Implementation Guide
ePA MHD Service
Version 1.1.0 - release

## Resource Profile: EPAMHDDocumentReference - Detailed Descriptions

Active as of 2025-12-15

Definitions for the epa-mhd-document-reference resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

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

0. DocumentReference
Definition | A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.
Short | A reference to a document
Comments | Usually, this is used for documents other than those defined by FHIR.
Control | 0..*
Is Modifier | false
Summary | false
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (`contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. DocumentReference.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. DocumentReference.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..0* This element is affected by the following invariants: ele-1
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `DocumentReference.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
6. DocumentReference.masterIdentifier
Definition | An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. 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.
Short | An identifier intended for computationMaster Version Specific Identifier
Comments | CDA Document Id extension and root.
Control | 10..1 This element is affected by the following invariants: ele-1
Type | Identifier(uniqueId Identifier)
Is Modifier | false
Summary | true
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.).
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. DocumentReference.identifier
Definition | Other identifiers associated with the document, including version independent identifiers.
Short | Other identifiers for the document
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..* This element is affected by the following invariants: ele-1
Type | Identifier
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
Slicing | This element introduces a set of slices on `DocumentReference.identifier`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ use
10. DocumentReference.identifier:entryUUID
Slice Name | entryUUID
Definition | An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Other identifiers associated with the document, including version independent identifiers.
Short | An identifier intended for computationOther identifiers for the document
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..* This element is affected by the following invariants: ele-1
Type | Identifier(entryUUID Identifier)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. DocumentReference.status
Definition | Status des Dokuments (DocumentEntry.availabilityStatus) unter Berücksichtigung des MHD Mapping The status of this document reference.
Short | Status des Dokumentscurrent | superseded | entered-in-error
Comments | Dies ist der Status des DocumentReference-Objekts, das unabhängig vom docStatus-Element ist. Dieses Element wird als Modifier gekennzeichnet, da der Status Codes enthält, die das Dokument oder die Referenz als derzeit nicht gültig markieren. This is the status of the DocumentReference object, which might be independent from the docStatus element. This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from MHD DocumentReference status codes http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 (required to `https://profiles.ihe.net/ITI/MHD/ValueSet/DocumentReferenceStats` ) The status of the document reference.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. DocumentReference.docStatus
Definition | n/a The status of the underlying document.
Short | n/apreliminary | final | amended | entered-in-error
Comments | n/a The document that is pointed to might be in various lifecycle states.
Control | 0..01
Binding | The codes SHALL be taken from CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 (required to `http://hl7.org/fhir/ValueSet/composition-status|4.0.1` ) Status of the underlying document.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. DocumentReference.type
Definition | Art des Dokuments (DocumentEntry.typeCode) Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.
Short | Art des DokumentsKind of document (LOINC if possible)
Comments | Das Attribut typeCode ist gemäß IHE XDS zwingend gefordert und kann zusätzlich zu (bzw. zusammen mit) dem classCode zur genaueren Klassifizierung des Dokuments genutzt werden, z.B. kann ein Dokument mit classCode 'Befundberichte' durch den typeCode als 'Pathologiebefundbericht' oder als 'Ergebnisse bildgebender Diagnostik' gekennzeichnet werden. Das Attribut typeCode stellt keine Spezialisierung von classCode dar. Somit kann ein bestimmter typeCode mit verschiedenen classCodes zur Beschreibung unterschiedlicher Dokumente kombiniert werden. Zum Beispiel haben ein Röntgenbild und der dazugehörige Radiologie-Befund den gleichen typeCode 'Ergebnisse bildgebender Diagnostik' aber zwei unterschiedliche classCodes, 'Bilddaten' bzw.'Befundberichte'. Daraus folgt, dass ein Dokument sowohl einem classCode als auch einem typeCode explizit zugeordnet werden muss; die Zuordnung zu einem typeCode allein reicht nicht aus, weil hierüber kein implizites Mapping auf einen einzigen 'übergeordneten' classCode möglich ist. 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.
Control | 10..1 This element is affected by the following invariants: ele-1
Binding | The codes SHOULD be taken from DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes|4.0.1 (preferred to `http://hl7.org/fhir/ValueSet/c80-doc-typecodes` ) Precise type of clinical document.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. DocumentReference.type.coding
Definition | n/a A reference to a code defined by a terminology system.
Short | Code defined by a terminology system
Comments | n/a 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.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from For codes, see IHE XDS Type Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-type-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. DocumentReference.type.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 10..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. DocumentReference.type.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 10..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. DocumentReference.type.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. DocumentReference.category
Definition | Grobe Klassifizierung des Dokuments (DocumentEntry.classCode) A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.
Short | Grobe Klassifizierung des DokumentsCategorization of document
Comments | Das Attribut 'classCode' ist gemäß IHE XDS zwingend gefordert und erlaubt eine erste Klassifizierung der Dokumente in der XDS Document Registry in Dokumentenklassen, wie z.B. Briefe, Befundberichte oder Bilddaten. Die Wertemenge für diese Klassen sollte nicht zu detailliert sein, da im Attribut 'typeCode' eine weitere, verfeinerte Beschreibung der Dokumente erfolgt, die allerdings keine Spezialisierung des 'classCode' darstellen muss. 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.
Control | 10..1* This element is affected by the following invariants: ele-1
Binding | For example codes, see DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes|4.0.1 (example to `http://hl7.org/fhir/ValueSet/document-classcodes` ) High-level kind of a clinical document at a macro level.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | true
Alternate Names | claxs
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. DocumentReference.category.coding
Definition | n/a A reference to a code defined by a terminology system.
Short | Code defined by a terminology system
Comments | n/a 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.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from For codes, see IHE XDS Class Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-class-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. DocumentReference.category.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 10..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. DocumentReference.category.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 10..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
34. DocumentReference.category.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. DocumentReference.subject
Definition | Systemweit eindeutige Kennung des Patienten (DocumentEntry.patientId) Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).
Short | Systemweit eindeutige Kennung des PatientenWho/what is the subject of the document
Comments | EPAPatient|1.0.0 References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 10..1 This element is affected by the following invariants: ele-1
Type | Reference(Patient, Patient, Practitioner, Group, Device)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
38. DocumentReference.subject.identifier
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Short | Logical reference, when literal reference is not known
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 10..1 This element is affected by the following invariants: ele-1
Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. DocumentReference.date
Definition | n/a When the document reference was created.
Short | Das Erzeugungsdatum wird in content.attachment.creation abgebildet.When this document reference was created
Comments | n/a Referencing/indexing time is used for tracking, organizing versions and searching.
Control | 0..1
Type | instant
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | indexed
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. DocumentReference.author
Definition | Person oder System, welche(s) das Dokument erstellt hat (DocumentEntry.author) Identifies who is responsible for adding the information to the document.
Short | Person oder System, welche(s) das Dokument erstellt hatWho and/or what authored the document
Comments | Logical Reference unter Nutzung der KVNR oder Telematik-ID Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(Patient, Practitioner, Organization, Practitioner, PractitionerRole, Organization, Device, Patient, RelatedPerson)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
44. DocumentReference.author.identifier
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Short | Logical reference, when literal reference is not known
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer, Identifier-Profil für die Telematik-ID, Identifier-Profil für die Abbildung einer lebenslangen Arztnummer, Identifier-Profil für die Abbildung einer lebenslangen Zahnarztnummer)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
46. DocumentReference.author.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text alternative for the resource
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
48. DocumentReference.authenticator
Definition | Rechtlich Verantwortlicher für das Dokument (DocumentEntry.legalAuthenticator) Which person or organization authenticates that this document is valid.
Short | Rechtlich Verantwortlicher für das DokumentWho/what authenticated the document
Comments | Logical Reference unter Nutzung der Telematik-ID 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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Reference(Practitioner, Organization, Practitioner, PractitionerRole, Organization)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
50. DocumentReference.authenticator.identifier
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Short | Logical reference, when literal reference is not known
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 10..1 This element is affected by the following invariants: ele-1
Type | Identifier(Identifier-Profil für die Telematik-ID)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
52. DocumentReference.custodian
Definition | n/a Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.
Short | n/aOrganization which maintains the document
Comments | n/a 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.
Control | 0..01 This element is affected by the following invariants: ele-1
Type | Reference(Organization, Organization)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
54. DocumentReference.relatesTo
Definition | Relationships that this document has with other document references that already exist.
