| Official URL: https://fhir.kbv.de/StructureDefinition/KBV_PR_MIO_LAB_DocumentReference | Version: 1.0.0-update | |||
| Draft as of 2026-06-11 | Computable Name: KBV_PR_MIO_LAB_DocumentReference | |||
Copyright/Legal: Im folgenden Profil können Codes aus den Code-Systemen SNOMED CT®, LOINC, Ucum, ATC, ICD-10-GM, ICD-10-WHO, OPS, Alpha-ID/Alpha-ID-SE und ICF enthalten sein, die dem folgenden Urheberrecht unterliegen: This material includes SNOMED CT® Clinical Terms® (SNOMED CT® CT®) which is used by permission of SNOMED CT® International. All rights reserved. SNOMED CT® CT®, was originally created by The College of American Pathologists. SNOMED CT® and SNOMED CT® CT are registered trademarks of SNOMED CT® International. Implementers of these artefacts must have the appropriate SNOMED CT® CT Affiliate license. This material contains content from LOINC (http://LOINC.org). LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://LOINC.org/license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc. This product includes all or a portion of the UCUM table, UCUM codes, and UCUM definitions or is derived from it, subject to a license from Regenstrief Institute, Inc. and The UCUM Organization. Your use of the UCUM table, UCUM codes, UCUM definitions also is subject to this license, a copy of which is available at http://unitsofmeasure.org. The current complete UCUM table, UCUM Specification are available for download at http://unitsofmeasure.org. The UCUM table and UCUM codes are copyright © 1995-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. THE UCUM TABLE (IN ALL FORMATS), UCUM DEFINITIONS, AND SPECIFICATION ARE PROVIDED ‘AS IS.’ ANY EXPRESS OR IMPLIED WARRANTIES ARE DISCLAIMED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. Dieses Material enthält Inhalte aus ATC. Die Erstellung erfolgte unter Verwendung der Datenträger der amtlichen Fassung der ATC-Klassifikation mit DDD des Bundesinstituts für Arzneimittel und Medizinprodukte (BfArM). Dieses Material enthält Inhalte aus ICD-10-GM, ICD-10-WHO, OPS Alpha-ID ans Alpha-ID-SE. Die Erstellung erfolgt unter Verwendung der maschinenlesbaren Fassung des Bundesinstituts für Arzneimittel und Medizinprodukte (BfArM). Dieses Material enthält Inhalte aus ICF. Die Erstellung erfolgt unter Verwendung der maschinenlesbaren Fassung des Deutschen Instituts für Medizinische Dokumentation und Information (DIMDI). ICF-Kodes, -Begriffe und -Texte © Weltgesundheitsorganisation, übersetzt und herausgegeben durch das Deutsche Institut für Medizinische Dokumentation und Information von der International classification of functioning, disability and health - ICF, herausgegeben durch die Weltgesundheitsorganisation. |
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Hier werden zusätzliche Resultate, die nicht Teil des strukturierten MIO Laborbefundes sind, abgebildet.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  DocumentReference |
0..* | DocumentReference | A reference to a document | |
  meta |
SΣ | 0..1 | Meta | Metadata about the resource |
   versionId |
SΣ | 0..1 | id | Version specific identifier |
 lastUpdated |
SΣ | 0..1 | instant | When the resource version last changed |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!SΣ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. |
| type |
Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document. |
 Slices for coding |
Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this |
  coding:xds |
SΣ | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS typeCode (required) |
  system |
SΣ | 1..1 | uri | Identity of the terminology system |
| version |
SΣ | 0..1 | string | Version of the system - if relevant |
| code |
SΣ | 1..1 | code | Symbol in syntax defined by the system |
 display |
SΣ | 1..1 | string | Representation defined by the system |
| text |
Σ | 0..1 | string | Plain text representation of the concept |
| category |
Σ | 0..* | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. |
| Slices for coding |
Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this |
| coding:xds |
SΣ | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS classCode (required) |
| system |
SΣ | 1..1 | uri | Identity of the terminology system |
| version |
SΣ | 0..1 | string | Version of the system - if relevant |
| code |
SΣ | 1..1 | code | Symbol in syntax defined by the system |
| display |
SΣ | 1..1 | string | Representation defined by the system |
| text |
Σ | 0..1 | string | Plain text representation of the concept |
 subject |
SΣ | 1..1 | Reference(KBV_PR_MIO_LAB_Patient(1.0.0-update)) | Zu behandelnde Person |
| identifier |
SΣ | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known |
 Slices for content |
Σ | 1..* | BackboneElement | Document referenced Slice: Unordered, Closed by exists:attachment.url |
  content:All Slices |
Content/Rules for all slices | |||
  modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
 attachment |
Σ | 1..1 | Attachment | Where to access the document |
| content:appendix |
SΣ | 1..* | BackboneElement | Document referenced |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
 attachment |
SΣ | 1..1 | Attachment | Where to access the document |
| contentType |
SΣ | 1..1 | code | Mime type of the content, with charset etc. Binding: KBV_VS_MIO_LAB_MIME_Types (1.0.0-update) (required) Example General: text/plain; charset=UTF-8, image/png |
| data |
S | 1..1 | base64Binary | Data inline, base64ed |
| title |
SΣ | 1..1 | string | Label to display in place of the data Example General: Official Corporate Logo |
| creation |
SΣ | 0..1 | dateTime | Date attachment was first created |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.type.coding:xds | Base | required | IHE XDS typeCode | 📦2020-02-07T07:55:58 | de.ihe-d.terminology v3.0 |
| DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.category.coding:xds | Base | required | IHE XDS classCode | 📦2021-06-25T13:44:47 | de.ihe-d.terminology v3.0 |
| DocumentReference.relatesTo.code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std. |
| DocumentReference.content:appendix.attachment.contentType | Base | required | Dateiformat | 📍1.0.0-update | This IG |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
This structure is derived from DocumentReference
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| DocumentReference |
0..* | DocumentReference | A reference to a document | |
| meta |
S | 0..1 | Meta | Metadata about the resource |
| id |
0..0 | Unique id for inter-element referencing | ||
| versionId |
S | 0..1 | id | Version specific identifier |
| lastUpdated |
S | 0..1 | instant | When the resource version last changed |
| source |
0..0 | Identifies where the resource comes from | ||
| implicitRules |
0..0 | A set of rules under which this content was created | ||
| language |
0..0 | Language of the resource content | ||
| text |
||||
| status |
1..1 | code | generated | extensions | additional | empty Required Pattern: extensions | |
| contained |
0..0 | Contained, inline Resources | ||
| masterIdentifier |
0..0 | Master Version Specific Identifier | ||
| identifier |
0..0 | Other identifiers for the document | ||
| status |
S | 1..1 | code | current | superseded | entered-in-error |
| docStatus |
0..0 | preliminary | final | amended | entered-in-error | ||
| type |
0..1 | CodeableConcept | Kind of document (LOINC if possible) | |
| Slices for coding |
0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this | |
| coding:xds |
S | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS typeCode (required) |
| system |
S | 1..1 | uri | Identity of the terminology system |
| version |
S | 0..1 | string | Version of the system - if relevant |
| code |
S | 1..1 | code | Symbol in syntax defined by the system |
| display |
S | 1..1 | string | Representation defined by the system |
| userSelected |
0..0 | If this coding was chosen directly by the user | ||
| text |
0..1 | string | Plain text representation of the concept | |
| category |
0..* | CodeableConcept | Categorization of document | |
| Slices for coding |
0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this | |
| coding:xds |
S | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS classCode (required) |
| system |
S | 1..1 | uri | Identity of the terminology system |
| version |
S | 0..1 | string | Version of the system - if relevant |
| code |
S | 1..1 | code | Symbol in syntax defined by the system |
| display |
S | 1..1 | string | Representation defined by the system |
| userSelected |
0..0 | If this coding was chosen directly by the user | ||
| text |
0..1 | string | Plain text representation of the concept | |
| subject |
S | 1..1 | Reference(KBV_PR_MIO_LAB_Patient(1.0.0-update)) | Zu behandelnde Person |
| identifier |
S | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known |
| date |
0..0 | When this document reference was created | ||
| author |
0..0 | Who and/or what authored the document | ||
| authenticator |
0..0 | Who/what authenticated the document | ||
| custodian |
0..0 | Organization which maintains the document | ||
| relatesTo |
0..0 | Relationships to other documents | ||
| description |
0..0 | Human-readable description | ||
| securityLabel |
0..0 | Document security-tags | ||
| Slices for content |
1..* | BackboneElement | Document referenced Slice: Unordered, Closed by exists:attachment.url | |
| content:appendix |
S | 1..* | BackboneElement | Document referenced |
 attachment |
S | 1..1 | Attachment | Where to access the document |
 contentType |
S | 1..1 | code | Mime type of the content, with charset etc. Binding: KBV_VS_MIO_LAB_MIME_Types (1.0.0-update) (required) |
| language |
0..0 | Human language of the content (BCP-47) | ||
| data |
S | 1..1 | base64Binary | Data inline, base64ed |
