ESMD FHIR Implementation Guide - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• Examples
• JSON

Resource Profile: Esmd Document Reference Profile

The Esmd-DocumentReference profile extends the HL7 DocumentReference resource. It is used within the Esmd-BundleSubmission resource to transmit document metadata to the esMD System. The document metadata includes a Binary URL (also referred to as a storage URL) which points to the location where the document payload is stored in esMD's secure storage.

Usage:

• Use this Resource Profile: Esmd Bundle Submission Profile
• Refer to this Resource Profile: Esmd List SubmissionSet Profile
• Examples for this Resource Profile: DocumentReference/ExampleEsmdDocumentReferenceValid and DocumentReference/doc-002
• CapabilityStatements using this Resource Profile: esMD FHIR Server Capability Statement

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
meta	SΣ	0..1	EsmdMeta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
Slices for profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children
profile:esmddocumentreference	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children Fixed Value: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-DocumentReference
security	SΣC	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children inv-esmd-meta-security-01: esMD supports only V security code
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for identifier	Σ	1..*	Identifier	Other identifiers for the document Slice: Unordered, Open by pattern:system ele-1: All FHIR elements must have a @value or children
identifier:uniqueId	Σ	1..1	Identifier	Other identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-UniqueId
identifier:letterId	Σ	0..1	Identifier	Other identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-LetterId
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. ele-1: All FHIR elements must have a @value or children Required Pattern: current
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document. ele-1: All FHIR elements must have a @value or children
category	SΣ	0..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. ele-1: All FHIR elements must have a @value or children
date	SΣ	1..1	instant	When this document reference was created ele-1: All FHIR elements must have a @value or children
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document ele-1: All FHIR elements must have a @value or children
custodian		0..1	Reference(Organization)	Organization which maintains the document ele-1: All FHIR elements must have a @value or children
relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. ele-1: All FHIR elements must have a @value or children
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship ele-1: All FHIR elements must have a @value or children
description	Σ	0..1	string	Human-readable description ele-1: All FHIR elements must have a @value or children
securityLabel	SΣ	1..1	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children
content	Σ	1..*	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	Σ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children
id	S	1..1	string	Unique id for inter-element referencing
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: ESMD MimeTypes ValueSet (required) ele-1: All FHIR elements must have a @value or children Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding ele-1: All FHIR elements must have a @value or children Example General: en-AU
url	SΣ	1..1	url	Uri where the data can be found ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/logo-small.png
size	SΣ	1..1	unsignedInt	Number of bytes of content (if url provided) ele-1: All FHIR elements must have a @value or children
hash	SΣ	1..1	base64Binary	Hash of the data (sha-256) ele-1: All FHIR elements must have a @value or children
title	SΣ	1..1	string	Label to display in place of the data ele-1: All FHIR elements must have a @value or children Example General: Official Corporate Logo
creation	SΣ	1..1	dateTime	Date attachment was first created ele-1: All FHIR elements must have a @value or children
context	Σ	1..1	BackboneElement	Clinical context of document ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
facilityType		1..1	CodeableConcept	Kind of facility where patient was seen Binding: ESMD Facility Type Codes (required) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.identifier:uniqueId.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:letterId.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.status	required	Pattern: current http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes from the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	EsmdVSMimeTypes https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-MimeTypes from this IG
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.context.facilityType	required	EsmdVSFacilityTypeCodes (a valid code from esMD Facility Type Codes) https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-FacilityTypeCodes from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	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	error	DocumentReference	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	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
inv-esmd-meta-security-01	error	DocumentReference.meta.security	esMD supports only V security code : code.exists() implies (code = 'V' or code = 'HTEST')