Short | Relationships to other documents
Comments | This element is labeled as a modifier because documents that append to other documents are incomplete on their own.
Control | 0..* This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
56. DocumentReference.relatesTo.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
58. DocumentReference.relatesTo.code
Definition | The type of relationship that this document has with anther document.
Short | replaces | transforms | signs | appends
Comments | If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.
Control | 1..1
Binding | The codes SHALL be taken from DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 (required to `http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1` ) The type of relationship between documents.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
60. DocumentReference.relatesTo.target
Definition | The target document of this relationship.
Short | Target of the relationship
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Reference(DocumentReference, DocumentReference)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
62. DocumentReference.description
Definition | Ergänzende Hinweise in Freitext (DocumentEntry.comments) Human-readable description of the source document.
Short | Ergänzende Hinweise in FreitextHuman-readable description
Comments | n/a What the document is about, a terse summary of the document.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Helps humans to assess whether the document is of interest.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
64. DocumentReference.securityLabel
Definition | Vertraulichkeitskennzeichnung des Dokuments (DocumentEntry.confidentialityCode) 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.
Short | Vertraulichkeitskennzeichnung und Datenkategorie des DokumentsDocument security-tags
Comments | Der Confidentiality Code drückt die Vertraulichkeitsstufe des Dokuments aus. Die Vertraulichkeitsstufe ist üblicherweise die Einschätzung des Autors oder des Einstellenden wie schützenswert das Dokument ist. Die Einschätzung des Autors oder Erstellers sollte erhalten bleiben, auch wenn die des Betroffenen (d.h. des Patienten) davon abweicht. Das heißt, dass man dem Dokument mehrere ConfidentialityCodes zuordnen können sollte. Dies unterstützt IHE XDS auch. Daher enthält das deutsche Value Set neben Codes der Autoreneinschätzung explizite Codes zur Betroffeneneinschätzung, die aus einem separaten, dediziertem Codesystem stammen. Die Datenkategorie des Dokuments entsprechend der ePA Legal Policy ist ebenso Bestandteil dieser Liste. The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce. In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | Unless not suitable, these codes SHALL be taken from All Security Labels http://hl7.org/fhir/ValueSet/security-labels|4.0.1 (extensible to `http://hl7.org/fhir/ValueSet/security-labels` ) Security Labels from the Healthcare Privacy and Security Classification System.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | true
Requirements | Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. DocumentReference.securityLabel.coding
Definition | n/a A reference to a code defined by a terminology system.
Short | Code defined by a terminology system
Comments | n/a 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.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from For codes, see MHD Security Label Value Set for ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-mhd-security-label-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
68. DocumentReference.securityLabel.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 10..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
70. DocumentReference.securityLabel.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 10..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
72. DocumentReference.securityLabel.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
74. DocumentReference.content
Definition | The document and format referenced. The document and format referenced. There may be multiple content element repetitions, each with a different format.
Short | Document referenced
Control | 1..1* This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
76. DocumentReference.content.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
78. DocumentReference.content.attachment
Definition | The document or URL of the document along with critical metadata to prove content has integrity.
Short | Where to access the document
Comments | When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Attachment
Is Modifier | false
Summary | true
Invariants | att-1: If the Attachment has data, it SHALL have a contentType (data.empty() or contentType.exists()) ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
80. DocumentReference.content.attachment.contentType
Definition | Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.
Short | Mime type of the content, with charset etc.
Control | 10..1
Binding | The codes SHALL be taken from IHE XDS MIME Type ValueSet for ePA http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-mime-type-vs` )
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Processors of the data need to be able to know how to interpret the data.
Example | General: text/plain; charset=UTF-8, image/png
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
82. DocumentReference.content.attachment.language
Definition | Sprache, in der das Dokument abgefasst ist (DocumentEntry.languageCode) The human language of the content. The value can be any valid value according to BCP 47.
Short | Sprache, in der das Dokument abgefasst istHuman language of the content (BCP-47)
Comments | n/a
Control | 10..1
Binding | The codes SHOULD be taken from CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 (preferred to `http://hl7.org/fhir/ValueSet/languages` ) A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Users need to be able to choose between the languages in a set of attachments.
Example | General: en-AU
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
84. DocumentReference.content.attachment.data
Definition | The actual data of the attachment - a sequence of bytes, base64 encoded.
Short | Data inline, base64ed
Comments | The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.
Control | 0..01
Type | base64Binary
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Requirements | The data needs to able to be transmitted inline.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
86. DocumentReference.content.attachment.url
Definition | URI für das Dokument (DocumentEntry.URI) A location where the data can be accessed.
Short | URI für das DokumentUri where the data can be found
Comments | Dateiname mit Extension ohne Pfadangabe 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.
Control | 10..1
Type | url
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | The data needs to be transmitted by reference.
Example | General: http://www.acme.com/logo-small.png
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
88. DocumentReference.content.attachment.size
Definition | Größe des Dokuments in Bytes (DocumentEntry.size) The number of bytes of data that make up this attachment (before base64 encoding, if that is done).
Short | Größe des Dokuments in BytesNumber of bytes of content (if url provided)
Comments | n/a 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.
Control | 0..1
Type | unsignedInt
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
90. DocumentReference.content.attachment.hash
Definition | Kryptographische Prüfsumme des Dokuments (DocumentEntry.hash) The calculated hash of the data using SHA-1. Represented using base64.
Short | Kryptographische Prüfsumme des DokumentsHash of the data (sha-1, base64ed)
Comments | n/a The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.
Control | 0..1
Type | base64Binary
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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).
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
92. DocumentReference.content.attachment.title
Definition | Titel des Dokuments (DocumentEntry.title) A label or set of text to display in place of the data.
Short | Titel des DokumentsLabel to display in place of the data
Comments | n/a Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.
Example | General: Official Corporate Logo
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
94. DocumentReference.content.attachment.creation
Definition | Erstellungszeitpunkt des Dokuments (DocumentEntry.creationTime) The date that the attachment was first created.
Short | Erstellungszeitpunkt des DokumentsDate attachment was first created
Comments | n/a
Control | 10..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | This is often tracked as an integrity issue for use of the attachment.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
96. DocumentReference.content.format
Definition | Global eindeutiger Code für das Dokumentenformat (DocumentEntry.formatCode) An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.
Short | Global eindeutiger Code für das DokumentenformatFormat/content rules for the document
Comments | Das Attribut 'formatCode' spezifiziert das Format des Dokumentes. Zusammen mit dem typeCode (und ggf. mit dem mimeType) soll der formatCode für hinreichende Information sorgen, um einem Dokument-Konsumenten die Entscheidung zu ermöglichen, ob und wie er das Dokumentenformat verarbeiten kann. Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.
Control | 10..1 This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from The codes SHOULD be taken from IHE XDS Format Code ValueSet für ePA http://hl7.org/fhir/ValueSet/formatcodes|4.0.1 (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-format-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
98. DocumentReference.context
Definition | The clinical context in which the document was prepared.
Short | Clinical context of document
Comments | These values are primarily added to help with searching for interesting/relevant documents.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
100. DocumentReference.context.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
102. DocumentReference.context.encounter
Definition | Describes the clinical encounter or type of care that the document content is associated with.
Short | Context of the document content
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..0* This element is affected by the following invariants: ele-1
Type | Reference(Encounter, EpisodeOfCare, Encounter, EpisodeOfCare)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
104. DocumentReference.context.event
Definition | Ereignisse, die zur Erstellung des Dokuments geführt haben (DocumentEntry.eventCodeList) 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.
Short | Ereignisse, die zur Erstellung des Dokuments geführt habenMain clinical acts documented
Comments | Die eventCode Liste wurde konzipiert, um den medizinischen Kontext von Dokumenten abzubilden. Jedem Dokument können beliebig viele eventCodes zugeordnet werden. Zum Beispiel kann ein OP-Bericht über die eventCodeList mit je einem kodierten Wert für die durchgeführte Prozedur (z.B. Blinddarmentfernung) und die vorliegende Erkrankung (z.B. Appendizitis) versehen werden. Dies ermöglicht die Suche nach Dokumenten, die mit einer bestimmten Prozedur oder Diagnose zusammenhängen. Über den medizinischen Kontext hinaus kann das Attribut auch allgemein zur Kontextualisierung und zur Inhaltszusammenfassung verwendet werden. 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.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | For example codes, see v3 Code System ActCode http://terminology.hl7.org/ValueSet/v3-ActCode (example to `http://terminology.hl7.org/ValueSet/v3-ActCode` ) This list of codes represents the main clinical acts being documented.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
106. DocumentReference.context.event.coding
Definition | n/a A reference to a code defined by a terminology system.
