haau3 FHIR Implementation Guide (HFIG) - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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• Detailed Descriptions
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• XML
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Resource Profile: KTC Patient-Shared DocumentReference

This profile aligns with https://ktc-spec.github.io/#documentreference-profile-patientshareddocumentreference that is part of the CMS Health Tech Ecosystem Kill the Clipboard use case.

Usages:

• Use this Profile: KTC Patient-Shared Bundle
• Examples for this Profile: DocumentReference/example-fhir-rendered-pdf and DocumentReference/example-patient-story-pdf

You can also check for usages in the FHIR IG Statistics

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    Filter: Bindings Constraints Obligations
DocumentReference		0..*	USCoreDocumentReferenceProfile(6.1.0)	A reference to a document
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.meta.Slices for security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Slice: Unordered, Open by pattern:$this Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.meta.Slices for security.security:ktc	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Required Pattern: At least the following
DocumentReference.meta.Slices for security.security:ktc.id		0..1	string	Unique id for inter-element referencing
DocumentReference.meta.Slices for security.security:ktc.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.meta.Slices for security.security:ktc.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ObservationValue
DocumentReference.meta.Slices for security.security:ktc.version		0..1	string	Version of the system - if relevant
DocumentReference.meta.Slices for security.security:ktc.code		1..1	code	Symbol in syntax defined by the system Fixed Value: PATAST
DocumentReference.meta.Slices for security.security:ktc.display		0..1	string	Representation defined by the system
DocumentReference.meta.Slices for security.security:ktc.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.identifier	S This element must be supported. Σ This element is included in summaries.	0..*	Identifier	(USCDI) Other identifiers for the document
DocumentReference.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	(USCDI) current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Fixed Value: current
DocumentReference.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	(USCDI) Kind of document (LOINC if possible) Binding: KTC Patient-Shared Document Type ValueSet (required)
DocumentReference.Slices for category	S This element must be supported. Σ This element is included in summaries.	1..*	CodeableConcept	(USCDI) Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:uscore	Σ This element is included in summaries.	0..*	CodeableConcept	(USCDI) Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
DocumentReference.Slices for category.category:ktc	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
DocumentReference.Slices for category.category:ktc.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:ktc.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:ktc.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for category.category:ktc.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:ktc.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:ktc.coding.system		1..1	uri	Identity of the terminology system Fixed Value: https://cms.gov/fhir/CodeSystem/patient-shared-category
DocumentReference.Slices for category.category:ktc.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for category.category:ktc.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: patient-shared
DocumentReference.Slices for category.category:ktc.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for category.category:ktc.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for category.category:ktc.text		0..1	string	Plain text representation of the concept
DocumentReference.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile)	(USCDI) Who/what is the subject of the document
DocumentReference.date	S This element must be supported. Σ This element is included in summaries.	1..1	instant	(USCDI) When this document reference was created
DocumentReference.Slices for author	S This element must be supported. Σ This element is included in summaries.	1..*	Reference(US Core Practitioner Profile S This type must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Who and/or what authored the document Slice: Unordered, Open by profile:resolve() Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:patientAuthor	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what authored the document
DocumentReference.content	S This element must be supported. Σ This element is included in summaries.	1..1	BackboneElement	(USCDI) Document referenced
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.content.attachment	S This element must be supported. Σ This element is included in summaries. C	1..1	Attachment	(USCDI) Where to access the document Constraints: us-core-6
DocumentReference.content.attachment.contentType	S This element must be supported. Σ This element is included in summaries.	1..1	code	(USCDI) Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Fixed Value: application/pdf
DocumentReference.content.attachment.data	S This element must be supported. C	1..1	base64Binary	(USCDI) Data inline, base64ed
DocumentReference.content.attachment.url	S This element must be supported. Σ This element is included in summaries. C	0..1	url	(USCDI) Uri where the data can be found Example General: http://www.acme.com/logo-small.png
DocumentReference.content.format	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	(USCDI) Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
DocumentReference.context	S This element must be supported. Σ This element is included in summaries.	0..1	BackboneElement	(USCDI) Clinical context of document
DocumentReference.context.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.context.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	(USCDI) Context of the document content
DocumentReference.context.period	S This element must be supported. Σ This element is included in summaries.	0..1	Period	(USCDI) Time of service that is being documented
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​security:ktc	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.0.1	FHIR Std.
DocumentReference.type	Base	required	KTC Patient-Shared Document Type ValueSet	📦1.0.0	This IG
DocumentReference.category	Base	example	Document Class Value Set	📦4.0.1	FHIR Std.
DocumentReference.category:uscore	Base	required	US Core DocumentReference Category	📦6.1.0	US Core v6.1
DocumentReference.category:ktc	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	extensible	DocumentReference Format Code Set	📦4.0.1	FHIR Std.