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document
meta	S	0..1	EsmdMeta	Metadata about the resource
profile		1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for profile				Content/Rules for all slices
profile:esmddocumentreference		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Fixed Value: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-DocumentReference
security	S	0..*	Coding	Security Labels applied to this resource
modifierExtension		0..0
Slices for identifier		1..*	Identifier	Other identifiers for the document Slice: Unordered, Open by pattern:system
identifier:uniqueId		1..1	Identifier	Other identifiers for the document
system		1..1	uri	The namespace for the identifier value Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-UniqueId
identifier:letterId		0..1	Identifier	Other identifiers for the document
system		1..1	uri	The namespace for the identifier value Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-LetterId
status	S	1..1	code	current | superseded | entered-in-error Required Pattern: current
docStatus		0..0
type	S	0..1	CodeableConcept	Kind of document (LOINC if possible)
category	S	0..1	CodeableConcept	Categorization of document
subject		0..0
date	S	1..1	instant	When this document reference was created
author	S	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
relatesTo	S	0..*	BackboneElement	Relationships to other documents
code		1..1	code	replaces | transforms | signs | appends
target		1..1	Reference(DocumentReference)	Target of the relationship
description		0..1	string	Human-readable description
securityLabel	S	1..1	CodeableConcept	Document security-tags
content		1..*	BackboneElement	Document referenced
attachment
id	S	1..1	string	Unique id for inter-element referencing
contentType	S	1..1	code	Mime type of the content, with charset etc. Binding: ESMD MimeTypes ValueSet (required)
language	S	0..1	code	Human language of the content (BCP-47)
data		0..0
url	S	1..1	url	Uri where the data can be found
size	S	1..1	unsignedInt	Number of bytes of content (if url provided)
hash	S	1..1	base64Binary	Hash of the data (sha-256)
title	S	1..1	string	Label to display in place of the data
creation	S	1..1	dateTime	Date attachment was first created
context		1..1	BackboneElement	Clinical context of document
facilityType		1..1	CodeableConcept	Kind of facility where patient was seen Binding: ESMD Facility Type Codes (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.content.attachment.contentType	required	EsmdVSMimeTypes https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-MimeTypes from this IG
DocumentReference.context.facilityType	required	EsmdVSFacilityTypeCodes (a valid code from esMD Facility Type Codes) https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-FacilityTypeCodes from this IG

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document
id	Σ	0..1	id	Logical id of this artifact
meta	SΣ	0..1	EsmdMeta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
Slices for profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to Slice: Unordered, Open by value:$this
profile:esmddocumentreference	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Fixed Value: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-DocumentReference
security	SΣC	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. inv-esmd-meta-security-01: esMD supports only V security code
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
Slices for identifier	Σ	1..*	Identifier	Other identifiers for the document Slice: Unordered, Open by pattern:system
identifier:uniqueId	Σ	1..1	Identifier	Other identifiers for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-UniqueId
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:letterId	Σ	0..1	Identifier	Other identifiers for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-LetterId
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. Required Pattern: current
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
authenticator		0..1	Reference(Practitioner | PractitionerRole | Organization)	Who/what authenticated the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	SΣ	1..1	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id	S	1..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: ESMD MimeTypes ValueSet (required) Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	SΣ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	SΣ	1..1	unsignedInt	Number of bytes of content (if url provided)
hash	SΣ	1..1	base64Binary	Hash of the data (sha-256)
title	SΣ	1..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	SΣ	1..1	dateTime	Date attachment was first created
format	Σ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
context	Σ	1..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter		0..*	Reference(Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	Time of service that is being documented
facilityType		1..1	CodeableConcept	Kind of facility where patient was seen Binding: ESMD Facility Type Codes (required)
practiceSetting		0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
DocumentReference.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier:uniqueId.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:uniqueId.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.identifier:letterId.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:letterId.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	Pattern: current http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes from the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	EsmdVSMimeTypes https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-MimeTypes from this IG
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	preferred	DocumentReferenceFormatCodeSet (a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes from the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	required	EsmdVSFacilityTypeCodes (a valid code from esMD Facility Type Codes) https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-FacilityTypeCodes from this IG
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	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	error	DocumentReference	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	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
inv-esmd-meta-security-01	error	DocumentReference.meta.security	esMD supports only V security code : code.exists() implies (code = 'V' or code = 'HTEST')

This structure is derived from DocumentReference

Summary

Mandatory: 14 elements(2 nested mandatory elements)
Must-Support: 17 elements
Fixed: 1 element
Prohibited: 4 elements

Structures

This structure refers to these other structures:

• esMD Meta (https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Meta)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.identifier