Short | Code defined by a terminology system
Comments | n/a 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.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from For codes, see IHE XDS Event Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-event-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
108. DocumentReference.context.event.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 10..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
110. DocumentReference.context.event.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 10..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
112. DocumentReference.context.event.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
114. DocumentReference.context.period
Definition | The time period over which the service that is described by the document was provided.
Short | Time of service that is being documented
Comments | A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Period
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) per-1: If present, start SHALL have a lower value than end (start.hasValue().not() or end.hasValue().not() or (start <= end))
116. DocumentReference.context.period.start
Definition | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis begonnen wurde (DocumentEntry.serviceStartTime) The start of the period. The boundary is inclusive.
Short | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis begonnen wurdeStarting time with inclusive boundary
Comments | n/a If the low element is missing, the meaning is that the low boundary is not known.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
118. DocumentReference.context.period.end
Definition | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis beendet wurde (DocumentEntry.serviceStopTime) 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.
Short | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis beendet wurdeEnd time with inclusive boundary, if not ongoing
Comments | n/a 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.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Meaning if Missing | If the end of the period is missing, it means that the period is ongoing
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
120. DocumentReference.context.facilityType
Definition | Art der Einrichtung, in der das dokumentierte Ereignis stattgefunden hat (DocumentEntry.healthcareFacilityTypeCode) The kind of facility where the patient was seen.
Short | Art der Einrichtung, in der das dokumentierte Ereignis stattgefunden hatKind of facility where patient was seen
Comments | DocumentEntry.healthcareFacilityTypeCode repräsentiert die Art der Einrichtung, in der die Tätigkeit stattfand, die zur Erzeugung des Dokuments führte. Zum Beispiel sollten Dokumente, die während eines ambulanten Falls in einem Krankenhaus entstehen, mit dem healthcareFacilityTypeCode für 'Krankenhaus' gekennzeichnet werden. Dabei ist zu beachten, dass es sich nicht notwendigerweise um die Art der Einrichtung handelt, in der das Dokument erstellt wurde. Beispielsweise ist es bei teleradiologischer Befundung eines Röntgenbildes für den healthcareFacilityTypeCode unerheblich, ob der befundende Radiologe in einem Krankenhaus oder in einer radiologischen Praxis ansässig ist; für den healthcareFacilityTypeCode wird die Einrichtungsart der Untersuchungsstelle (in der das Gerät betrieben wird) herangezogen. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Control | 10..1 This element is affected by the following invariants: ele-1
Binding | For example codes, see FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes|4.0.1 (example to `http://hl7.org/fhir/ValueSet/c80-facilitycodes` ) XDS Facility Type.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
122. DocumentReference.context.facilityType.coding
Definition | n/a A reference to a code defined by a terminology system.
Short | Code defined by a terminology system
Comments | n/a 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.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from For codes, see IHE XDS Healthcare Facility Type Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-healthcare-facility-type-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
124. DocumentReference.context.facilityType.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 10..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
126. DocumentReference.context.facilityType.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 10..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
128. DocumentReference.context.facilityType.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
130. DocumentReference.context.practiceSetting
Definition | Art der Fachrichtung der erstellenden Einrichtung, in der das dokumentiere Ereignis stattgefunden hat (DocumentEntry.practiceSettingCode) This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.
Short | Art der Fachrichtung der erstellenden Einrichtung, in der das dokumentiere Ereignis stattgefunden hatAdditional details about where the content was created (e.g. clinical specialty)
Comments | DocumentEntry.practiceSettingCode spezifiziert die Fachrichtung der erstellenden Einrichtung. Typische Beispiele hierfür sind ärztliche Fachgebiete wie Allgemeinmedizin oder Radiologie. IHE International empfiehlt, dass die Codeliste zwischen 10 und 100 Codes umfassen sollte, so dass die Fachrichtung hinreichend genau abgebildet werden kann. 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.
Control | 0..1 This element is affected by the following invariants: ele-1
Binding | For example codes, see PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes|4.0.1 (example to `http://hl7.org/fhir/ValueSet/c80-practice-codes` ) Additional details about where the content was created (e.g. clinical specialty).
Type | CodeableConcept
Is Modifier | false
Must Support | true
Requirements | This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
132. DocumentReference.context.practiceSetting.coding
Definition | n/a A reference to a code defined by a terminology system.
Short | Code defined by a terminology system
Comments | n/a 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.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from For codes, see IHE XDS Practice Setting Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-practice-setting-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
134. DocumentReference.context.practiceSetting.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 10..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
136. DocumentReference.context.practiceSetting.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 10..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
138. DocumentReference.context.practiceSetting.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
140. DocumentReference.context.sourcePatientInfo
Definition | The Patient Information as known when the document was published. May be a reference to a version specific, or contained.
Short | Patient demographics from source
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Reference(Patient, Patient)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
142. DocumentReference.context.sourcePatientInfo.reference
Definition | Demographische Daten zum Patienten im Quellsystem (DocumentEntry.sourcePatientInfo) A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Short | Demographische Daten zum Patienten im QuellsystemLiteral reference, Relative, internal or absolute URL
Comments | n/a Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Control | 0..1 This element is affected by the following invariants: ref-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
144. DocumentReference.context.sourcePatientInfo.identifier
Definition | Kennung des Patienten im Quellsystem (DocumentEntry.sourcePatientId) An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Short | Kennung des Patienten im QuellsystemLogical reference, when literal reference is not known
Comments | n/a When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Identifier
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
146. DocumentReference.context.related
Definition | Liste von IDs, mit denen das Dokument assoziiert wird (DocumentEntry.referenceIdList) Related identifiers or resources associated with the DocumentReference.
Short | Liste von IDs, mit denen das Dokument assoziiert wirdRelated identifiers or resources
Comments | n/a May be identifiers or resources that caused the DocumentReference or referenced Document to be created.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(Resource, Resource)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))

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

0. DocumentReference
2. DocumentReference.meta
4. DocumentReference.meta.profile
6. DocumentReference.masterIdentifier
8. DocumentReference.identifier
Note | This is a business identifier, not a resource identifier (see discussion)
10. DocumentReference.status
Definition | Status des Dokuments (DocumentEntry.availabilityStatus) unter Berücksichtigung des MHD Mapping
Short | Status des Dokuments
Comments | Dies ist der Status des DocumentReference-Objekts, das unabhängig vom docStatus-Element ist. Dieses Element wird als Modifier gekennzeichnet, da der Status Codes enthält, die das Dokument oder die Referenz als derzeit nicht gültig markieren.
Must Support | true
12. DocumentReference.docStatus
Definition | n/a
Short | n/a
Comments | n/a
14. DocumentReference.type
Definition | Art des Dokuments (DocumentEntry.typeCode)
Short | Art des Dokuments
Comments | Das Attribut typeCode ist gemäß IHE XDS zwingend gefordert und kann zusätzlich zu (bzw. zusammen mit) dem classCode zur genaueren Klassifizierung des Dokuments genutzt werden, z.B. kann ein Dokument mit classCode 'Befundberichte' durch den typeCode als 'Pathologiebefundbericht' oder als 'Ergebnisse bildgebender Diagnostik' gekennzeichnet werden. Das Attribut typeCode stellt keine Spezialisierung von classCode dar. Somit kann ein bestimmter typeCode mit verschiedenen classCodes zur Beschreibung unterschiedlicher Dokumente kombiniert werden. Zum Beispiel haben ein Röntgenbild und der dazugehörige Radiologie-Befund den gleichen typeCode 'Ergebnisse bildgebender Diagnostik' aber zwei unterschiedliche classCodes, 'Bilddaten' bzw.'Befundberichte'. Daraus folgt, dass ein Dokument sowohl einem classCode als auch einem typeCode explizit zugeordnet werden muss; die Zuordnung zu einem typeCode allein reicht nicht aus, weil hierüber kein implizites Mapping auf einen einzigen 'übergeordneten' classCode möglich ist.