Constraints

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()
us-core-6	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.	url.exists() or data.exists()

This structure is derived from USCoreDocumentReferenceProfile

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference			USCoreDocumentReferenceProfile(6.1.0)
DocumentReference.meta
DocumentReference.meta.Slices for security		0..*	Coding	Security Labels applied to this resource Slice: Unordered, Open by pattern:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.meta.Slices for security.security:ktc	S This element must be supported.	0..1	Coding	Security Labels applied to this resource Required Pattern: At least the following
DocumentReference.meta.Slices for security.security:ktc.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ObservationValue
DocumentReference.meta.Slices for security.security:ktc.code		1..1	code	Symbol in syntax defined by the system Fixed Value: PATAST
DocumentReference.status		1..1	code	(USCDI) current | superseded | entered-in-error Fixed Value: current
DocumentReference.type		1..1	CodeableConcept	(USCDI) Kind of document (LOINC if possible) Binding: KTC Patient-Shared Document Type ValueSet (required)
DocumentReference.Slices for category				Content/Rules for all slices
DocumentReference.Slices for category.category:ktc	S This element must be supported.	1..1	CodeableConcept	Categorization of document Required Pattern: At least the following
DocumentReference.Slices for category.category:ktc.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for category.category:ktc.coding.system		1..1	uri	Identity of the terminology system Fixed Value: https://cms.gov/fhir/CodeSystem/patient-shared-category
DocumentReference.Slices for category.category:ktc.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: patient-shared
DocumentReference.date		1..1	instant	(USCDI) When this document reference was created
DocumentReference.Slices for author		1..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Who and/or what authored the document Slice: Unordered, Open by profile:resolve() Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:patientAuthor	S This element must be supported.	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what authored the document
DocumentReference.content		1..1	BackboneElement	(USCDI) Document referenced
DocumentReference.content.attachment
DocumentReference.content.attachment.contentType		1..1	code	(USCDI) Mime type of the content, with charset etc. Fixed Value: application/pdf
DocumentReference.content.attachment.data		1..1	base64Binary	(USCDI) Data inline, base64ed
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.type	Base	required	KTC Patient-Shared Document Type ValueSet	📦1.0.0	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	USCoreDocumentReferenceProfile(6.1.0)	A reference to a document
DocumentReference.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.meta.id		0..1	string	Unique id for inter-element referencing
DocumentReference.meta.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
DocumentReference.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
DocumentReference.meta.source	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from
DocumentReference.meta.profile	Σ This element is included in summaries.	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
DocumentReference.meta.Slices for security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Slice: Unordered, Open by pattern:$this Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.meta.Slices for security.security:ktc	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Required Pattern: At least the following
DocumentReference.meta.Slices for security.security:ktc.id		0..1	string	Unique id for inter-element referencing
DocumentReference.meta.Slices for security.security:ktc.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.meta.Slices for security.security:ktc.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ObservationValue
DocumentReference.meta.Slices for security.security:ktc.version		0..1	string	Version of the system - if relevant
DocumentReference.meta.Slices for security.security:ktc.code		1..1	code	Symbol in syntax defined by the system Fixed Value: PATAST
DocumentReference.meta.Slices for security.security:ktc.display		0..1	string	Representation defined by the system
DocumentReference.meta.Slices for security.security:ktc.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.meta.tag	Σ This element is included in summaries.	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".
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.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
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.masterIdentifier	Σ This element is included in summaries.	0..1	Identifier	Master Version Specific Identifier
DocumentReference.identifier	S This element must be supported. Σ This element is included in summaries.	0..*	Identifier	(USCDI) Other identifiers for the document
DocumentReference.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	(USCDI) current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Fixed Value: current
DocumentReference.docStatus	Σ This element is included in summaries.	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
DocumentReference.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	(USCDI) Kind of document (LOINC if possible) Binding: KTC Patient-Shared Document Type ValueSet (required)
DocumentReference.Slices for category	S This element must be supported. Σ This element is included in summaries.	1..*	CodeableConcept	(USCDI) Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:uscore	Σ This element is included in summaries.	0..*	CodeableConcept	(USCDI) Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
DocumentReference.Slices for category.category:ktc	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
DocumentReference.Slices for category.category:ktc.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:ktc.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:ktc.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for category.category:ktc.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:ktc.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:ktc.coding.system		1..1	uri	Identity of the terminology system Fixed Value: https://cms.gov/fhir/CodeSystem/patient-shared-category