| url |
0..0 | Uri where the data can be found | ||
| size |
0..0 | Number of bytes of content (if url provided) | ||
| hash |
0..0 | Hash of the data (sha-1, base64ed) | ||
| title |
S | 1..1 | string | Label to display in place of the data |
| creation |
S | 0..1 | dateTime | Date attachment was first created |
| format |
0..0 | Format/content rules for the document | ||
| context |
0..0 | Clinical context of document | ||
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.type.coding:xds | Base | required | IHE XDS typeCode | 📦2020-02-07T07:55:58 | de.ihe-d.terminology v3.0 |
| DocumentReference.category.coding:xds | Base | required | IHE XDS classCode | 📦2021-06-25T13:44:47 | de.ihe-d.terminology v3.0 |
| DocumentReference.content:appendix.attachment.contentType | Base | required | Dateiformat | 📍1.0.0-update | This IG |
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| DocumentReference |
0..* | DocumentReference | A reference to a document | |
| id |
Σ | 0..1 | id | Logical id of this artifact |
| meta |
SΣ | 0..1 | Meta | Metadata about the resource |
 extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| versionId |
SΣ | 0..1 | id | Version specific identifier |
| lastUpdated |
SΣ | 0..1 | instant | When the resource version last changed |
| profile |
Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. |
| 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". |
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| status |
1..1 | code | generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative. Required Pattern: extensions | |
| div |
C | 1..1 | xhtml | Limited xhtml content Constraints: txt-1, txt-2 |
| extension |
0..* | Extension | Additional content defined by implementations | |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!SΣ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. |
| type |
Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical 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 | |
| Slices for coding |
Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this |
| coding:xds |
SΣ | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS typeCode (required) |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| system |
SΣ | 1..1 | uri | Identity of the terminology system |
| version |
SΣ | 0..1 | string | Version of the system - if relevant |
| code |
SΣ | 1..1 | code | Symbol in syntax defined by the system |
| display |
SΣ | 1..1 | string | Representation defined by the system |
| text |
Σ | 0..1 | string | Plain text representation of the concept |
| category |
Σ | 0..* | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| Slices for coding |
Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this |
| coding:xds |
SΣ | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS classCode (required) |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| system |
SΣ | 1..1 | uri | Identity of the terminology system |
| version |
SΣ | 0..1 | string | Version of the system - if relevant |
| code |
SΣ | 1..1 | code | Symbol in syntax defined by the system |
| display |
SΣ | 1..1 | string | Representation defined by the system |
| text |
Σ | 0..1 | string | Plain text representation of the concept |
| subject |
SΣ | 1..1 | Reference(KBV_PR_MIO_LAB_Patient(1.0.0-update)) | Zu behandelnde Person |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). |
| identifier |
SΣ | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known |
| display |
Σ | 0..1 | string | Text alternative for the resource |
| Slices for content |
Σ | 1..* | BackboneElement | Document referenced Slice: Unordered, Closed by exists:attachment.url |
| content:All Slices |
Content/Rules for all slices | |||
| 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 |
| format |
Σ | 0..1 | Coding | Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes. |
| content:appendix |
SΣ | 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 |
SΣ | 1..1 | Attachment | Where to access 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 | |
| contentType |
SΣ | 1..1 | code | Mime type of the content, with charset etc. Binding: KBV_VS_MIO_LAB_MIME_Types (1.0.0-update) (required) Example General: text/plain; charset=UTF-8, image/png |
| data |
S | 1..1 | base64Binary | Data inline, base64ed |
| title |
SΣ | 1..1 | string | Label to display in place of the data Example General: Official Corporate Logo |
| creation |
SΣ | 0..1 | dateTime | Date attachment was first created |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| DocumentReference.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| DocumentReference.text.status | Base | required | NarrativeStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.type.coding:xds | Base | required | IHE XDS typeCode | 📦2020-02-07T07:55:58 | de.ihe-d.terminology v3.0 |
| DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.category.coding:xds | Base | required | IHE XDS classCode | 📦2021-06-25T13:44:47 | de.ihe-d.terminology v3.0 |
| DocumentReference.subject.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| DocumentReference.relatesTo.code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std. |
| DocumentReference.content.format | Base | preferred | DocumentReference Format Code Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.content:appendix.attachment.contentType | Base | required | Dateiformat | 📍1.0.0-update | This IG |
| DocumentReference.context.event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v7.2 |
| DocumentReference.context.facilityType | Base | example | Facility Type Code Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.context.practiceSetting | Base | example | Practice Setting Code Value Set | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
| txt-1 | error | DocumentReference.text.div | The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes |
htmlChecks()
|
| txt-2 | error | DocumentReference.text.div | The narrative SHALL have some non-whitespace content |
htmlChecks()
|
This structure is derived from DocumentReference
Summary
Mandatory: 6 elements(6 nested mandatory elements)
Must-Support: 22 elements
Prohibited: 23 elements
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| DocumentReference |
0..* | DocumentReference | A reference to a document | |
| meta |
SΣ | 0..1 | Meta | Metadata about the resource |
| versionId |
SΣ | 0..1 | id | Version specific identifier |
| lastUpdated |
SΣ | 0..1 | instant | When the resource version last changed |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!SΣ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. |
| type |
Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document. |
| Slices for coding |
Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this |
| coding:xds |
SΣ | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS typeCode (required) |
| system |
SΣ | 1..1 | uri | Identity of the terminology system |
| version |
SΣ | 0..1 | string | Version of the system - if relevant |
| code |
SΣ | 1..1 | code | Symbol in syntax defined by the system |
| display |
SΣ | 1..1 | string | Representation defined by the system |
| text |
Σ | 0..1 | string | Plain text representation of the concept |
| category |
Σ | 0..* | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. |
| Slices for coding |
Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this |
| coding:xds |
SΣ | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS classCode (required) |
| system |
SΣ | 1..1 | uri | Identity of the terminology system |
| version |
SΣ | 0..1 | string | Version of the system - if relevant |
| code |
SΣ | 1..1 | code | Symbol in syntax defined by the system |
| display |
SΣ | 1..1 | string | Representation defined by the system |
| text |
Σ | 0..1 | string | Plain text representation of the concept |
| subject |
SΣ | 1..1 | Reference(KBV_PR_MIO_LAB_Patient(1.0.0-update)) | Zu behandelnde Person |
| identifier |
SΣ | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known |
| Slices for content |
Σ | 1..* | BackboneElement | Document referenced Slice: Unordered, Closed by exists:attachment.url |
| content:All Slices |
Content/Rules for all slices | |||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| attachment |
Σ | 1..1 | Attachment | Where to access the document |
| content:appendix |
SΣ | 1..* | BackboneElement | Document referenced |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| attachment |
SΣ | 1..1 | Attachment | Where to access the document |
| contentType |
SΣ | 1..1 | code | Mime type of the content, with charset etc. Binding: KBV_VS_MIO_LAB_MIME_Types (1.0.0-update) (required) Example General: text/plain; charset=UTF-8, image/png |
| data |
S | 1..1 | base64Binary | Data inline, base64ed |
| title |
SΣ | 1..1 | string | Label to display in place of the data Example General: Official Corporate Logo |
| creation |
SΣ | 0..1 | dateTime | Date attachment was first created |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.type.coding:xds | Base | required | IHE XDS typeCode | 📦2020-02-07T07:55:58 | de.ihe-d.terminology v3.0 |
| DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.category.coding:xds | Base | required | IHE XDS classCode | 📦2021-06-25T13:44:47 | de.ihe-d.terminology v3.0 |
| DocumentReference.relatesTo.code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std. |
| DocumentReference.content:appendix.attachment.contentType | Base | required | Dateiformat | 📍1.0.0-update | This IG |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
Differential View
This structure is derived from DocumentReference
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| DocumentReference |
0..* | DocumentReference | A reference to a document | |
| meta |