Control | 1..?
16. DocumentReference.type.coding
Definition | n/a
Comments | n/a
Binding | The codes SHALL be taken from IHE XDS Type Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-type-code-vs` )
Must Support | true
18. DocumentReference.type.coding.system
Control | 1..?
Must Support | true
20. DocumentReference.type.coding.code
Control | 1..?
Must Support | true
22. DocumentReference.type.coding.display
Control | 1..?
Must Support | true
24. DocumentReference.category
Definition | Grobe Klassifizierung des Dokuments (DocumentEntry.classCode)
Short | Grobe Klassifizierung des Dokuments
Comments | Das Attribut 'classCode' ist gemäß IHE XDS zwingend gefordert und erlaubt eine erste Klassifizierung der Dokumente in der XDS Document Registry in Dokumentenklassen, wie z.B. Briefe, Befundberichte oder Bilddaten. Die Wertemenge für diese Klassen sollte nicht zu detailliert sein, da im Attribut 'typeCode' eine weitere, verfeinerte Beschreibung der Dokumente erfolgt, die allerdings keine Spezialisierung des 'classCode' darstellen muss.
Control | 1..?
26. DocumentReference.category.coding
Definition | n/a
Comments | n/a
Binding | The codes SHALL be taken from IHE XDS Class Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-class-code-vs` )
Must Support | true
28. DocumentReference.category.coding.system
Control | 1..?
Must Support | true
30. DocumentReference.category.coding.code
Control | 1..?
Must Support | true
32. DocumentReference.category.coding.display
Control | 1..?
Must Support | true
34. DocumentReference.subject
Definition | Systemweit eindeutige Kennung des Patienten (DocumentEntry.patientId)
Short | Systemweit eindeutige Kennung des Patienten
Comments | EPAPatient|1.0.0
Control | 1..?
36. DocumentReference.subject.identifier
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..?
Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer)
Must Support | true
38. DocumentReference.date
Definition | n/a
Short | Das Erzeugungsdatum wird in content.attachment.creation abgebildet.
Comments | n/a
40. DocumentReference.author
Definition | Person oder System, welche(s) das Dokument erstellt hat (DocumentEntry.author)
Short | Person oder System, welche(s) das Dokument erstellt hat
Comments | Logical Reference unter Nutzung der KVNR oder Telematik-ID
Type | Reference(Patient, Practitioner, Organization)
42. DocumentReference.author.identifier
Note | This is a business identifier, not a resource identifier (see discussion)
Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer, Identifier-Profil für die Telematik-ID, Identifier-Profil für die Abbildung einer lebenslangen Arztnummer, Identifier-Profil für die Abbildung einer lebenslangen Zahnarztnummer)
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
44. DocumentReference.author.display
Control | 1..?
Must Support | true
46. DocumentReference.authenticator
Definition | Rechtlich Verantwortlicher für das Dokument (DocumentEntry.legalAuthenticator)
Short | Rechtlich Verantwortlicher für das Dokument
Comments | Logical Reference unter Nutzung der Telematik-ID
Type | Reference(Practitioner, Organization)
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
48. DocumentReference.authenticator.identifier
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..?
Type | Identifier(Identifier-Profil für die Telematik-ID)
Must Support | true
50. DocumentReference.custodian
Definition | n/a
Short | n/a
Comments | n/a
Control | 0..0
52. DocumentReference.relatesTo
54. DocumentReference.description
Definition | Ergänzende Hinweise in Freitext (DocumentEntry.comments)
Short | Ergänzende Hinweise in Freitext
Comments | n/a
Must Support | true
56. DocumentReference.securityLabel
Definition | Vertraulichkeitskennzeichnung des Dokuments (DocumentEntry.confidentialityCode)
Short | Vertraulichkeitskennzeichnung und Datenkategorie des Dokuments
Comments | Der Confidentiality Code drückt die Vertraulichkeitsstufe des Dokuments aus. Die Vertraulichkeitsstufe ist üblicherweise die Einschätzung des Autors oder des Einstellenden wie schützenswert das Dokument ist. Die Einschätzung des Autors oder Erstellers sollte erhalten bleiben, auch wenn die des Betroffenen (d.h. des Patienten) davon abweicht. Das heißt, dass man dem Dokument mehrere ConfidentialityCodes zuordnen können sollte. Dies unterstützt IHE XDS auch. Daher enthält das deutsche Value Set neben Codes der Autoreneinschätzung explizite Codes zur Betroffeneneinschätzung, die aus einem separaten, dediziertem Codesystem stammen. Die Datenkategorie des Dokuments entsprechend der ePA Legal Policy ist ebenso Bestandteil dieser Liste.
58. DocumentReference.securityLabel.coding
Definition | n/a
Comments | n/a
Binding | The codes SHALL be taken from MHD Security Label Value Set for ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-mhd-security-label-vs` )
Must Support | true
60. DocumentReference.securityLabel.coding.system
Control | 1..?
Must Support | true
62. DocumentReference.securityLabel.coding.code
Control | 1..?
Must Support | true
64. DocumentReference.securityLabel.coding.display
Control | 1..?
Must Support | true
66. DocumentReference.content
68. DocumentReference.content.attachment
70. DocumentReference.content.attachment.contentType
Binding | The codes SHALL be taken from IHE XDS MIME Type ValueSet for ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-mime-type-vs` )
Must Support | true
72. DocumentReference.content.attachment.language
Definition | Sprache, in der das Dokument abgefasst ist (DocumentEntry.languageCode)
Short | Sprache, in der das Dokument abgefasst ist
Comments | n/a
Control | 1..?
74. DocumentReference.content.attachment.url
Definition | URI für das Dokument (DocumentEntry.URI)
Short | URI für das Dokument
Comments | Dateiname mit Extension ohne Pfadangabe
Must Support | true
76. DocumentReference.content.attachment.size
Definition | Größe des Dokuments in Bytes (DocumentEntry.size)
Short | Größe des Dokuments in Bytes
Comments | n/a
Must Support | true
78. DocumentReference.content.attachment.hash
Definition | Kryptographische Prüfsumme des Dokuments (DocumentEntry.hash)
Short | Kryptographische Prüfsumme des Dokuments
Comments | n/a
Must Support | true
80. DocumentReference.content.attachment.title
Definition | Titel des Dokuments (DocumentEntry.title)
Short | Titel des Dokuments
Comments | n/a
Control | 1..?
Must Support | true
82. DocumentReference.content.attachment.creation
Definition | Erstellungszeitpunkt des Dokuments (DocumentEntry.creationTime)
Short | Erstellungszeitpunkt des Dokuments
Comments | n/a
Control | 1..?
84. DocumentReference.content.format
Definition | Global eindeutiger Code für das Dokumentenformat (DocumentEntry.formatCode)
Short | Global eindeutiger Code für das Dokumentenformat
Comments | Das Attribut 'formatCode' spezifiziert das Format des Dokumentes. Zusammen mit dem typeCode (und ggf. mit dem mimeType) soll der formatCode für hinreichende Information sorgen, um einem Dokument-Konsumenten die Entscheidung zu ermöglichen, ob und wie er das Dokumentenformat verarbeiten kann.
Control | 1..?
Binding | The codes SHALL be taken from IHE XDS Format Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-format-code-vs` )
86. DocumentReference.context
88. DocumentReference.context.encounter
Control | 0..0
90. DocumentReference.context.event
Definition | Ereignisse, die zur Erstellung des Dokuments geführt haben (DocumentEntry.eventCodeList)
Short | Ereignisse, die zur Erstellung des Dokuments geführt haben
Comments | Die eventCode Liste wurde konzipiert, um den medizinischen Kontext von Dokumenten abzubilden. Jedem Dokument können beliebig viele eventCodes zugeordnet werden. Zum Beispiel kann ein OP-Bericht über die eventCodeList mit je einem kodierten Wert für die durchgeführte Prozedur (z.B. Blinddarmentfernung) und die vorliegende Erkrankung (z.B. Appendizitis) versehen werden. Dies ermöglicht die Suche nach Dokumenten, die mit einer bestimmten Prozedur oder Diagnose zusammenhängen. Über den medizinischen Kontext hinaus kann das Attribut auch allgemein zur Kontextualisierung und zur Inhaltszusammenfassung verwendet werden.