DocumentReference.Slices for category.category:ktc.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for category.category:ktc.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: patient-shared
DocumentReference.Slices for category.category:ktc.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for category.category:ktc.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for category.category:ktc.text		0..1	string	Plain text representation of the concept
DocumentReference.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile)	(USCDI) Who/what is the subject of the document
DocumentReference.date	S This element must be supported. Σ This element is included in summaries.	1..1	instant	(USCDI) When this document reference was created
DocumentReference.Slices for author	S This element must be supported. Σ This element is included in summaries.	1..*	Reference(US Core Practitioner Profile S This type must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Who and/or what authored the document Slice: Unordered, Open by profile:resolve() Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:patientAuthor	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what authored the document
DocumentReference.authenticator		0..1	Reference(Practitioner | PractitionerRole | Organization)	Who/what authenticated the document
DocumentReference.custodian		0..1	Reference(Organization)	Organization which maintains the document
DocumentReference.relatesTo	Σ This element is included in summaries.	0..*	BackboneElement	Relationships to other documents
DocumentReference.relatesTo.id		0..1	string	Unique id for inter-element referencing
DocumentReference.relatesTo.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.relatesTo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.relatesTo.code	Σ This element is included in summaries.	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
DocumentReference.relatesTo.target	Σ This element is included in summaries.	1..1	Reference(DocumentReference)	Target of the relationship
DocumentReference.description	Σ This element is included in summaries.	0..1	string	Human-readable description
DocumentReference.securityLabel	Σ This element is included in summaries.	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
DocumentReference.content	S This element must be supported. Σ This element is included in summaries.	1..1	BackboneElement	(USCDI) Document referenced
DocumentReference.content.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.content.attachment	S This element must be supported. Σ This element is included in summaries. C	1..1	Attachment	(USCDI) Where to access the document Constraints: us-core-6
DocumentReference.content.attachment.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.attachment.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.content.attachment.contentType	S This element must be supported. Σ This element is included in summaries.	1..1	code	(USCDI) Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Fixed Value: application/pdf
DocumentReference.content.attachment.language	Σ This element is included in summaries.	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
DocumentReference.content.attachment.data	S This element must be supported. C	1..1	base64Binary	(USCDI) Data inline, base64ed
DocumentReference.content.attachment.url	S This element must be supported. Σ This element is included in summaries. C	0..1	url	(USCDI) Uri where the data can be found Example General: http://www.acme.com/logo-small.png
DocumentReference.content.attachment.size	Σ This element is included in summaries.	0..1	unsignedInt	Number of bytes of content (if url provided)
DocumentReference.content.attachment.hash	Σ This element is included in summaries.	0..1	base64Binary	Hash of the data (sha-1, base64ed)
DocumentReference.content.attachment.title	Σ This element is included in summaries.	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
DocumentReference.content.attachment.creation	Σ This element is included in summaries.	0..1	dateTime	Date attachment was first created
DocumentReference.content.format	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	(USCDI) Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
DocumentReference.context	S This element must be supported. Σ This element is included in summaries.	0..1	BackboneElement	(USCDI) Clinical context of document
DocumentReference.context.id		0..1	string	Unique id for inter-element referencing
DocumentReference.context.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.context.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.context.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	(USCDI) Context of the document content
DocumentReference.context.event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
DocumentReference.context.period	S This element must be supported. Σ This element is included in summaries.	0..1	Period	(USCDI) Time of service that is being documented
DocumentReference.context.facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
DocumentReference.context.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).
DocumentReference.context.sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
DocumentReference.context.related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​security:ktc	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
DocumentReference.language	Base	preferred	Common Languages	📦4.0.1	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.0.1	FHIR Std.
DocumentReference.docStatus	Base	required	CompositionStatus	📍4.0.1	FHIR Std.
DocumentReference.type	Base	required	KTC Patient-Shared Document Type ValueSet	📦1.0.0	This IG
DocumentReference.category	Base	example	Document Class Value Set	📦4.0.1	FHIR Std.
DocumentReference.category:uscore	Base	required	US Core DocumentReference Category	📦6.1.0	US Core v6.1
DocumentReference.category:ktc	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📦4.0.1	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📦4.0.1	FHIR Std.
DocumentReference.content.​format	Base	extensible	DocumentReference Format Code Set	📦4.0.1	FHIR Std.
DocumentReference.context.​event	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.4
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.