S | 0..1 | Meta | Metadata about the resource |
| id |
0..0 | Unique id for inter-element referencing | ||
| versionId |
S | 0..1 | id | Version specific identifier |
| lastUpdated |
S | 0..1 | instant | When the resource version last changed |
| source |
0..0 | Identifies where the resource comes from | ||
| implicitRules |
0..0 | A set of rules under which this content was created | ||
| language |
0..0 | Language of the resource content | ||
| text |
||||
| status |
1..1 | code | generated | extensions | additional | empty Required Pattern: extensions | |
| contained |
0..0 | Contained, inline Resources | ||
| masterIdentifier |
0..0 | Master Version Specific Identifier | ||
| identifier |
0..0 | Other identifiers for the document | ||
| status |
S | 1..1 | code | current | superseded | entered-in-error |
| docStatus |
0..0 | preliminary | final | amended | entered-in-error | ||
| type |
0..1 | CodeableConcept | Kind of document (LOINC if possible) | |
| Slices for coding |
0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this | |
| coding:xds |
S | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS typeCode (required) |
| system |
S | 1..1 | uri | Identity of the terminology system |
| version |
S | 0..1 | string | Version of the system - if relevant |
| code |
S | 1..1 | code | Symbol in syntax defined by the system |
| display |
S | 1..1 | string | Representation defined by the system |
| userSelected |
0..0 | If this coding was chosen directly by the user | ||
| text |
0..1 | string | Plain text representation of the concept | |
| category |
0..* | CodeableConcept | Categorization of document | |
| Slices for coding |
0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this | |
| coding:xds |
S | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS classCode (required) |
| system |
S | 1..1 | uri | Identity of the terminology system |
| version |
S | 0..1 | string | Version of the system - if relevant |
| code |
S | 1..1 | code | Symbol in syntax defined by the system |
| display |
S | 1..1 | string | Representation defined by the system |
| userSelected |
0..0 | If this coding was chosen directly by the user | ||
| text |
0..1 | string | Plain text representation of the concept | |
| subject |
S | 1..1 | Reference(KBV_PR_MIO_LAB_Patient(1.0.0-update)) | Zu behandelnde Person |
| identifier |
S | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known |
| date |
0..0 | When this document reference was created | ||
| author |
0..0 | Who and/or what authored the document | ||
| authenticator |
0..0 | Who/what authenticated the document | ||
| custodian |
0..0 | Organization which maintains the document | ||
| relatesTo |
0..0 | Relationships to other documents | ||
| description |
0..0 | Human-readable description | ||
| securityLabel |
0..0 | Document security-tags | ||
| Slices for content |
1..* | BackboneElement | Document referenced Slice: Unordered, Closed by exists:attachment.url | |
| content:appendix |
S | 1..* | BackboneElement | Document referenced |
| attachment |
S | 1..1 | Attachment | Where to access the document |
| contentType |
S | 1..1 | code | Mime type of the content, with charset etc. Binding: KBV_VS_MIO_LAB_MIME_Types (1.0.0-update) (required) |
| language |
0..0 | Human language of the content (BCP-47) | ||
| data |
S | 1..1 | base64Binary | Data inline, base64ed |
| url |
0..0 | Uri where the data can be found | ||
| size |
0..0 | Number of bytes of content (if url provided) | ||
| hash |
0..0 | Hash of the data (sha-1, base64ed) | ||
| title |
S | 1..1 | string | Label to display in place of the data |
| creation |
S | 0..1 | dateTime | Date attachment was first created |
| format |
0..0 | Format/content rules for the document | ||
| context |
0..0 | Clinical context of document | ||
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.type.coding:xds | Base | required | IHE XDS typeCode | 📦2020-02-07T07:55:58 | de.ihe-d.terminology v3.0 |
| DocumentReference.category.coding:xds | Base | required | IHE XDS classCode | 📦2021-06-25T13:44:47 | de.ihe-d.terminology v3.0 |
| DocumentReference.content:appendix.attachment.contentType | Base | required | Dateiformat | 📍1.0.0-update | This IG |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| DocumentReference |
0..* | DocumentReference | A reference to a document | |
| id |
Σ | 0..1 | id | Logical id of this artifact |
| meta |
SΣ | 0..1 | Meta | Metadata about the resource |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| versionId |
SΣ | 0..1 | id | Version specific identifier |
| lastUpdated |
SΣ | 0..1 | instant | When the resource version last changed |
| profile |
Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. |
| 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". |
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| status |
1..1 | code | generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative. Required Pattern: extensions | |