Must Support | true
92. DocumentReference.context.event.coding
Definition | n/a
Comments | n/a
Binding | The codes SHALL be taken from IHE XDS Event Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-event-code-vs` )
Must Support | true
94. DocumentReference.context.event.coding.system
Control | 1..?
Must Support | true
96. DocumentReference.context.event.coding.code
Control | 1..?
Must Support | true
98. DocumentReference.context.event.coding.display
Control | 1..?
Must Support | true
100. DocumentReference.context.period
102. DocumentReference.context.period.start
Definition | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis begonnen wurde (DocumentEntry.serviceStartTime)
Short | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis begonnen wurde
Comments | n/a
Must Support | true
104. DocumentReference.context.period.end
Definition | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis beendet wurde (DocumentEntry.serviceStopTime)
Short | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis beendet wurde
Comments | n/a
Must Support | true
106. DocumentReference.context.facilityType
Definition | Art der Einrichtung, in der das dokumentierte Ereignis stattgefunden hat (DocumentEntry.healthcareFacilityTypeCode)
Short | Art der Einrichtung, in der das dokumentierte Ereignis stattgefunden hat
Comments | DocumentEntry.healthcareFacilityTypeCode repräsentiert die Art der Einrichtung, in der die Tätigkeit stattfand, die zur Erzeugung des Dokuments führte. Zum Beispiel sollten Dokumente, die während eines ambulanten Falls in einem Krankenhaus entstehen, mit dem healthcareFacilityTypeCode für 'Krankenhaus' gekennzeichnet werden. Dabei ist zu beachten, dass es sich nicht notwendigerweise um die Art der Einrichtung handelt, in der das Dokument erstellt wurde. Beispielsweise ist es bei teleradiologischer Befundung eines Röntgenbildes für den healthcareFacilityTypeCode unerheblich, ob der befundende Radiologe in einem Krankenhaus oder in einer radiologischen Praxis ansässig ist; für den healthcareFacilityTypeCode wird die Einrichtungsart der Untersuchungsstelle (in der das Gerät betrieben wird) herangezogen.
Control | 1..?
108. DocumentReference.context.facilityType.coding
Definition | n/a
Comments | n/a
Binding | The codes SHALL be taken from IHE XDS Healthcare Facility Type Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-healthcare-facility-type-code-vs` )
Must Support | true
110. DocumentReference.context.facilityType.coding.system
Control | 1..?
Must Support | true
112. DocumentReference.context.facilityType.coding.code
Control | 1..?
Must Support | true
114. DocumentReference.context.facilityType.coding.display
Control | 1..?
Must Support | true
116. DocumentReference.context.practiceSetting
Definition | Art der Fachrichtung der erstellenden Einrichtung, in der das dokumentiere Ereignis stattgefunden hat (DocumentEntry.practiceSettingCode)
Short | Art der Fachrichtung der erstellenden Einrichtung, in der das dokumentiere Ereignis stattgefunden hat
Comments | DocumentEntry.practiceSettingCode spezifiziert die Fachrichtung der erstellenden Einrichtung. Typische Beispiele hierfür sind ärztliche Fachgebiete wie Allgemeinmedizin oder Radiologie. IHE International empfiehlt, dass die Codeliste zwischen 10 und 100 Codes umfassen sollte, so dass die Fachrichtung hinreichend genau abgebildet werden kann.
118. DocumentReference.context.practiceSetting.coding
Definition | n/a
Comments | n/a
Binding | The codes SHALL be taken from IHE XDS Practice Setting Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-practice-setting-code-vs` )
Must Support | true
120. DocumentReference.context.practiceSetting.coding.system
Control | 1..?
Must Support | true
122. DocumentReference.context.practiceSetting.coding.code
Control | 1..?
Must Support | true
124. DocumentReference.context.practiceSetting.coding.display
Control | 1..?
Must Support | true
126. DocumentReference.context.sourcePatientInfo
128. DocumentReference.context.sourcePatientInfo.reference
Definition | Demographische Daten zum Patienten im Quellsystem (DocumentEntry.sourcePatientInfo)
Short | Demographische Daten zum Patienten im Quellsystem
Comments | n/a
Must Support | true
130. DocumentReference.context.sourcePatientInfo.identifier
Definition | Kennung des Patienten im Quellsystem (DocumentEntry.sourcePatientId)
Short | Kennung des Patienten im Quellsystem
Comments | n/a
Note | This is a business identifier, not a resource identifier (see discussion)
Must Support | true
132. DocumentReference.context.related
Definition | Liste von IDs, mit denen das Dokument assoziiert wird (DocumentEntry.referenceIdList)
Short | Liste von IDs, mit denen das Dokument assoziiert wird
Comments | n/a
Must Support | true

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

0. DocumentReference
Definition | A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.
Short | A reference to a document
Comments | Usually, this is used for documents other than those defined by FHIR.
Control | 0..*
Is Modifier | false
Summary | false
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (`contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`)
2. DocumentReference.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical id of this artifact
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Control | 0..1
Type | id
Is Modifier | false
Summary | true
4. DocumentReference.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. DocumentReference.meta.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
8. DocumentReference.meta.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.meta.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
10. DocumentReference.meta.versionId
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.
Short | Version specific identifier
Comments | 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.
Control | 0..1
Type | id
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. DocumentReference.meta.lastUpdated
Definition | When the resource last changed - e.g. when the version changed.
Short | When the resource version last changed
Comments | 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 interaction.
Control | 0..1
Type | instant
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
14. DocumentReference.meta.source
Definition | A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
Short | Identifies where the resource comes from
Comments | 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. This 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.
Control | 0..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
16. DocumentReference.meta.profile
Definition | A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.
Short | Profiles this resource claims to conform to
Comments | 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.
Control | 0..*
Type | canonical(StructureDefinition)
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
18. DocumentReference.meta.security
Definition | Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
Short | Security Labels applied to this resource
Comments | 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.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | Unless not suitable, these codes SHALL be taken from All Security Labels (extensible to `http://hl7.org/fhir/ValueSet/security-labels` ) Security Labels from the Healthcare Privacy and Security Classification System.
Type | Coding
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
20. DocumentReference.meta.tag
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.
Short | Tags applied to this resource
Comments | 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.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | For example codes, see CommonTags (example to `http://hl7.org/fhir/ValueSet/common-tags` ) Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Type | Coding
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
22. DocumentReference.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
24. DocumentReference.language
Definition | The base language in which the resource is written.
Short | Language of the resource content
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages (preferred to `http://hl7.org/fhir/ValueSet/languages` ) A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. DocumentReference.text
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Short | Text summary of the resource, for human interpretation
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Control | 0..1
Type | Narrative
Is Modifier | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
28. DocumentReference.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Control | 0..*
Type | Resource
Is Modifier | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
30. DocumentReference.extension
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
32. DocumentReference.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..0
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
34. DocumentReference.masterIdentifier
Definition | An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Short | An identifier intended for computation
Comments | CDA Document Id extension and root.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Identifier(uniqueId Identifier)
Is Modifier | false
Summary | true
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.).
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. DocumentReference.identifier
Definition | Other identifiers associated with the document, including version independent identifiers.
Short | Other identifiers for the document
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..* This element is affected by the following invariants: ele-1
Type | Identifier
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `DocumentReference.identifier`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ use
38. DocumentReference.identifier:entryUUID
Slice Name | entryUUID
Definition | An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Short | An identifier intended for computation
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..* This element is affected by the following invariants: ele-1
Type | Identifier(entryUUID Identifier)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
40. DocumentReference.status
Definition | Status des Dokuments (DocumentEntry.availabilityStatus) unter Berücksichtigung des MHD Mapping
Short | Status des Dokuments
Comments | Dies ist der Status des DocumentReference-Objekts, das unabhängig vom docStatus-Element ist. Dieses Element wird als Modifier gekennzeichnet, da der Status Codes enthält, die das Dokument oder die Referenz als derzeit nicht gültig markieren.