Constraints

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()
us-core-6	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.	url.exists() or data.exists()

This structure is derived from USCoreDocumentReferenceProfile

Summary

Mandatory: 6 elements
Must-Support: 3 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|6.1.0)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.meta.security
• The element 1 is sliced based on the value of DocumentReference.author

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	USCoreDocumentReferenceProfile(6.1.0)	A reference to a document
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.meta.Slices for security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Slice: Unordered, Open by pattern:$this Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.meta.Slices for security.security:ktc	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Required Pattern: At least the following
DocumentReference.meta.Slices for security.security:ktc.id		0..1	string	Unique id for inter-element referencing
DocumentReference.meta.Slices for security.security:ktc.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.meta.Slices for security.security:ktc.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ObservationValue
DocumentReference.meta.Slices for security.security:ktc.version		0..1	string	Version of the system - if relevant
DocumentReference.meta.Slices for security.security:ktc.code		1..1	code	Symbol in syntax defined by the system Fixed Value: PATAST
DocumentReference.meta.Slices for security.security:ktc.display		0..1	string	Representation defined by the system
DocumentReference.meta.Slices for security.security:ktc.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.identifier	S This element must be supported. Σ This element is included in summaries.	0..*	Identifier	(USCDI) Other identifiers for the document
DocumentReference.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	(USCDI) current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Fixed Value: current
DocumentReference.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	(USCDI) Kind of document (LOINC if possible) Binding: KTC Patient-Shared Document Type ValueSet (required)
DocumentReference.Slices for category	S This element must be supported. Σ This element is included in summaries.	1..*	CodeableConcept	(USCDI) Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:uscore	Σ This element is included in summaries.	0..*	CodeableConcept	(USCDI) Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
DocumentReference.Slices for category.category:ktc	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
DocumentReference.Slices for category.category:ktc.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:ktc.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:ktc.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for category.category:ktc.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:ktc.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:ktc.coding.system		1..1	uri	Identity of the terminology system Fixed Value: https://cms.gov/fhir/CodeSystem/patient-shared-category
DocumentReference.Slices for category.category:ktc.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for category.category:ktc.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: patient-shared
DocumentReference.Slices for category.category:ktc.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for category.category:ktc.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for category.category:ktc.text		0..1	string	Plain text representation of the concept
DocumentReference.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile)	(USCDI) Who/what is the subject of the document
DocumentReference.date	S This element must be supported. Σ This element is included in summaries.	1..1	instant	(USCDI) When this document reference was created
DocumentReference.Slices for author	S This element must be supported. Σ This element is included in summaries.	1..*	Reference(US Core Practitioner Profile S This type must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Who and/or what authored the document Slice: Unordered, Open by profile:resolve() Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:patientAuthor	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what authored the document
DocumentReference.content	S This element must be supported. Σ This element is included in summaries.	1..1	BackboneElement	(USCDI) Document referenced
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.content.attachment	S This element must be supported. Σ This element is included in summaries. C	1..1	Attachment	(USCDI) Where to access the document Constraints: us-core-6
DocumentReference.content.attachment.contentType	S This element must be supported. Σ This element is included in summaries.	1..1	code	(USCDI) Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Fixed Value: application/pdf
DocumentReference.content.attachment.data	S This element must be supported. C	1..1	base64Binary	(USCDI) Data inline, base64ed
DocumentReference.content.attachment.url	S This element must be supported. Σ This element is included in summaries. C	0..1	url	(USCDI) Uri where the data can be found Example General: http://www.acme.com/logo-small.png
DocumentReference.content.format	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	(USCDI) Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
DocumentReference.context	S This element must be supported. Σ This element is included in summaries.	0..1	BackboneElement	(USCDI) Clinical context of document
DocumentReference.context.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.context.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	(USCDI) Context of the document content
DocumentReference.context.period	S This element must be supported. Σ This element is included in summaries.	0..1	Period	(USCDI) Time of service that is being documented
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​security:ktc	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.0.1	FHIR Std.
DocumentReference.type	Base	required	KTC Patient-Shared Document Type ValueSet	📦1.0.0	This IG
DocumentReference.category	Base	example	Document Class Value Set	📦4.0.1	FHIR Std.
DocumentReference.category:uscore	Base	required	US Core DocumentReference Category	📦6.1.0	US Core v6.1
DocumentReference.category:ktc	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​format	Base	extensible	DocumentReference Format Code Set	📦4.0.1	FHIR Std.

