This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

2.42 Resource DocumentReference - Content

Structured Documents

Work Group

Maturity Level: 3

Trial Use

Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

A reference to a document.

2.42.1 Scope and Usage

A DocumentReference resource is used to describe a document that is made available to a healthcare system. A document is some sequence of bytes that is identifiable, establishes its own context (e.g., what subject, author, etc. can be displayed to the user), and has defined update management. The DocumentReference resource can be used with any document format that has a recognized mime type and that conforms to this definition.

Typically, DocumentReference resources are used in document indexing systems, such as IHE XDS , and are used to refer to:

CDA documents in FHIR systems
FHIR documents stored elsewhere (i.e. registry/repository following the XDS model)
PDF documents , and even digital records of faxes where sufficient information is available
Other kinds of documents, such as records of prescriptions

2.42.2 Boundaries and Relationships

FHIR defines both a document format and this document reference. FHIR documents are for documents that are authored and assembled in FHIR. This resource is mainly intended for general references to other documents.

The document that is a target of the reference can be a reference to a FHIR document served by another server, or the target can be stored in the special FHIR Binary Resource, or the target can be stored on some other server system. The document reference is also able to address documents that are retrieved by a service call such as an XDS.b RetrieveDocumentSet, or a DICOM exchange, or an HL7 v2 message query - though the way each of these service calls works must be specified in some external standard or other documentation.

A DocumentReference describes some other document. This means that there are two sets of provenance information relevant here: the provenance of the document, and the provenance of the document reference. Sometimes, the provenance information is closely related, as when the document producer also produces the document reference, but in other workflows, the document reference is generated later by other actors. In the DocumentReference resource, the meta content refers to the provenance of the reference itself, while the content described below concerns the document it references. Like all resources, there is overlap between the information in the resource directly, and in the general Provenance resource. This is discussed as part of the description of the Provenance resource.

This resource is referenced by AdverseEvent, Consent and Contract

Structure

Name	Flags	Card.	Type	Description & Constraints
DocumentReference			DomainResource	A reference to a document Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
identifier	Σ	0..*	Identifier	Other identifiers for the document
status	?!Σ	1..1	code	current \| superseded \| entered-in-error DocumentReferenceStatus (Required)
docStatus	Σ	0..1	code	preliminary \| final \| appended \| amended \| entered-in-error CompositionStatus (Required)
type	Σ	1..1	CodeableConcept	Kind of document (LOINC if possible) Document Type Value Set (Preferred)
class	Σ	0..1	CodeableConcept	Categorization of document Document Class Value Set (Example)
subject	Σ	0..1	Reference(Patient \| Practitioner \| Group \| Device)	Who/what is the subject of the document
created	Σ	0..1	dateTime	Document creation time
indexed	Σ	1..1	instant	When this document reference was created
author	Σ	0..*	Reference(Practitioner \| Organization \| Device \| Patient \| RelatedPerson)	Who and/or what authored the document
authenticator	Σ	0..1	Reference(Practitioner \| Organization)	Who/what authenticated the document
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the document
relatesTo	?!Σ	0..*	BackboneElement	Relationships to other documents
code	Σ	1..1	code	replaces \| transforms \| signs \| appends DocumentRelationshipType (Required)
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	string	Human-readable description (title)
securityLabel	Σ	0..*	CodeableConcept	Document security-tags All Security Labels (Extensible)
content	Σ	1..*	BackboneElement	Document referenced
attachment	Σ	1..1	Attachment	Where to access the document
format	Σ	0..1	Coding	Format/content rules for the document DocumentReference Format Code Set (Preferred)
context	Σ	0..1	BackboneElement	Clinical context of document
encounter	Σ	0..1	Reference(Encounter)	Context of the document content
event	Σ	0..*	CodeableConcept	Main clinical acts documented v3 Code System ActCode (Example)
period	Σ	0..1	Period	Time of service that is being documented
facilityType	Σ	0..1	CodeableConcept	Kind of facility where patient was seen Facility Type Code Value Set (Example)
practiceSetting	Σ	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Practice Setting Code Value Set (Example)
sourcePatientInfo	Σ	0..1	Reference(Patient)	Patient demographics from source
related	Σ	0..*	BackboneElement	Related identifiers or resources
identifier	Σ	0..1	Identifier	Identifier of related objects or events
ref	Σ	0..1	Reference(Any)	Related Resource
Documentation for this format

