not point this element at\narbitrary external systems -- content that lives outside the platform should be ingested, not\nlinked." }, { "id": "DocumentReference.content.attachment.title", "path": "DocumentReference.content.attachment.title", "short": "Document title for display", "definition": "Human-readable title for the document. While optional, this field is strongly recommended for user experience. \nThe title should be:\n- Descriptive and meaningful\n- Suitable for display in document lists\n- Include relevant context (e.g., date, type)\n- 50-100 characters typically\n\nExamples:\n- \"Discharge Summary - April 15, 2025\"\n- \"CBC Results - Hemoglobin 10.2\"\n- \"Cardiology Referral - Dr. Smith\"\n- \"Chest X-Ray Report - Normal\"", "mustSupport": true }, { "id": "DocumentReference.content.attachment.creation", "path": "DocumentReference.content.attachment.creation", "short": "Date/time document was created", "definition": "The date/time when the document was originally created (not when the DocumentReference was created). \nUseful for:\n- Distinguishing between multiple versions\n- Understanding document timeline\n- Sorting documents chronologically\n- Audit trail purposes\n\nFormat: FHIR dateTime (e.g., \"2025-04-20T10:00:00-06:00\")" }, { "id": "DocumentReference.context.encounter", "path": "DocumentReference.context.encounter", "short": "Related clinical encounter(s)", "definition": "Encounter(s) related to the document content. Links the document to specific clinical visits, admissions, or \nother healthcare interactions. Multiple encounters can be referenced if the document spans multiple visits.\n\nExamples:\n- Discharge summary → Inpatient admission encounter\n- Consultation note → Outpatient consultation encounter\n- Operative report → Surgical encounter\n- Progress note → Daily hospital round encounter\n\nProviding encounter context enables:\n- Grouping documents by visit\n- Understanding care continuity\n- Encounter-based searches\n- Billing/administrative workflows", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-encounter" ] } ], "mustSupport": true }, { "id": "DocumentReference.context.period", "path": "DocumentReference.context.period", "short": "Time period of documented service. Only 'start' expected", "definition": "The time period over which the service described by the document was provided. This represents the clinical \nrelevance timeframe, not when the document was created. Critical for understanding temporal context.\n\nExamples:\n- Discharge summary: Admission to discharge dates\n- Consultation note: Consultation appointment time\n- Progress note: Specific day of care\n- Procedure report: Surgery start to end time\n\nIf only a point in time is relevant, use 'start' only.\nFor ongoing care, 'end' may be absent.", "mustSupport": true }, { "id": "DocumentReference.context.period.start", "path": "DocumentReference.context.period.start", "min": 1, "mustSupport": true }, { "id": "DocumentReference.context.related", "path": "DocumentReference.context.related", "short": "What this document was assembled from or sent with -- the packet, and its host", "definition": "Other resources this document is related to. For a rendered outbound artifact this is the BACK\nPOINTER: the attachment packet whose members it renders, and the host that packet travelled with\n(a letter's `Composition`, a referral's `ServiceRequest`).\n\nThe FORWARD link is on the host and is the one to navigate: a letter names its packet in one\n`Composition.section.entry`, a referral in `ServiceRequest.supportingInfo`. This element exists so\na reader that starts from the document can get back, not so the relationship can be discovered by\nsearch -- `related` is not a declared search parameter on this server.", "mustSupport": true } ] } }