Constraints

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()
us-core-6	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.	url.exists() or data.exists()

Differential View

This structure is derived from USCoreDocumentReferenceProfile

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference			USCoreDocumentReferenceProfile(6.1.0)
DocumentReference.meta
DocumentReference.meta.Slices for security		0..*	Coding	Security Labels applied to this resource Slice: Unordered, Open by pattern:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.meta.Slices for security.security:ktc	S This element must be supported.	0..1	Coding	Security Labels applied to this resource Required Pattern: At least the following
DocumentReference.meta.Slices for security.security:ktc.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ObservationValue
DocumentReference.meta.Slices for security.security:ktc.code		1..1	code	Symbol in syntax defined by the system Fixed Value: PATAST
DocumentReference.status		1..1	code	(USCDI) current | superseded | entered-in-error Fixed Value: current
DocumentReference.type		1..1	CodeableConcept	(USCDI) Kind of document (LOINC if possible) Binding: KTC Patient-Shared Document Type ValueSet (required)
DocumentReference.Slices for category				Content/Rules for all slices
DocumentReference.Slices for category.category:ktc	S This element must be supported.	1..1	CodeableConcept	Categorization of document Required Pattern: At least the following
DocumentReference.Slices for category.category:ktc.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for category.category:ktc.coding.system		1..1	uri	Identity of the terminology system Fixed Value: https://cms.gov/fhir/CodeSystem/patient-shared-category
DocumentReference.Slices for category.category:ktc.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: patient-shared
DocumentReference.date		1..1	instant	(USCDI) When this document reference was created
DocumentReference.Slices for author		1..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Who and/or what authored the document Slice: Unordered, Open by profile:resolve() Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:patientAuthor	S This element must be supported.	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what authored the document
DocumentReference.content		1..1	BackboneElement	(USCDI) Document referenced
DocumentReference.content.attachment
DocumentReference.content.attachment.contentType		1..1	code	(USCDI) Mime type of the content, with charset etc. Fixed Value: application/pdf
DocumentReference.content.attachment.data		1..1	base64Binary	(USCDI) Data inline, base64ed
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.type	Base	required	KTC Patient-Shared Document Type ValueSet	📦1.0.0	This IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	USCoreDocumentReferenceProfile(6.1.0)	A reference to a document
DocumentReference.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
DocumentReference.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
DocumentReference.meta.id		0..1	string	Unique id for inter-element referencing
DocumentReference.meta.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
DocumentReference.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
DocumentReference.meta.source	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from
DocumentReference.meta.profile	Σ This element is included in summaries.	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
DocumentReference.meta.Slices for security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Slice: Unordered, Open by pattern:$this Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.meta.Slices for security.security:ktc	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Required Pattern: At least the following
DocumentReference.meta.Slices for security.security:ktc.id		0..1	string	Unique id for inter-element referencing
DocumentReference.meta.Slices for security.security:ktc.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.meta.Slices for security.security:ktc.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ObservationValue
DocumentReference.meta.Slices for security.security:ktc.version		0..1	string	Version of the system - if relevant
DocumentReference.meta.Slices for security.security:ktc.code		1..1	code	Symbol in syntax defined by the system Fixed Value: PATAST
DocumentReference.meta.Slices for security.security:ktc.display		0..1	string	Representation defined by the system
DocumentReference.meta.Slices for security.security:ktc.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.meta.tag	Σ This element is included in summaries.	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".
DocumentReference.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
DocumentReference.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.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