UML Diagram (Legend)

XML Template

<DocumentReference xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <masterIdentifier><!-- 0..1 Identifier Master Version Specific Identifier --></masterIdentifier>
 <identifier><!-- 0..* Identifier Other identifiers for the document --></identifier>
 <status value="[code]"/><!-- 1..1 current | superseded | entered-in-error -->
 <docStatus value="[code]"/><!-- 0..1 preliminary | final | appended | amended | entered-in-error -->
 <type><!-- 1..1 CodeableConcept Kind of document (LOINC if possible) --></type>
 <class><!-- 0..1 CodeableConcept Categorization of document --></class>
 <subject><!-- 0..1 Reference(Patient|Practitioner|Group|Device) Who/what is the subject of the document --></subject>
 <created value="[dateTime]"/><!-- 0..1 Document creation time -->
 <indexed value="[instant]"/><!-- 1..1 When this document reference was created -->
 <author><!-- 0..* Reference(Practitioner|Organization|Device|Patient|
   RelatedPerson) Who and/or what authored the document --></author>
 <authenticator><!-- 0..1 Reference(Practitioner|Organization) Who/what authenticated the document --></authenticator>
 <custodian><!-- 0..1 Reference(Organization) Organization which maintains the document --></custodian>
 <relatesTo>  <!-- 0..* Relationships to other documents -->
  <code value="[code]"/><!-- 1..1 replaces | transforms | signs | appends -->
  <target><!-- 1..1 Reference(DocumentReference) Target of the relationship --></target>
 </relatesTo>
 <description value="[string]"/><!-- 0..1 Human-readable description (title) -->
 <securityLabel><!-- 0..* CodeableConcept Document security-tags --></securityLabel>
 <content>  <!-- 1..* Document referenced -->
  <attachment><!-- 1..1 Attachment Where to access the document --></attachment>
  <format><!-- 0..1 Coding Format/content rules for the document --></format>
 </content>
 <context>  <!-- 0..1 Clinical context of document -->
  <encounter><!-- 0..1 Reference(Encounter) Context of the document  content --></encounter>
  <event><!-- 0..* CodeableConcept Main clinical acts documented --></event>
  <period><!-- 0..1 Period Time of service that is being documented --></period>
  <facilityType><!-- 0..1 CodeableConcept Kind of facility where patient was seen --></facilityType>
  <practiceSetting><!-- 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty) --></practiceSetting>
  <sourcePatientInfo><!-- 0..1 Reference(Patient) Patient demographics from source --></sourcePatientInfo>
  <related>  <!-- 0..* Related identifiers or resources -->
   <identifier><!-- 0..1 Identifier Identifier of related objects or events --></identifier>
   <ref><!-- 0..1 Reference(Any) Related Resource --></ref>
  </related>
 </context>
</DocumentReference>

