3.0.0-alpha - ci-build
3.0.0-alpha - ci-build
Publication Build: This will be filled in by the publication tooling
| Official URL: http://hl7.no/fhir/StructureDefinition/no-basis-DocumentReference | Version: 3.0.0-alpha | |||
| Active as of 2020-08-21 | Computable Name: NoBasisDocumentReference | |||
Basisprofil for Norwegian DocumentReference. Defined by The Norwegian Directorate of eHealth and HL7 Norway. The profile adds terminology and extensions specific to Norway. The basis profile is open, derived profiles should close down the information elements according to specification relevant to the use-case.
The profile sets the absolute minimum requirements when searching, fething and storing documents within the healtcare domain. It sets the basic requirements for extensions and terminology which can be present.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from DocumentReference
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  DocumentReference | 0..* | DocumentReference | A reference to a document | |
  type | 0..1 | CodeableConcept | Kind of document Binding: no-basis-documentreference-type.valueset (required) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| DocumentReference.type | required | NoBasisDocumentReferenceType |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DocumentReference | C | 0..* | DocumentReference | A reference to a document |
  implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| contained | 0..* | Resource | Contained, inline Resources | |
 modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
| status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. |
 type | Σ | 0..1 | CodeableConcept | Kind of document Binding: no-basis-documentreference-type.valueset (required) |
 context | C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content |
 content | Σ | 1..* | BackboneElement | Document referenced |
 modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| attachment | Σ | 1..1 | Attachment | Where to access the document |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| DocumentReference.status | required | DocumentReferenceStatus |
| DocumentReference.type | required | NoBasisDocumentReferenceType |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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() | |
| docRef-1 | warning | DocumentReference | facilityType SHALL only be present if context is not an encounter : facilityType.empty() or context.where(resolve() is Encounter).empty() | |
| docRef-2 | warning | DocumentReference | practiceSetting SHALL only be present if context is not present : practiceSetting.empty() or context.where(resolve() is Encounter).empty() | |
| 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() |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DocumentReference | C | 0..* | DocumentReference | A reference to a document |
| id | Σ | 0..1 | id | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| 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: AllLanguages (required): IETF language tag for a human language | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
 extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
| identifier | Σ | 0..* | Identifier | Business identifiers for the document |
| version | Σ | 0..1 | string | An explicitly assigned identifer of a variation of the content in the DocumentReference |
| basedOn | 0..* | Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) | Procedure that caused this media to be created | |
| status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. |
| docStatus | Σ | 0..1 | code | registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document. |
| modality | Σ | 0..* | CodeableConcept | Imaging modality used Binding: http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html (extensible): Type of acquired data in the instance. |
| type | Σ | 0..1 | CodeableConcept | Kind of document Binding: no-basis-documentreference-type.valueset (required) |
| category | Σ | 0..* | CodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. |
| subject | Σ | 0..1 | Reference(Resource) | Who/what is the subject of the document |
| context | C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content |
| event | 0..* | CodeableReference() | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. | |
| bodySite | Σ | 0..* | CodeableReference(BodyStructure) | Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts |
| facilityType | C | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. |
| practiceSetting | C | 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). |
| period | Σ | 0..1 | Period | Time of service that is being documented |
| date | Σ | 0..1 | instant | When this document reference was created |
| author | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) | Who and/or what authored the document |
 attester | 0..* | BackboneElement | Attests to accuracy of the 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 |
| mode | 1..1 | CodeableConcept | personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document. | |
| time | 0..1 | dateTime | When the document was attested | |
| party | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested 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 | CodeableConcept | The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents. |
| target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship |
| description | Σ | 0..1 | markdown | Human-readable description |
| securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System. |
| content | Σ | 1..* | BackboneElement | Document referenced |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| attachment | Σ | 1..1 | Attachment | Where to access the document |
| profile | Σ | 0..* | BackboneElement | Content profile rules for the 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 |
 value[x] | Σ | 1..1 | Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes. | |
| valueCoding | Coding | |||
| valueUri | uri | |||
| valueCanonical | canonical(Any) | |||
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| DocumentReference.language | required | AllLanguages |
| DocumentReference.status | required | DocumentReferenceStatus |
| DocumentReference.docStatus | required | CompositionStatus |
| DocumentReference.modality | extensible | http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html |
| DocumentReference.type | required | NoBasisDocumentReferenceType |
| DocumentReference.category | example | ReferencedItemCategoryValueSet |
| DocumentReference.event | example | ActCode |
| DocumentReference.bodySite | example | SNOMEDCTBodyStructures |
| DocumentReference.facilityType | example | FacilityTypeCodeValueSet |
| DocumentReference.practiceSetting | example | PracticeSettingCodeValueSet |
| DocumentReference.attester.mode | preferred | CompositionAttestationMode |