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
meta	SΣ	0..1	EsmdMeta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
Slices for profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to Slice: Unordered, Open by value:$this ele-1: All FHIR elements must have a @value or children
profile:esmddocumentreference	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children Fixed Value: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-DocumentReference
security	SΣC	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children inv-esmd-meta-security-01: esMD supports only V security code
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for identifier	Σ	1..*	Identifier	Other identifiers for the document Slice: Unordered, Open by pattern:system ele-1: All FHIR elements must have a @value or children
identifier:uniqueId	Σ	1..1	Identifier	Other identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-UniqueId
identifier:letterId	Σ	0..1	Identifier	Other identifiers for the document ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-LetterId
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. ele-1: All FHIR elements must have a @value or children Required Pattern: current
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document. ele-1: All FHIR elements must have a @value or children
category	SΣ	0..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. ele-1: All FHIR elements must have a @value or children
date	SΣ	1..1	instant	When this document reference was created ele-1: All FHIR elements must have a @value or children
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document ele-1: All FHIR elements must have a @value or children
custodian		0..1	Reference(Organization)	Organization which maintains the document ele-1: All FHIR elements must have a @value or children
relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. ele-1: All FHIR elements must have a @value or children
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship ele-1: All FHIR elements must have a @value or children
description	Σ	0..1	string	Human-readable description ele-1: All FHIR elements must have a @value or children
securityLabel	SΣ	1..1	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children
content	Σ	1..*	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	Σ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children
id	S	1..1	string	Unique id for inter-element referencing
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: ESMD MimeTypes ValueSet (required) ele-1: All FHIR elements must have a @value or children Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding ele-1: All FHIR elements must have a @value or children Example General: en-AU
url	SΣ	1..1	url	Uri where the data can be found ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/logo-small.png
size	SΣ	1..1	unsignedInt	Number of bytes of content (if url provided) ele-1: All FHIR elements must have a @value or children
hash	SΣ	1..1	base64Binary	Hash of the data (sha-256) ele-1: All FHIR elements must have a @value or children
title	SΣ	1..1	string	Label to display in place of the data ele-1: All FHIR elements must have a @value or children Example General: Official Corporate Logo
creation	SΣ	1..1	dateTime	Date attachment was first created ele-1: All FHIR elements must have a @value or children
context	Σ	1..1	BackboneElement	Clinical context of document ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
facilityType		1..1	CodeableConcept	Kind of facility where patient was seen Binding: ESMD Facility Type Codes (required) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.identifier:uniqueId.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:letterId.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.status	required	Pattern: current http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes from the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	EsmdVSMimeTypes https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-MimeTypes from this IG
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.context.facilityType	required	EsmdVSFacilityTypeCodes (a valid code from esMD Facility Type Codes) https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-FacilityTypeCodes from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	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	error	DocumentReference	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	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
inv-esmd-meta-security-01	error	DocumentReference.meta.security	esMD supports only V security code : code.exists() implies (code = 'V' or code = 'HTEST')