Control | 1..1
Binding | The codes SHALL be taken from MHD DocumentReference status codes (required to `https://profiles.ihe.net/ITI/MHD/ValueSet/DocumentReferenceStats` ) The status of the document reference.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. DocumentReference.docStatus
Definition | n/a
Short | n/a
Comments | n/a
Control | 0..0
Binding | The codes SHALL be taken from CompositionStatus (required to `http://hl7.org/fhir/ValueSet/composition-status|4.0.1` ) Status of the underlying document.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
44. DocumentReference.type
Definition | Art des Dokuments (DocumentEntry.typeCode)
Short | Art des Dokuments
Comments | Das Attribut typeCode ist gemäß IHE XDS zwingend gefordert und kann zusätzlich zu (bzw. zusammen mit) dem classCode zur genaueren Klassifizierung des Dokuments genutzt werden, z.B. kann ein Dokument mit classCode 'Befundberichte' durch den typeCode als 'Pathologiebefundbericht' oder als 'Ergebnisse bildgebender Diagnostik' gekennzeichnet werden. Das Attribut typeCode stellt keine Spezialisierung von classCode dar. Somit kann ein bestimmter typeCode mit verschiedenen classCodes zur Beschreibung unterschiedlicher Dokumente kombiniert werden. Zum Beispiel haben ein Röntgenbild und der dazugehörige Radiologie-Befund den gleichen typeCode 'Ergebnisse bildgebender Diagnostik' aber zwei unterschiedliche classCodes, 'Bilddaten' bzw.'Befundberichte'. Daraus folgt, dass ein Dokument sowohl einem classCode als auch einem typeCode explizit zugeordnet werden muss; die Zuordnung zu einem typeCode allein reicht nicht aus, weil hierüber kein implizites Mapping auf einen einzigen 'übergeordneten' classCode möglich ist.
Control | 1..1 This element is affected by the following invariants: ele-1
Binding | The codes SHOULD be taken from DocumentTypeValueSet (preferred to `http://hl7.org/fhir/ValueSet/c80-doc-typecodes` ) Precise type of clinical document.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
46. DocumentReference.type.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
48. DocumentReference.type.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.type.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
50. DocumentReference.type.coding
Definition | n/a
Short | Code defined by a terminology system
Comments | n/a
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from IHE XDS Type Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-type-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. DocumentReference.type.coding.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
54. DocumentReference.type.coding.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.type.coding.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
56. DocumentReference.type.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 1..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. DocumentReference.type.coding.version
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.
Short | Version of the system - if relevant
Comments | 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.
Note | This is a business version Id, not a resource version Id (see discussion)
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
60. DocumentReference.type.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 1..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
62. DocumentReference.type.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
64. DocumentReference.type.coding.userSelected
Definition | Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Short | If this coding was chosen directly by the user
Comments | 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.
Control | 0..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
66. DocumentReference.type.text
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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
68. DocumentReference.category
Definition | Grobe Klassifizierung des Dokuments (DocumentEntry.classCode)
Short | Grobe Klassifizierung des Dokuments
Comments | Das Attribut 'classCode' ist gemäß IHE XDS zwingend gefordert und erlaubt eine erste Klassifizierung der Dokumente in der XDS Document Registry in Dokumentenklassen, wie z.B. Briefe, Befundberichte oder Bilddaten. Die Wertemenge für diese Klassen sollte nicht zu detailliert sein, da im Attribut 'typeCode' eine weitere, verfeinerte Beschreibung der Dokumente erfolgt, die allerdings keine Spezialisierung des 'classCode' darstellen muss.
Control | 1..1 This element is affected by the following invariants: ele-1
Binding | For example codes, see DocumentClassValueSet (example to `http://hl7.org/fhir/ValueSet/document-classcodes` ) High-level kind of a clinical document at a macro level.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | true
Alternate Names | claxs
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
70. DocumentReference.category.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
72. DocumentReference.category.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.category.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
74. DocumentReference.category.coding
Definition | n/a
Short | Code defined by a terminology system
Comments | n/a
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from IHE XDS Class Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-class-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
76. DocumentReference.category.coding.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
78. DocumentReference.category.coding.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.category.coding.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
80. DocumentReference.category.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 1..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
82. DocumentReference.category.coding.version
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.
Short | Version of the system - if relevant
Comments | 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.
Note | This is a business version Id, not a resource version Id (see discussion)
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
84. DocumentReference.category.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 1..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
86. DocumentReference.category.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
88. DocumentReference.category.coding.userSelected
Definition | Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Short | If this coding was chosen directly by the user
Comments | 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.
Control | 0..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
90. DocumentReference.category.text
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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
92. DocumentReference.subject
Definition | Systemweit eindeutige Kennung des Patienten (DocumentEntry.patientId)
Short | Systemweit eindeutige Kennung des Patienten
Comments | EPAPatient|1.0.0
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Reference(Patient)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: SHALL have a contained resource if a local reference is provided (`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`)
94. DocumentReference.subject.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
96. DocumentReference.subject.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.subject.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
98. DocumentReference.subject.reference
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Short | Literal reference, Relative, internal or absolute URL
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Control | 0..1 This element is affected by the following invariants: ref-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
100. DocumentReference.subject.type
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Short | Type the reference refers to (e.g. "Patient")
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to `http://hl7.org/fhir/ValueSet/resource-types|4.0.1` ) Aa resource (or, for logical models, the URI of the logical model).
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
102. DocumentReference.subject.identifier
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Short | Logical reference, when literal reference is not known
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
104. DocumentReference.subject.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text alternative for the resource
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
106. DocumentReference.date
Definition | n/a
Short | Das Erzeugungsdatum wird in content.attachment.creation abgebildet.
Comments | n/a
Control | 0..1
Type | instant
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | indexed
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
108. DocumentReference.author
Definition | Person oder System, welche(s) das Dokument erstellt hat (DocumentEntry.author)
Short | Person oder System, welche(s) das Dokument erstellt hat
Comments | Logical Reference unter Nutzung der KVNR oder Telematik-ID
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(Patient, Practitioner, Organization)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: SHALL have a contained resource if a local reference is provided (`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`)
110. DocumentReference.author.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
112. DocumentReference.author.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.author.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
114. DocumentReference.author.reference
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Short | Literal reference, Relative, internal or absolute URL
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Control | 0..1 This element is affected by the following invariants: ref-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
116. DocumentReference.author.type
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Short | Type the reference refers to (e.g. "Patient")
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to `http://hl7.org/fhir/ValueSet/resource-types|4.0.1` ) Aa resource (or, for logical models, the URI of the logical model).
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
118. DocumentReference.author.identifier
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Short | Logical reference, when literal reference is not known
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer, Identifier-Profil für die Telematik-ID, Identifier-Profil für die Abbildung einer lebenslangen Arztnummer, Identifier-Profil für die Abbildung einer lebenslangen Zahnarztnummer)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
120. DocumentReference.author.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text alternative for the resource
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
122. DocumentReference.authenticator
Definition | Rechtlich Verantwortlicher für das Dokument (DocumentEntry.legalAuthenticator)
Short | Rechtlich Verantwortlicher für das Dokument
Comments | Logical Reference unter Nutzung der Telematik-ID
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Reference(Practitioner, Organization)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: SHALL have a contained resource if a local reference is provided (`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`)
124. DocumentReference.authenticator.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
126. DocumentReference.authenticator.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.authenticator.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
128. DocumentReference.authenticator.reference
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Short | Literal reference, Relative, internal or absolute URL
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Control | 0..1 This element is affected by the following invariants: ref-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
130. DocumentReference.authenticator.type
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Short | Type the reference refers to (e.g. "Patient")
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to `http://hl7.org/fhir/ValueSet/resource-types|4.0.1` ) Aa resource (or, for logical models, the URI of the logical model).
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
132. DocumentReference.authenticator.identifier
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Short | Logical reference, when literal reference is not known
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Identifier(Identifier-Profil für die Telematik-ID)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
134. DocumentReference.authenticator.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text alternative for the resource
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
136. DocumentReference.custodian
Definition | n/a
Short | n/a
Comments | n/a
Control | 0..0 This element is affected by the following invariants: ele-1
Type | Reference(Organization)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: SHALL have a contained resource if a local reference is provided (`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`)
138. DocumentReference.relatesTo
Definition | Relationships that this document has with other document references that already exist.
Short | Relationships to other documents
Comments | This element is labeled as a modifier because documents that append to other documents are incomplete on their own.