JSON Template

{
  "resourceType" : "DocumentReference",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "masterIdentifier" : { Identifier }, // Master Version Specific Identifier
  "identifier" : [{ Identifier }], // Other identifiers for the document
  "status" : "<code>", // R!  current | superseded | entered-in-error
  "docStatus" : "<code>", // preliminary | final | appended | amended | entered-in-error
  "type" : { CodeableConcept }, // R!  Kind of document (LOINC if possible)
  "class" : { CodeableConcept }, // Categorization of document
  "subject" : { Reference(Patient|Practitioner|Group|Device) }, // Who/what is the subject of the document
  "created" : "<dateTime>", // Document creation time
  "indexed" : "<instant>", // R!  When this document reference was created
  "author" : [{ Reference(Practitioner|Organization|Device|Patient|
   RelatedPerson) }], // Who and/or what authored the document
  "authenticator" : { Reference(Practitioner|Organization) }, // Who/what authenticated the document
  "custodian" : { Reference(Organization) }, // Organization which maintains the document
  "relatesTo" : [{ // Relationships to other documents
    "code" : "<code>", // R!  replaces | transforms | signs | appends
    "target" : { Reference(DocumentReference) } // R!  Target of the relationship
  }],
  "description" : "<string>", // Human-readable description (title)
  "securityLabel" : [{ CodeableConcept }], // Document security-tags
  "content" : [{ // R!  Document referenced
    "attachment" : { Attachment }, // R!  Where to access the document
    "format" : { Coding } // Format/content rules for the document
  }],
  "context" : { // Clinical context of document
    "encounter" : { Reference(Encounter) }, // Context of the document  content
    "event" : [{ CodeableConcept }], // Main clinical acts documented
    "period" : { Period }, // Time of service that is being documented
    "facilityType" : { CodeableConcept }, // Kind of facility where patient was seen
    "practiceSetting" : { CodeableConcept }, // Additional details about where the content was created (e.g. clinical specialty)
    "sourcePatientInfo" : { Reference(Patient) }, // Patient demographics from source
    "related" : [{ // Related identifiers or resources
      "identifier" : { Identifier }, // Identifier of related objects or events
      "ref" : { Reference(Any) } // Related Resource
    }]
  }
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:DocumentReference;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:DocumentReference.masterIdentifier [ Identifier ]; # 0..1 Master Version Specific Identifier
  fhir:DocumentReference.identifier [ Identifier ], ... ; # 0..* Other identifiers for the document
  fhir:DocumentReference.status [ code ]; # 1..1 current | superseded | entered-in-error
  fhir:DocumentReference.docStatus [ code ]; # 0..1 preliminary | final | appended | amended | entered-in-error
  fhir:DocumentReference.type [ CodeableConcept ]; # 1..1 Kind of document (LOINC if possible)
  fhir:DocumentReference.class [ CodeableConcept ]; # 0..1 Categorization of document
  fhir:DocumentReference.subject [ Reference(Patient|Practitioner|Group|Device) ]; # 0..1 Who/what is the subject of the document
  fhir:DocumentReference.created [ dateTime ]; # 0..1 Document creation time
  fhir:DocumentReference.indexed [ instant ]; # 1..1 When this document reference was created
  fhir:DocumentReference.author [ Reference(Practitioner|Organization|Device|Patient|RelatedPerson) ], ... ; # 0..* Who and/or what authored the document
  fhir:DocumentReference.authenticator [ Reference(Practitioner|Organization) ]; # 0..1 Who/what authenticated the document
  fhir:DocumentReference.custodian [ Reference(Organization) ]; # 0..1 Organization which maintains the document
  fhir:DocumentReference.relatesTo [ # 0..* Relationships to other documents
    fhir:DocumentReference.relatesTo.code [ code ]; # 1..1 replaces | transforms | signs | appends
    fhir:DocumentReference.relatesTo.target [ Reference(DocumentReference) ]; # 1..1 Target of the relationship
  ], ...;
  fhir:DocumentReference.description [ string ]; # 0..1 Human-readable description (title)
  fhir:DocumentReference.securityLabel [ CodeableConcept ], ... ; # 0..* Document security-tags
  fhir:DocumentReference.content [ # 1..* Document referenced
    fhir:DocumentReference.content.attachment [ Attachment ]; # 1..1 Where to access the document
    fhir:DocumentReference.content.format [ Coding ]; # 0..1 Format/content rules for the document
  ], ...;
  fhir:DocumentReference.context [ # 0..1 Clinical context of document
    fhir:DocumentReference.context.encounter [ Reference(Encounter) ]; # 0..1 Context of the document  content
    fhir:DocumentReference.context.event [ CodeableConcept ], ... ; # 0..* Main clinical acts documented
    fhir:DocumentReference.context.period [ Period ]; # 0..1 Time of service that is being documented
    fhir:DocumentReference.context.facilityType [ CodeableConcept ]; # 0..1 Kind of facility where patient was seen
    fhir:DocumentReference.context.practiceSetting [ CodeableConcept ]; # 0..1 Additional details about where the content was created (e.g. clinical specialty)
    fhir:DocumentReference.context.sourcePatientInfo [ Reference(Patient) ]; # 0..1 Patient demographics from source
    fhir:DocumentReference.context.related [ # 0..* Related identifiers or resources
      fhir:DocumentReference.context.related.identifier [ Identifier ]; # 0..1 Identifier of related objects or events
      fhir:DocumentReference.context.related.ref [ Reference(Any) ]; # 0..1 Related Resource
    ], ...;
  ];
]

Changes since DSTU2

DocumentReference

DocumentReference.docStatus

Type changed from CodeableConcept to code

DocumentReference.content.format

Max Cardinality changed from * to 1

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and all r3 resources are valid.).