Differential View

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document
meta	S	0..1	EsmdMeta	Metadata about the resource
profile		1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for profile				Content/Rules for all slices
profile:esmddocumentreference		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Fixed Value: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-DocumentReference
security	S	0..*	Coding	Security Labels applied to this resource
modifierExtension		0..0
Slices for identifier		1..*	Identifier	Other identifiers for the document Slice: Unordered, Open by pattern:system
identifier:uniqueId		1..1	Identifier	Other identifiers for the document
system		1..1	uri	The namespace for the identifier value Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-UniqueId
identifier:letterId		0..1	Identifier	Other identifiers for the document
system		1..1	uri	The namespace for the identifier value Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-LetterId
status	S	1..1	code	current | superseded | entered-in-error Required Pattern: current
docStatus		0..0
type	S	0..1	CodeableConcept	Kind of document (LOINC if possible)
category	S	0..1	CodeableConcept	Categorization of document
subject		0..0
date	S	1..1	instant	When this document reference was created
author	S	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
relatesTo	S	0..*	BackboneElement	Relationships to other documents
code		1..1	code	replaces | transforms | signs | appends
target		1..1	Reference(DocumentReference)	Target of the relationship
description		0..1	string	Human-readable description
securityLabel	S	1..1	CodeableConcept	Document security-tags
content		1..*	BackboneElement	Document referenced
attachment
id	S	1..1	string	Unique id for inter-element referencing
contentType	S	1..1	code	Mime type of the content, with charset etc. Binding: ESMD MimeTypes ValueSet (required)
language	S	0..1	code	Human language of the content (BCP-47)
data		0..0
url	S	1..1	url	Uri where the data can be found
size	S	1..1	unsignedInt	Number of bytes of content (if url provided)
hash	S	1..1	base64Binary	Hash of the data (sha-256)
title	S	1..1	string	Label to display in place of the data
creation	S	1..1	dateTime	Date attachment was first created
context		1..1	BackboneElement	Clinical context of document
facilityType		1..1	CodeableConcept	Kind of facility where patient was seen Binding: ESMD Facility Type Codes (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.content.attachment.contentType	required	EsmdVSMimeTypes https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-MimeTypes from this IG
DocumentReference.context.facilityType	required	EsmdVSFacilityTypeCodes (a valid code from esMD Facility Type Codes) https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-FacilityTypeCodes from this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document
id	Σ	0..1	id	Logical id of this artifact
meta	SΣ	0..1	EsmdMeta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
Slices for profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to Slice: Unordered, Open by value:$this
profile:esmddocumentreference	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Fixed Value: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-DocumentReference
security	SΣC	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. inv-esmd-meta-security-01: esMD supports only V security code
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
Slices for identifier	Σ	1..*	Identifier	Other identifiers for the document Slice: Unordered, Open by pattern:system
identifier:uniqueId	Σ	1..1	Identifier	Other identifiers for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-UniqueId
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:letterId	Σ	0..1	Identifier	Other identifiers for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Idn-LetterId
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. Required Pattern: current
type	SΣ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
category	SΣ	0..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
authenticator		0..1	Reference(Practitioner | PractitionerRole | Organization)	Who/what authenticated the document
custodian		0..1	Reference(Organization)	Organization which maintains the document
relatesTo	SΣ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	SΣ	1..1	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id	S	1..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: ESMD MimeTypes ValueSet (required) Example General: text/plain; charset=UTF-8, image/png
language	SΣ	0..1	code	Human language of the content (BCP-47) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
url	SΣ	1..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	SΣ	1..1	unsignedInt	Number of bytes of content (if url provided)
hash	SΣ	1..1	base64Binary	Hash of the data (sha-256)
title	SΣ	1..1	string	Label to display in place of the data Example General: Official Corporate Logo
creation	SΣ	1..1	dateTime	Date attachment was first created
format	Σ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
context	Σ	1..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter		0..*	Reference(Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	Time of service that is being documented
facilityType		1..1	CodeableConcept	Kind of facility where patient was seen Binding: ESMD Facility Type Codes (required)
practiceSetting		0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
DocumentReference.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier:uniqueId.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:uniqueId.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.identifier:letterId.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
DocumentReference.identifier:letterId.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
DocumentReference.status	required	Pattern: current http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes from the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.attachment.contentType	required	EsmdVSMimeTypes https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-MimeTypes from this IG
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	preferred	DocumentReferenceFormatCodeSet (a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes from the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	required	EsmdVSFacilityTypeCodes (a valid code from esMD Facility Type Codes) https://terminology.esmduat.cms.gov:8099/fhir/ValueSet/Esmd-VS-FacilityTypeCodes from this IG
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	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	error	DocumentReference	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	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
inv-esmd-meta-security-01	error	DocumentReference.meta.security	esMD supports only V security code : code.exists() implies (code = 'V' or code = 'HTEST')

This structure is derived from DocumentReference

Summary

Mandatory: 14 elements(2 nested mandatory elements)
Must-Support: 17 elements
Fixed: 1 element
Prohibited: 4 elements

Structures

This structure refers to these other structures:

• esMD Meta (https://terminology.esmduat.cms.gov:8099/fhir/StructureDefinition/Esmd-Meta)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.identifier

Other representations of profile: CSV, Excel, Schematron