DocumentReference.contained		0..*	Resource	Contained, inline Resources
DocumentReference.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
DocumentReference.masterIdentifier	Σ This element is included in summaries.	0..1	Identifier	Master Version Specific Identifier
DocumentReference.identifier	S This element must be supported. Σ This element is included in summaries.	0..*	Identifier	(USCDI) Other identifiers for the document
DocumentReference.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	(USCDI) current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Fixed Value: current
DocumentReference.docStatus	Σ This element is included in summaries.	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
DocumentReference.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	(USCDI) Kind of document (LOINC if possible) Binding: KTC Patient-Shared Document Type ValueSet (required)
DocumentReference.Slices for category	S This element must be supported. Σ This element is included in summaries.	1..*	CodeableConcept	(USCDI) Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for category.category:uscore	Σ This element is included in summaries.	0..*	CodeableConcept	(USCDI) Categorization of document Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a "starter set" of categories supported for fetching and storing clinical notes. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
DocumentReference.Slices for category.category:ktc	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
DocumentReference.Slices for category.category:ktc.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:ktc.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:ktc.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
DocumentReference.Slices for category.category:ktc.coding.id		0..1	string	Unique id for inter-element referencing
DocumentReference.Slices for category.category:ktc.coding.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.Slices for category.category:ktc.coding.system		1..1	uri	Identity of the terminology system Fixed Value: https://cms.gov/fhir/CodeSystem/patient-shared-category
DocumentReference.Slices for category.category:ktc.coding.version		0..1	string	Version of the system - if relevant
DocumentReference.Slices for category.category:ktc.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: patient-shared
DocumentReference.Slices for category.category:ktc.coding.display		0..1	string	Representation defined by the system
DocumentReference.Slices for category.category:ktc.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
DocumentReference.Slices for category.category:ktc.text		0..1	string	Plain text representation of the concept
DocumentReference.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile)	(USCDI) Who/what is the subject of the document
DocumentReference.date	S This element must be supported. Σ This element is included in summaries.	1..1	instant	(USCDI) When this document reference was created
DocumentReference.Slices for author	S This element must be supported. Σ This element is included in summaries.	1..*	Reference(US Core Practitioner Profile S This type must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Who and/or what authored the document Slice: Unordered, Open by profile:resolve() Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
DocumentReference.Slices for author.author:patientAuthor	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what authored the document
DocumentReference.authenticator		0..1	Reference(Practitioner | PractitionerRole | Organization)	Who/what authenticated the document
DocumentReference.custodian		0..1	Reference(Organization)	Organization which maintains the document
DocumentReference.relatesTo	Σ This element is included in summaries.	0..*	BackboneElement	Relationships to other documents
DocumentReference.relatesTo.id		0..1	string	Unique id for inter-element referencing
DocumentReference.relatesTo.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.relatesTo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.relatesTo.code	Σ This element is included in summaries.	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
DocumentReference.relatesTo.target	Σ This element is included in summaries.	1..1	Reference(DocumentReference)	Target of the relationship
DocumentReference.description	Σ This element is included in summaries.	0..1	string	Human-readable description
DocumentReference.securityLabel	Σ This element is included in summaries.	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
DocumentReference.content	S This element must be supported. Σ This element is included in summaries.	1..1	BackboneElement	(USCDI) Document referenced
DocumentReference.content.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.content.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.content.attachment	S This element must be supported. Σ This element is included in summaries. C	1..1	Attachment	(USCDI) Where to access the document Constraints: us-core-6