Structure

Name	Flags	Card.	Type	Description & Constraints
DocumentReference			DomainResource	A reference to a document Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
identifier	Σ	0..*	Identifier	Other identifiers for the document
status	?!Σ	1..1	code	current \| superseded \| entered-in-error DocumentReferenceStatus (Required)
docStatus	Σ	0..1	code	preliminary \| final \| appended \| amended \| entered-in-error CompositionStatus (Required)
type	Σ	1..1	CodeableConcept	Kind of document (LOINC if possible) Document Type Value Set (Preferred)
class	Σ	0..1	CodeableConcept	Categorization of document Document Class Value Set (Example)
subject	Σ	0..1	Reference(Patient \| Practitioner \| Group \| Device)	Who/what is the subject of the document
created	Σ	0..1	dateTime	Document creation time
indexed	Σ	1..1	instant	When this document reference was created
author	Σ	0..*	Reference(Practitioner \| Organization \| Device \| Patient \| RelatedPerson)	Who and/or what authored the document
authenticator	Σ	0..1	Reference(Practitioner \| Organization)	Who/what authenticated the document
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the document
relatesTo	?!Σ	0..*	BackboneElement	Relationships to other documents
code	Σ	1..1	code	replaces \| transforms \| signs \| appends DocumentRelationshipType (Required)
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	string	Human-readable description (title)
securityLabel	Σ	0..*	CodeableConcept	Document security-tags All Security Labels (Extensible)
content	Σ	1..*	BackboneElement	Document referenced
attachment	Σ	1..1	Attachment	Where to access the document
format	Σ	0..1	Coding	Format/content rules for the document DocumentReference Format Code Set (Preferred)
context	Σ	0..1	BackboneElement	Clinical context of document
encounter	Σ	0..1	Reference(Encounter)	Context of the document content
event	Σ	0..*	CodeableConcept	Main clinical acts documented v3 Code System ActCode (Example)
period	Σ	0..1	Period	Time of service that is being documented
facilityType	Σ	0..1	CodeableConcept	Kind of facility where patient was seen Facility Type Code Value Set (Example)
practiceSetting	Σ	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Practice Setting Code Value Set (Example)
sourcePatientInfo	Σ	0..1	Reference(Patient)	Patient demographics from source
related	Σ	0..*	BackboneElement	Related identifiers or resources
identifier	Σ	0..1	Identifier	Identifier of related objects or events
ref	Σ	0..1	Reference(Any)	Related Resource
Documentation for this format

UML Diagram (Legend)

XML Template

<DocumentReference xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <masterIdentifier><!-- 0..1 Identifier Master Version Specific Identifier --></masterIdentifier>
 <identifier><!-- 0..* Identifier Other identifiers for the document --></identifier>
 <status value="[code]"/><!-- 1..1 current | superseded | entered-in-error -->
 <docStatus value="[code]"/><!-- 0..1 preliminary | final | appended | amended | entered-in-error -->
 <type><!-- 1..1 CodeableConcept Kind of document (LOINC if possible) --></type>
 <class><!-- 0..1 CodeableConcept Categorization of document --></class>
 <subject><!-- 0..1 Reference(Patient|Practitioner|Group|Device) Who/what is the subject of the document --></subject>
 <created value="[dateTime]"/><!-- 0..1 Document creation time -->
 <indexed value="[instant]"/><!-- 1..1 When this document reference was created -->
 <author><!-- 0..* Reference(Practitioner|Organization|Device|Patient|
   RelatedPerson) Who and/or what authored the document --></author>
 <authenticator><!-- 0..1 Reference(Practitioner|Organization) Who/what authenticated the document --></authenticator>
 <custodian><!-- 0..1 Reference(Organization) Organization which maintains the document --></custodian>
 <relatesTo>  <!-- 0..* Relationships to other documents -->
  <code value="[code]"/><!-- 1..1 replaces | transforms | signs | appends -->
  <target><!-- 1..1 Reference(DocumentReference) Target of the relationship --></target>
 </relatesTo>
 <description value="[string]"/><!-- 0..1 Human-readable description (title) -->
 <securityLabel><!-- 0..* CodeableConcept Document security-tags --></securityLabel>
 <content>  <!-- 1..* Document referenced -->
  <attachment><!-- 1..1 Attachment Where to access the document --></attachment>
  <format><!-- 0..1 Coding Format/content rules for the document --></format>
 </content>
 <context>  <!-- 0..1 Clinical context of document -->
  <encounter><!-- 0..1 Reference(Encounter) Context of the document  content --></encounter>
  <event><!-- 0..* CodeableConcept Main clinical acts documented --></event>
  <period><!-- 0..1 Period Time of service that is being documented --></period>
  <facilityType><!-- 0..1 CodeableConcept Kind of facility where patient was seen --></facilityType>
  <practiceSetting><!-- 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty) --></practiceSetting>
  <sourcePatientInfo><!-- 0..1 Reference(Patient) Patient demographics from source --></sourcePatientInfo>
  <related>  <!-- 0..* Related identifiers or resources -->
   <identifier><!-- 0..1 Identifier Identifier of related objects or events --></identifier>
   <ref><!-- 0..1 Reference(Any) Related Resource --></ref>
  </related>
 </context>
</DocumentReference>