Control | 0..* This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
140. DocumentReference.relatesTo.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
142. DocumentReference.relatesTo.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.relatesTo.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
144. DocumentReference.relatesTo.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
146. DocumentReference.relatesTo.code
Definition | The type of relationship that this document has with anther document.
Short | replaces | transforms | signs | appends
Comments | If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.
Control | 1..1
Binding | The codes SHALL be taken from DocumentRelationshipType (required to `http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1` ) The type of relationship between documents.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
148. DocumentReference.relatesTo.target
Definition | The target document of this relationship.
Short | Target of the relationship
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Reference(DocumentReference)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: SHALL have a contained resource if a local reference is provided (`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`)
150. DocumentReference.description
Definition | Ergänzende Hinweise in Freitext (DocumentEntry.comments)
Short | Ergänzende Hinweise in Freitext
Comments | n/a
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Helps humans to assess whether the document is of interest.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
152. DocumentReference.securityLabel
Definition | Vertraulichkeitskennzeichnung des Dokuments (DocumentEntry.confidentialityCode)
Short | Vertraulichkeitskennzeichnung und Datenkategorie des Dokuments
Comments | Der Confidentiality Code drückt die Vertraulichkeitsstufe des Dokuments aus. Die Vertraulichkeitsstufe ist üblicherweise die Einschätzung des Autors oder des Einstellenden wie schützenswert das Dokument ist. Die Einschätzung des Autors oder Erstellers sollte erhalten bleiben, auch wenn die des Betroffenen (d.h. des Patienten) davon abweicht. Das heißt, dass man dem Dokument mehrere ConfidentialityCodes zuordnen können sollte. Dies unterstützt IHE XDS auch. Daher enthält das deutsche Value Set neben Codes der Autoreneinschätzung explizite Codes zur Betroffeneneinschätzung, die aus einem separaten, dediziertem Codesystem stammen. Die Datenkategorie des Dokuments entsprechend der ePA Legal Policy ist ebenso Bestandteil dieser Liste.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | Unless not suitable, these codes SHALL be taken from All Security Labels (extensible to `http://hl7.org/fhir/ValueSet/security-labels` ) Security Labels from the Healthcare Privacy and Security Classification System.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | true
Requirements | Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
154. DocumentReference.securityLabel.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
156. DocumentReference.securityLabel.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.securityLabel.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
158. DocumentReference.securityLabel.coding
Definition | n/a
Short | Code defined by a terminology system
Comments | n/a
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from MHD Security Label Value Set for ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-mhd-security-label-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
160. DocumentReference.securityLabel.coding.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
162. DocumentReference.securityLabel.coding.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.securityLabel.coding.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
164. DocumentReference.securityLabel.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 1..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
166. DocumentReference.securityLabel.coding.version
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.
Short | Version of the system - if relevant
Comments | 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.
Note | This is a business version Id, not a resource version Id (see discussion)
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
168. DocumentReference.securityLabel.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 1..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
170. DocumentReference.securityLabel.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
172. DocumentReference.securityLabel.coding.userSelected
Definition | Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Short | If this coding was chosen directly by the user
Comments | 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.
Control | 0..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
174. DocumentReference.securityLabel.text
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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
176. DocumentReference.content
Definition | The document and format referenced.
Short | Document referenced
Control | 1..1 This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
178. DocumentReference.content.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
180. DocumentReference.content.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.content.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
182. DocumentReference.content.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
184. DocumentReference.content.attachment
Definition | The document or URL of the document along with critical metadata to prove content has integrity.
Short | Where to access the document
Comments | When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Attachment
Is Modifier | false
Summary | true
Invariants | att-1: If the Attachment has data, it SHALL have a contentType (`data.empty() or contentType.exists()`) ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
186. DocumentReference.content.attachment.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
188. DocumentReference.content.attachment.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.content.attachment.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
190. DocumentReference.content.attachment.contentType
Definition | Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.
Short | Mime type of the content, with charset etc.
Control | 1..1
Binding | The codes SHALL be taken from IHE XDS MIME Type ValueSet for ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-mime-type-vs` )
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Processors of the data need to be able to know how to interpret the data.
Example | General: text/plain; charset=UTF-8, image/png
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
192. DocumentReference.content.attachment.language
Definition | Sprache, in der das Dokument abgefasst ist (DocumentEntry.languageCode)
Short | Sprache, in der das Dokument abgefasst ist
Comments | n/a
Control | 1..1
Binding | The codes SHOULD be taken from CommonLanguages (preferred to `http://hl7.org/fhir/ValueSet/languages` ) A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Users need to be able to choose between the languages in a set of attachments.
Example | General: en-AU
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
194. DocumentReference.content.attachment.data
Definition | The actual data of the attachment - a sequence of bytes, base64 encoded.
Short | Data inline, base64ed
Comments | The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.
Control | 0..0
Type | base64Binary
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Requirements | The data needs to able to be transmitted inline.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
196. DocumentReference.content.attachment.url
Definition | URI für das Dokument (DocumentEntry.URI)
Short | URI für das Dokument
Comments | Dateiname mit Extension ohne Pfadangabe
Control | 1..1
Type | url
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | The data needs to be transmitted by reference.
Example | General: http://www.acme.com/logo-small.png
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
198. DocumentReference.content.attachment.size
Definition | Größe des Dokuments in Bytes (DocumentEntry.size)
Short | Größe des Dokuments in Bytes
Comments | n/a
Control | 0..1
Type | unsignedInt
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
200. DocumentReference.content.attachment.hash
Definition | Kryptographische Prüfsumme des Dokuments (DocumentEntry.hash)
Short | Kryptographische Prüfsumme des Dokuments
Comments | n/a
Control | 0..1
Type | base64Binary
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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).
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
202. DocumentReference.content.attachment.title
Definition | Titel des Dokuments (DocumentEntry.title)
Short | Titel des Dokuments
Comments | n/a
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.
Example | General: Official Corporate Logo
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
204. DocumentReference.content.attachment.creation
Definition | Erstellungszeitpunkt des Dokuments (DocumentEntry.creationTime)
Short | Erstellungszeitpunkt des Dokuments
Comments | n/a
Control | 1..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | This is often tracked as an integrity issue for use of the attachment.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
206. DocumentReference.content.format
Definition | Global eindeutiger Code für das Dokumentenformat (DocumentEntry.formatCode)
Short | Global eindeutiger Code für das Dokumentenformat
Comments | Das Attribut 'formatCode' spezifiziert das Format des Dokumentes. Zusammen mit dem typeCode (und ggf. mit dem mimeType) soll der formatCode für hinreichende Information sorgen, um einem Dokument-Konsumenten die Entscheidung zu ermöglichen, ob und wie er das Dokumentenformat verarbeiten kann.
Control | 1..1 This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from IHE XDS Format Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-format-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
208. DocumentReference.context
Definition | The clinical context in which the document was prepared.
Short | Clinical context of document
Comments | These values are primarily added to help with searching for interesting/relevant documents.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
210. DocumentReference.context.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
212. DocumentReference.context.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.context.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
214. DocumentReference.context.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
216. DocumentReference.context.encounter
Definition | Describes the clinical encounter or type of care that the document content is associated with.
Short | Context of the document content
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..0 This element is affected by the following invariants: ele-1
Type | Reference(Encounter, EpisodeOfCare)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: SHALL have a contained resource if a local reference is provided (`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`)
218. DocumentReference.context.event
Definition | Ereignisse, die zur Erstellung des Dokuments geführt haben (DocumentEntry.eventCodeList)
Short | Ereignisse, die zur Erstellung des Dokuments geführt haben
Comments | Die eventCode Liste wurde konzipiert, um den medizinischen Kontext von Dokumenten abzubilden. Jedem Dokument können beliebig viele eventCodes zugeordnet werden. Zum Beispiel kann ein OP-Bericht über die eventCodeList mit je einem kodierten Wert für die durchgeführte Prozedur (z.B. Blinddarmentfernung) und die vorliegende Erkrankung (z.B. Appendizitis) versehen werden. Dies ermöglicht die Suche nach Dokumenten, die mit einer bestimmten Prozedur oder Diagnose zusammenhängen. Über den medizinischen Kontext hinaus kann das Attribut auch allgemein zur Kontextualisierung und zur Inhaltszusammenfassung verwendet werden.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | For example codes, see v3 Code System ActCode (example to `http://terminology.hl7.org/ValueSet/v3-ActCode` ) This list of codes represents the main clinical acts being documented.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
220. DocumentReference.context.event.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
222. DocumentReference.context.event.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.context.event.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
224. DocumentReference.context.event.coding
Definition | n/a
Short | Code defined by a terminology system
Comments | n/a
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from IHE XDS Event Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-event-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
226. DocumentReference.context.event.coding.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
228. DocumentReference.context.event.coding.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.context.event.coding.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
230. DocumentReference.context.event.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 1..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
232. DocumentReference.context.event.coding.version
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.