DocumentReference.content.attachment.id		0..1	string	Unique id for inter-element referencing
DocumentReference.content.attachment.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
DocumentReference.content.attachment.contentType	S This element must be supported. Σ This element is included in summaries.	1..1	code	(USCDI) Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Fixed Value: application/pdf
DocumentReference.content.attachment.language	Σ This element is included in summaries.	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
DocumentReference.content.attachment.data	S This element must be supported. C	1..1	base64Binary	(USCDI) Data inline, base64ed
DocumentReference.content.attachment.url	S This element must be supported. Σ This element is included in summaries. C	0..1	url	(USCDI) Uri where the data can be found Example General: http://www.acme.com/logo-small.png
DocumentReference.content.attachment.size	Σ This element is included in summaries.	0..1	unsignedInt	Number of bytes of content (if url provided)
DocumentReference.content.attachment.hash	Σ This element is included in summaries.	0..1	base64Binary	Hash of the data (sha-1, base64ed)
DocumentReference.content.attachment.title	Σ This element is included in summaries.	0..1	string	Label to display in place of the data Example General: Official Corporate Logo
DocumentReference.content.attachment.creation	Σ This element is included in summaries.	0..1	dateTime	Date attachment was first created
DocumentReference.content.format	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	(USCDI) Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
DocumentReference.context	S This element must be supported. Σ This element is included in summaries.	0..1	BackboneElement	(USCDI) Clinical context of document
DocumentReference.context.id		0..1	string	Unique id for inter-element referencing
DocumentReference.context.extension		0..*	Extension	Additional content defined by implementations
DocumentReference.context.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
DocumentReference.context.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	(USCDI) Context of the document content
DocumentReference.context.event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
DocumentReference.context.period	S This element must be supported. Σ This element is included in summaries.	0..1	Period	(USCDI) Time of service that is being documented
DocumentReference.context.facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
DocumentReference.context.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).
DocumentReference.context.sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
DocumentReference.context.related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
DocumentReference.meta.​security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​security:ktc	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
DocumentReference.meta.​tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
DocumentReference.language	Base	preferred	Common Languages	📦4.0.1	FHIR Std.
DocumentReference.status	Base	required	DocumentReferenceStatus	📦4.0.1	FHIR Std.
DocumentReference.docStatus	Base	required	CompositionStatus	📍4.0.1	FHIR Std.
DocumentReference.type	Base	required	KTC Patient-Shared Document Type ValueSet	📦1.0.0	This IG
DocumentReference.category	Base	example	Document Class Value Set	📦4.0.1	FHIR Std.
DocumentReference.category:uscore	Base	required	US Core DocumentReference Category	📦6.1.0	US Core v6.1
DocumentReference.category:ktc	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
DocumentReference.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
DocumentReference.securityLabel	Base	extensible	SecurityLabels	📦4.0.1	FHIR Std.
DocumentReference.content.​attachment.contentType	Base	required	MimeType	📍4.0.1	FHIR Std.
DocumentReference.content.​attachment.language	Base	preferred	Common Languages	📦4.0.1	FHIR Std.
DocumentReference.content.​format	Base	extensible	DocumentReference Format Code Set	📦4.0.1	FHIR Std.
DocumentReference.context.​event	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.4
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.

Constraints

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()
us-core-6	error	DocumentReference.content.attachment	DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.	url.exists() or data.exists()

This structure is derived from USCoreDocumentReferenceProfile

Summary

Mandatory: 6 elements
Must-Support: 3 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|6.1.0)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.meta.security
• The element 1 is sliced based on the value of DocumentReference.author

Other representations of profile: CSV, Excel, Schematron