JSON Template

{
  "resourceType" : "DocumentReference",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "masterIdentifier" : { Identifier }, // Master Version Specific Identifier
  "identifier" : [{ Identifier }], // Other identifiers for the document
  "status" : "<code>", // R!  current | superseded | entered-in-error
  "docStatus" : "<code>", // preliminary | final | appended | amended | entered-in-error
  "type" : { CodeableConcept }, // R!  Kind of document (LOINC if possible)
  "class" : { CodeableConcept }, // Categorization of document
  "subject" : { Reference(Patient|Practitioner|Group|Device) }, // Who/what is the subject of the document
  "created" : "<dateTime>", // Document creation time
  "indexed" : "<instant>", // R!  When this document reference was created
  "author" : [{ Reference(Practitioner|Organization|Device|Patient|
   RelatedPerson) }], // Who and/or what authored the document
  "authenticator" : { Reference(Practitioner|Organization) }, // Who/what authenticated the document
  "custodian" : { Reference(Organization) }, // Organization which maintains the document
  "relatesTo" : [{ // Relationships to other documents
    "code" : "<code>", // R!  replaces | transforms | signs | appends
    "target" : { Reference(DocumentReference) } // R!  Target of the relationship
  }],
  "description" : "<string>", // Human-readable description (title)
  "securityLabel" : [{ CodeableConcept }], // Document security-tags
  "content" : [{ // R!  Document referenced
    "attachment" : { Attachment }, // R!  Where to access the document
    "format" : { Coding } // Format/content rules for the document
  }],
  "context" : { // Clinical context of document
    "encounter" : { Reference(Encounter) }, // Context of the document  content
    "event" : [{ CodeableConcept }], // Main clinical acts documented
    "period" : { Period }, // Time of service that is being documented
    "facilityType" : { CodeableConcept }, // Kind of facility where patient was seen
    "practiceSetting" : { CodeableConcept }, // Additional details about where the content was created (e.g. clinical specialty)
    "sourcePatientInfo" : { Reference(Patient) }, // Patient demographics from source
    "related" : [{ // Related identifiers or resources
      "identifier" : { Identifier }, // Identifier of related objects or events
      "ref" : { Reference(Any) } // Related Resource
    }]
  }
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:DocumentReference;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:DocumentReference.masterIdentifier [ Identifier ]; # 0..1 Master Version Specific Identifier
  fhir:DocumentReference.identifier [ Identifier ], ... ; # 0..* Other identifiers for the document
  fhir:DocumentReference.status [ code ]; # 1..1 current | superseded | entered-in-error
  fhir:DocumentReference.docStatus [ code ]; # 0..1 preliminary | final | appended | amended | entered-in-error
  fhir:DocumentReference.type [ CodeableConcept ]; # 1..1 Kind of document (LOINC if possible)
  fhir:DocumentReference.class [ CodeableConcept ]; # 0..1 Categorization of document
  fhir:DocumentReference.subject [ Reference(Patient|Practitioner|Group|Device) ]; # 0..1 Who/what is the subject of the document
  fhir:DocumentReference.created [ dateTime ]; # 0..1 Document creation time
  fhir:DocumentReference.indexed [ instant ]; # 1..1 When this document reference was created
  fhir:DocumentReference.author [ Reference(Practitioner|Organization|Device|Patient|RelatedPerson) ], ... ; # 0..* Who and/or what authored the document
  fhir:DocumentReference.authenticator [ Reference(Practitioner|Organization) ]; # 0..1 Who/what authenticated the document
  fhir:DocumentReference.custodian [ Reference(Organization) ]; # 0..1 Organization which maintains the document
  fhir:DocumentReference.relatesTo [ # 0..* Relationships to other documents
    fhir:DocumentReference.relatesTo.code [ code ]; # 1..1 replaces | transforms | signs | appends
    fhir:DocumentReference.relatesTo.target [ Reference(DocumentReference) ]; # 1..1 Target of the relationship
  ], ...;
  fhir:DocumentReference.description [ string ]; # 0..1 Human-readable description (title)
  fhir:DocumentReference.securityLabel [ CodeableConcept ], ... ; # 0..* Document security-tags
  fhir:DocumentReference.content [ # 1..* Document referenced
    fhir:DocumentReference.content.attachment [ Attachment ]; # 1..1 Where to access the document
    fhir:DocumentReference.content.format [ Coding ]; # 0..1 Format/content rules for the document
  ], ...;
  fhir:DocumentReference.context [ # 0..1 Clinical context of document
    fhir:DocumentReference.context.encounter [ Reference(Encounter) ]; # 0..1 Context of the document  content
    fhir:DocumentReference.context.event [ CodeableConcept ], ... ; # 0..* Main clinical acts documented
    fhir:DocumentReference.context.period [ Period ]; # 0..1 Time of service that is being documented
    fhir:DocumentReference.context.facilityType [ CodeableConcept ]; # 0..1 Kind of facility where patient was seen
    fhir:DocumentReference.context.practiceSetting [ CodeableConcept ]; # 0..1 Additional details about where the content was created (e.g. clinical specialty)
    fhir:DocumentReference.context.sourcePatientInfo [ Reference(Patient) ]; # 0..1 Patient demographics from source
    fhir:DocumentReference.context.related [ # 0..* Related identifiers or resources
      fhir:DocumentReference.context.related.identifier [ Identifier ]; # 0..1 Identifier of related objects or events
      fhir:DocumentReference.context.related.ref [ Reference(Any) ]; # 0..1 Related Resource
    ], ...;
  ];
]