| div |
C | 1..1 | xhtml | Limited xhtml content Constraints: txt-1, txt-2 |
| extension |
0..* | Extension | Additional content defined by implementations | |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!SΣ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. |
| type |
Σ | 0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical 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 | |
| Slices for coding |
Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this |
| coding:xds |
SΣ | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS typeCode (required) |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| system |
SΣ | 1..1 | uri | Identity of the terminology system |
| version |
SΣ | 0..1 | string | Version of the system - if relevant |
| code |
SΣ | 1..1 | code | Symbol in syntax defined by the system |
| display |
SΣ | 1..1 | string | Representation defined by the system |
| text |
Σ | 0..1 | string | Plain text representation of the concept |
| category |
Σ | 0..* | CodeableConcept | Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| Slices for coding |
Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this |
| coding:xds |
SΣ | 0..1 | Coding | Code defined by a terminology system Binding: IHE XDS classCode (required) |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| system |
SΣ | 1..1 | uri | Identity of the terminology system |
| version |
SΣ | 0..1 | string | Version of the system - if relevant |
| code |
SΣ | 1..1 | code | Symbol in syntax defined by the system |
| display |
SΣ | 1..1 | string | Representation defined by the system |
| text |
Σ | 0..1 | string | Plain text representation of the concept |
| subject |
SΣ | 1..1 | Reference(KBV_PR_MIO_LAB_Patient(1.0.0-update)) | Zu behandelnde Person |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). |
| identifier |
SΣ | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known |
| display |
Σ | 0..1 | string | Text alternative for the resource |
| Slices for content |
Σ | 1..* | BackboneElement | Document referenced Slice: Unordered, Closed by exists:attachment.url |
| content:All Slices |
Content/Rules for all slices | |||
| 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 |
| format |
Σ | 0..1 | Coding | Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes. |
| content:appendix |
SΣ | 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 |
SΣ | 1..1 | Attachment | Where to access 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 | |
| contentType |
SΣ | 1..1 | code | Mime type of the content, with charset etc. Binding: KBV_VS_MIO_LAB_MIME_Types (1.0.0-update) (required) Example General: text/plain; charset=UTF-8, image/png |
| data |
S | 1..1 | base64Binary | Data inline, base64ed |
| title |
SΣ | 1..1 | string | Label to display in place of the data Example General: Official Corporate Logo |
| creation |
SΣ | 0..1 | dateTime | Date attachment was first created |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| DocumentReference.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| DocumentReference.text.status | Base | required | NarrativeStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.type | Base | preferred | Document Type Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.type.coding:xds | Base | required | IHE XDS typeCode | 📦2020-02-07T07:55:58 | de.ihe-d.terminology v3.0 |
| DocumentReference.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.category.coding:xds | Base | required | IHE XDS classCode | 📦2021-06-25T13:44:47 | de.ihe-d.terminology v3.0 |
| DocumentReference.subject.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| DocumentReference.relatesTo.code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std. |
| DocumentReference.content.format | Base | preferred | DocumentReference Format Code Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.content:appendix.attachment.contentType | Base | required | Dateiformat | 📍1.0.0-update | This IG |
| DocumentReference.context.event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v7.2 |
| DocumentReference.context.facilityType | Base | example | Facility Type Code Value Set | 📍4.0.1 | FHIR Std. |
| DocumentReference.context.practiceSetting | Base | example | Practice Setting Code Value Set | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
| txt-1 | error | DocumentReference.text.div | The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes |
htmlChecks()
|
| txt-2 | error | DocumentReference.text.div | The narrative SHALL have some non-whitespace content |
htmlChecks()
|
This structure is derived from DocumentReference
Summary
Mandatory: 6 elements(6 nested mandatory elements)
Must-Support: 22 elements
Prohibited: 23 elements
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Other representations of profile: CSV, Excel, Schematron