Short | Version of the system - if relevant
Comments | 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.
Note | This is a business version Id, not a resource version Id (see discussion)
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
234. DocumentReference.context.event.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 1..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
236. DocumentReference.context.event.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
238. DocumentReference.context.event.coding.userSelected
Definition | Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Short | If this coding was chosen directly by the user
Comments | 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.
Control | 0..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
240. DocumentReference.context.event.text
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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
242. DocumentReference.context.period
Definition | The time period over which the service that is described by the document was provided.
Short | Time of service that is being documented
Comments | A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Period
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) per-1: If present, start SHALL have a lower value than end (`start.hasValue().not() or end.hasValue().not() or (start <= end)`)
244. DocumentReference.context.period.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
246. DocumentReference.context.period.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.context.period.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
248. DocumentReference.context.period.start
Definition | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis begonnen wurde (DocumentEntry.serviceStartTime)
Short | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis begonnen wurde
Comments | n/a
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
250. DocumentReference.context.period.end
Definition | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis beendet wurde (DocumentEntry.serviceStopTime)
Short | Zeitpunkt, an dem das im Dokument dokumentierte (Behandlungs-)Ereignis beendet wurde
Comments | n/a
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Meaning if Missing | If the end of the period is missing, it means that the period is ongoing
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
252. DocumentReference.context.facilityType
Definition | Art der Einrichtung, in der das dokumentierte Ereignis stattgefunden hat (DocumentEntry.healthcareFacilityTypeCode)
Short | Art der Einrichtung, in der das dokumentierte Ereignis stattgefunden hat
Comments | DocumentEntry.healthcareFacilityTypeCode repräsentiert die Art der Einrichtung, in der die Tätigkeit stattfand, die zur Erzeugung des Dokuments führte. Zum Beispiel sollten Dokumente, die während eines ambulanten Falls in einem Krankenhaus entstehen, mit dem healthcareFacilityTypeCode für 'Krankenhaus' gekennzeichnet werden. Dabei ist zu beachten, dass es sich nicht notwendigerweise um die Art der Einrichtung handelt, in der das Dokument erstellt wurde. Beispielsweise ist es bei teleradiologischer Befundung eines Röntgenbildes für den healthcareFacilityTypeCode unerheblich, ob der befundende Radiologe in einem Krankenhaus oder in einer radiologischen Praxis ansässig ist; für den healthcareFacilityTypeCode wird die Einrichtungsart der Untersuchungsstelle (in der das Gerät betrieben wird) herangezogen.
Control | 1..1 This element is affected by the following invariants: ele-1
Binding | For example codes, see FacilityTypeCodeValueSet (example to `http://hl7.org/fhir/ValueSet/c80-facilitycodes` ) XDS Facility Type.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
254. DocumentReference.context.facilityType.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
256. DocumentReference.context.facilityType.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.context.facilityType.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
258. DocumentReference.context.facilityType.coding
Definition | n/a
Short | Code defined by a terminology system
Comments | n/a
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from IHE XDS Healthcare Facility Type Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-healthcare-facility-type-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
260. DocumentReference.context.facilityType.coding.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
262. DocumentReference.context.facilityType.coding.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.context.facilityType.coding.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
264. DocumentReference.context.facilityType.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 1..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
266. DocumentReference.context.facilityType.coding.version
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.
Short | Version of the system - if relevant
Comments | 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.
Note | This is a business version Id, not a resource version Id (see discussion)
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
268. DocumentReference.context.facilityType.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 1..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
270. DocumentReference.context.facilityType.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
272. DocumentReference.context.facilityType.coding.userSelected
Definition | Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Short | If this coding was chosen directly by the user
Comments | 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.
Control | 0..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
274. DocumentReference.context.facilityType.text
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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
276. DocumentReference.context.practiceSetting
Definition | Art der Fachrichtung der erstellenden Einrichtung, in der das dokumentiere Ereignis stattgefunden hat (DocumentEntry.practiceSettingCode)
Short | Art der Fachrichtung der erstellenden Einrichtung, in der das dokumentiere Ereignis stattgefunden hat
Comments | DocumentEntry.practiceSettingCode spezifiziert die Fachrichtung der erstellenden Einrichtung. Typische Beispiele hierfür sind ärztliche Fachgebiete wie Allgemeinmedizin oder Radiologie. IHE International empfiehlt, dass die Codeliste zwischen 10 und 100 Codes umfassen sollte, so dass die Fachrichtung hinreichend genau abgebildet werden kann.
Control | 0..1 This element is affected by the following invariants: ele-1
Binding | For example codes, see PracticeSettingCodeValueSet (example to `http://hl7.org/fhir/ValueSet/c80-practice-codes` ) Additional details about where the content was created (e.g. clinical specialty).
Type | CodeableConcept
Is Modifier | false
Must Support | true
Requirements | This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
278. DocumentReference.context.practiceSetting.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
280. DocumentReference.context.practiceSetting.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.context.practiceSetting.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
282. DocumentReference.context.practiceSetting.coding
Definition | n/a
Short | Code defined by a terminology system
Comments | n/a
Control | 0..* This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from IHE XDS Practice Setting Code ValueSet für ePA (required to `https://gematik.de/fhir/terminology/ValueSet/epa-xds-practice-setting-code-vs` )
Type | Coding
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
284. DocumentReference.context.practiceSetting.coding.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
286. DocumentReference.context.practiceSetting.coding.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.context.practiceSetting.coding.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
288. DocumentReference.context.practiceSetting.coding.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity of the terminology system
Comments | 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.
Control | 1..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
290. DocumentReference.context.practiceSetting.coding.version
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.
Short | Version of the system - if relevant
Comments | 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.
Note | This is a business version Id, not a resource version Id (see discussion)
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
292. DocumentReference.context.practiceSetting.coding.code
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).
Short | Symbol in syntax defined by the system
Control | 1..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to refer to a particular code in the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
294. DocumentReference.context.practiceSetting.coding.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
296. DocumentReference.context.practiceSetting.coding.userSelected
Definition | Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Short | If this coding was chosen directly by the user
Comments | 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.
Control | 0..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
298. DocumentReference.context.practiceSetting.text
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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
300. DocumentReference.context.sourcePatientInfo
Definition | The Patient Information as known when the document was published. May be a reference to a version specific, or contained.
Short | Patient demographics from source
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Reference(Patient)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: SHALL have a contained resource if a local reference is provided (`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`)
302. DocumentReference.context.sourcePatientInfo.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
304. DocumentReference.context.sourcePatientInfo.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `DocumentReference.context.sourcePatientInfo.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
306. DocumentReference.context.sourcePatientInfo.reference
Definition | Demographische Daten zum Patienten im Quellsystem (DocumentEntry.sourcePatientInfo)
Short | Demographische Daten zum Patienten im Quellsystem
Comments | n/a
Control | 0..1 This element is affected by the following invariants: ref-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
308. DocumentReference.context.sourcePatientInfo.type
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Short | Type the reference refers to (e.g. "Patient")
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to `http://hl7.org/fhir/ValueSet/resource-types` ) Aa resource (or, for logical models, the URI of the logical model).
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
310. DocumentReference.context.sourcePatientInfo.identifier
Definition | Kennung des Patienten im Quellsystem (DocumentEntry.sourcePatientId)
Short | Kennung des Patienten im Quellsystem
Comments | n/a
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Identifier
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
312. DocumentReference.context.sourcePatientInfo.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text alternative for the resource
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
314. DocumentReference.context.related
Definition | Liste von IDs, mit denen das Dokument assoziiert wird (DocumentEntry.referenceIdList)
Short | Liste von IDs, mit denen das Dokument assoziiert wird
Comments | n/a
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(Resource)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: SHALL have a contained resource if a local reference is provided (`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`)