Changes since DSTU2

DocumentReference

DocumentReference.docStatus

Type changed from CodeableConcept to code

DocumentReference.content.format

Max Cardinality changed from * to 1

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and all r3 resources are valid.).

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

2.42.3.1 Terminology Bindings

Path	Definition	Type	Reference
DocumentReference.status	The status of the document reference.	Required	DocumentReferenceStatus
DocumentReference.docStatus	Status of the underlying document.	Required	CompositionStatus
DocumentReference.type	Precise type of clinical document.	Preferred	Document Type Value Set
DocumentReference.class	High-level kind of a clinical document at a macro level.	Example	Document Class Value Set
DocumentReference.relatesTo.code	The type of relationship between documents.	Required	DocumentRelationshipType
DocumentReference.securityLabel	Security Labels from the Healthcare Privacy and Security Classification System.	Extensible	All Security Labels
DocumentReference.content.format	Document Format Codes.	Preferred	DocumentReference Format Code Set
DocumentReference.context.event	This list of codes represents the main clinical acts being documented.	Example	v3 Code System ActCode
DocumentReference.context.facilityType	XDS Facility Type.	Example	Facility Type Code Value Set
DocumentReference.context.practiceSetting	Additional details about where the content was created (e.g. clinical specialty).	Example	Practice Setting Code Value Set

Path

Definition

Type

Reference

DocumentReference.status

The status of the document reference.

Required

DocumentReferenceStatus

DocumentReference.docStatus

Status of the underlying document.

Required

CompositionStatus

DocumentReference.type

Precise type of clinical document.

Preferred

Document Type Value Set

DocumentReference.class

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

Example

Document Class Value Set

DocumentReference.relatesTo.code

The type of relationship between documents.