| DocumentReference.relatesTo.code | extensible | DocumentRelationshipType |
| DocumentReference.securityLabel | example | SecurityLabelExamples |
| DocumentReference.content.profile.value[x] | preferred | HL7FormatCodes |
| Id | Grade | Path(s) | Details | Requirements |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from DocumentReference
Differential View
This structure is derived from DocumentReference
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DocumentReference | 0..* | DocumentReference | A reference to a document | |
| type | 0..1 | CodeableConcept | Kind of document Binding: no-basis-documentreference-type.valueset (required) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| DocumentReference.type | required | NoBasisDocumentReferenceType |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DocumentReference | C | 0..* | DocumentReference | A reference to a document |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| contained | 0..* | Resource | Contained, inline Resources | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
| status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. |
| type | Σ | 0..1 | CodeableConcept | Kind of document Binding: no-basis-documentreference-type.valueset (required) |
| context | C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content |
| content | Σ | 1..* | BackboneElement | Document referenced |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| attachment | Σ | 1..1 | Attachment | Where to access the document |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| DocumentReference.status | required | DocumentReferenceStatus |
| DocumentReference.type | required | NoBasisDocumentReferenceType |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | DocumentReference | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | DocumentReference | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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() | |
| docRef-1 | warning | DocumentReference | facilityType SHALL only be present if context is not an encounter : facilityType.empty() or context.where(resolve() is Encounter).empty() | |
| docRef-2 | warning | DocumentReference | practiceSetting SHALL only be present if context is not present : practiceSetting.empty() or context.where(resolve() is Encounter).empty() | |
| 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() |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DocumentReference | C | 0..* | DocumentReference | A reference to a document |
| id | Σ | 0..1 | id | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| 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: AllLanguages (required): IETF language tag for a human language | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
| identifier | Σ | 0..* | Identifier | Business identifiers for the document |
| version | Σ | 0..1 | string | An explicitly assigned identifer of a variation of the content in the DocumentReference |
| basedOn | 0..* | Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription) | Procedure that caused this media to be created | |
| status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. |
| docStatus | Σ | 0..1 | code | registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document. |
| modality | Σ | 0..* | CodeableConcept | Imaging modality used Binding: http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html (extensible): Type of acquired data in the instance. |
| type | Σ | 0..1 | CodeableConcept | Kind of document Binding: no-basis-documentreference-type.valueset (required) |
| category | Σ | 0..* | CodeableConcept | Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. |
| subject | Σ | 0..1 | Reference(Resource) | Who/what is the subject of the document |
| context | C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Context of the document content |
| event | 0..* | CodeableReference() | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. | |
| bodySite | Σ | 0..* | CodeableReference(BodyStructure) | Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts |
| facilityType | C | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type. |
| practiceSetting | C | 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). |
| period | Σ | 0..1 | Period | Time of service that is being documented |
| date | Σ | 0..1 | instant | When this document reference was created |
| author | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam) | Who and/or what authored the document |
| attester | 0..* | BackboneElement | Attests to accuracy of the 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 |
| mode | 1..1 | CodeableConcept | personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document. | |
| time | 0..1 | dateTime | When the document was attested | |
| party | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested 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 | CodeableConcept | The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents. |
| target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship |
| description | Σ | 0..1 | markdown | Human-readable description |
| securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System. |
| content | Σ | 1..* | BackboneElement | Document referenced |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| attachment | Σ | 1..1 | Attachment | Where to access the document |
| profile | Σ | 0..* | BackboneElement | Content profile rules for the 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 |
| value[x] | Σ | 1..1 | Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes. | |
| valueCoding | Coding | |||
| valueUri | uri | |||
| valueCanonical | canonical(Any) | |||
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| DocumentReference.language | required | AllLanguages |
| DocumentReference.status | required | DocumentReferenceStatus |
| DocumentReference.docStatus | required | CompositionStatus |
| DocumentReference.modality | extensible | http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html |
| DocumentReference.type | required | NoBasisDocumentReferenceType |
| DocumentReference.category | example | ReferencedItemCategoryValueSet |
| DocumentReference.event | example | ActCode |
| DocumentReference.bodySite | example | SNOMEDCTBodyStructures |
| DocumentReference.facilityType | example | FacilityTypeCodeValueSet |
| DocumentReference.practiceSetting | example | PracticeSettingCodeValueSet |
| DocumentReference.attester.mode | preferred | CompositionAttestationMode |
| DocumentReference.relatesTo.code | extensible | DocumentRelationshipType |
| DocumentReference.securityLabel | example | SecurityLabelExamples |
| DocumentReference.content.profile.value[x] | preferred | HL7FormatCodes |
| Id | Grade | Path(s) | Details | Requirements |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from DocumentReference
Other representations of profile: CSV, Excel, Schematron