Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	USCoreDocumentReferenceProfile(6.1.0)	A reference to a document
meta	Σ	0..1	Meta	Metadata about the resource
Slices for security	Σ	0..*	Coding	Security Labels applied to this resource Slice: Unordered, Open by pattern:$this Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
security:ktc	SΣ	0..1	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ObservationValue
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: PATAST
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	(USCDI) Other identifiers for the document
status	?!SΣ	1..1	code	(USCDI) current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Fixed Value: current
type	SΣ	1..1	CodeableConcept	(USCDI) Kind of document (LOINC if possible) Binding: KTC Patient-Shared Document Type ValueSet (required)
Slices for category	SΣ	1..*	CodeableConcept	(USCDI) Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category:uscore	Σ	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
category:ktc	SΣ	1..1	CodeableConcept	(USCDI) Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: https://cms.gov/fhir/CodeSystem/patient-shared-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patient-shared
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who/what is the subject of the document
date	SΣ	1..1	instant	(USCDI) When this document reference was created
Slices for author	SΣ	1..*	Reference(US Core Practitioner Profile S | 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()
author:patientAuthor	SΣ	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what authored the document
content	SΣ	1..1	BackboneElement	(USCDI) Document referenced
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	(USCDI) Where to access the document Constraints: us-core-6
contentType	SΣ	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
data	SC	1..1	base64Binary	(USCDI) Data inline, base64ed
url	SΣC	0..1	url	(USCDI) Uri where the data can be found Example General: http://www.acme.com/logo-small.png
format	SΣ	0..1	Coding	(USCDI) Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
context	SΣ	0..1	BackboneElement	(USCDI) Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..1	Reference(US Core Encounter Profile)	(USCDI) Context of the document content
period	SΣ	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()

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

Terminology Bindings

Path	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	📦2018-08-12	FHIR Std.
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()

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference		0..*	USCoreDocumentReferenceProfile(6.1.0)	A reference to a document
meta	Σ	0..1	Meta	Metadata about the resource
Slices for security	Σ	0..*	Coding	Security Labels applied to this resource Slice: Unordered, Open by pattern:$this Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
security:ktc	SΣ	0..1	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ObservationValue
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: PATAST
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	(USCDI) Other identifiers for the document
status	?!SΣ	1..1	code	(USCDI) current | superseded | entered-in-error Binding: DocumentReferenceStatus (required) Fixed Value: current
type	SΣ	1..1	CodeableConcept	(USCDI) Kind of document (LOINC if possible) Binding: KTC Patient-Shared Document Type ValueSet (required)
Slices for category	SΣ	1..*	CodeableConcept	(USCDI) Categorization of document Slice: Unordered, Open by pattern:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category:uscore	Σ	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
category:ktc	SΣ	1..1	CodeableConcept	(USCDI) Categorization of document Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: https://cms.gov/fhir/CodeSystem/patient-shared-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patient-shared
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who/what is the subject of the document
date	SΣ	1..1	instant	(USCDI) When this document reference was created
Slices for author	SΣ	1..*	Reference(US Core Practitioner Profile S | 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()
author:patientAuthor	SΣ	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what authored the document
content	SΣ	1..1	BackboneElement	(USCDI) Document referenced
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣC	1..1	Attachment	(USCDI) Where to access the document Constraints: us-core-6
contentType	SΣ	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
data	SC	1..1	base64Binary	(USCDI) Data inline, base64ed
url	SΣC	0..1	url	(USCDI) Uri where the data can be found Example General: http://www.acme.com/logo-small.png
format	SΣ	0..1	Coding	(USCDI) Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
context	SΣ	0..1	BackboneElement	(USCDI) Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..1	Reference(US Core Encounter Profile)	(USCDI) Context of the document content
period	SΣ	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()

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

Terminology Bindings

Path	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	📦2018-08-12	FHIR Std.
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()

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