Required

DocumentRelationshipType

DocumentReference.securityLabel

Security Labels from the Healthcare Privacy and Security Classification System.

Extensible

All Security Labels

DocumentReference.content.format

Document Format Codes.

Preferred

DocumentReference Format Code Set

DocumentReference.context.event

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

Example

v3 Code System ActCode

DocumentReference.context.facilityType

XDS Facility Type.

Example

Facility Type Code Value Set

DocumentReference.context.practiceSetting

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

Example

Practice Setting Code Value Set

2.42.4 Implementation Notes

The use of the .docStatus codes is discussed in the Composition description
The resources maintain one way relationships that point backwards - e.g., the document that replaces one document points towards the document that it replaced. The reverse relationships can be followed by using indexes built from the resources. Typically, this is done using the search parameters described below. Given that documents may have other documents that replace or append them, clients should always check these relationships when accessing documents

2.42.4.1 Generating a Document Reference

A client can ask a server to generate a document reference from a document. The server reads the existing document and generates a matching DocumentReference resource, or returns one it has previously generated. Servers may be able to return or generate document references for the following types of content:

Type

Comments

FHIR Documents

The uri refers to an existing Document

CDA

Document

The uri is a reference to a Binary end-point that returns either a CDA document, or some kind of CDA Package that the server knows how to process (e.g., an IHE .zip)

Other

The server can be asked to generate a document reference for other kinds of documents. For some of these documents (e.g., PDF documents) a server could only provide a document reference if it already existed or the server had special knowledge of the document.

The server either returns a search result containing a single document reference, or it returns an error. If the URI refers to another server, it is at the discretion of the server whether to retrieve it or return an error.

The operation is initiated by a named query, using _query=generate on the /DocumentReference end-point:

  GET [service-url]/DocumentReference/?_query=generate&uri=:url&...

The "uri" parameter is a relative or absolute reference to one of the document types described above. Other parameters may be supplied:

Name

Meaning

persist

Whether to store the document at the document end-point (/Document) or not, once it is generated. Value = true or false (default is for the server to decide).

2.42.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Expression	In Common
authenticator	reference	Who/what authenticated the document	DocumentReference.authenticator (Practitioner, Organization)
author	reference	Who and/or what authored the document	DocumentReference.author (Practitioner, Organization, Device, Patient, RelatedPerson)
class	token	Categorization of document	DocumentReference.class
created	date	Document creation time	DocumentReference.created
custodian	reference	Organization which maintains the document	DocumentReference.custodian (Organization)
description	string	Human-readable description (title)	DocumentReference.description
encounter	reference	Context of the document content	DocumentReference.context.encounter (Encounter)	12 Resources
event	token	Main clinical acts documented	DocumentReference.context.event
facility	token	Kind of facility where patient was seen	DocumentReference.context.facilityType
format	token	Format/content rules for the document	DocumentReference.content.format
identifier	token	Master Version Specific Identifier	DocumentReference.masterIdentifier \| DocumentReference.identifier	26 Resources
indexed	date	When this document reference was created	DocumentReference.indexed
language	token	Human language of the content (BCP-47)	DocumentReference.content.attachment.language
location	uri	Uri where the data can be found	DocumentReference.content.attachment.url
patient	reference	Who/what is the subject of the document	DocumentReference.subject (Patient)	31 Resources
period	date	Time of service that is being documented	DocumentReference.context.period
related-id	token	Identifier of related objects or events	DocumentReference.context.related.identifier
related-ref	reference	Related Resource	DocumentReference.context.related.ref (Any)
relatesto	reference	Target of the relationship	DocumentReference.relatesTo.target (DocumentReference)
relation	token	replaces \| transforms \| signs \| appends	DocumentReference.relatesTo.code
relationship	composite	Combination of relation and relatesTo	DocumentReference.relatesTo
securitylabel	token	Document security-tags	DocumentReference.securityLabel
setting	token	Additional details about where the content was created (e.g. clinical specialty)	DocumentReference.context.practiceSetting
status	token	current \| superseded \| entered-in-error	DocumentReference.status
subject	reference	Who/what is the subject of the document	DocumentReference.subject (Practitioner, Group, Device, Patient)
type	token	Kind of document (LOINC if possible)	DocumentReference.type	6 Resources