Status: Active: Approved (STU)

Introduction

This profile sets minimum expectations for the DocumentReference resource.

Mandatory fields

The following mandatory fields are defined in order to properly describe a DocumentReference:

1. Status - already mandatory in FHIR, and will generally contain “current”. (A practical challenge for many systems can be to accurately maintain this, eg updating to “superseded” when necessary)
2. DocStatus - will generally contain “final”, as most documents will only be published for regional sharing once they are finalised. However there may be exceptions where it is useful to collaborate on preliminary versions of a document. (It is anticipated that additional guidance on the use of this field for collaborating on specific types of document may be added in future.)

3. Type - essential information to help categorise the type of document.

   The categorisation of document types is a much debated topic, with a number of alternative standards still vying for precedence. See discussion of code list options for further details. However for practical purposes of consistency a regional design decision has been made based on the SNOMED refset 24501000000105: EHR composition types. This is therefore specified as “preferred” and we ask that SNOMED coding based on this list is provided.

   • It is, of course, permissible to provide more than one code to also support other coding schemes if desired
   • We accept that this is an area where we will need to remain open to consultation as National standards continue to evolve.
4. Indexed - already mandatory in FHIR and essential for date-based searching and sorting
5. Subject - every document must be linked to a Patient
6. Content - usually a link to retrieve the actual document content (see further guidance below).
7. Content Type It is mandatory to populate the Content Type, so that consumers can be aware and process accordingly.

Data Providers and Data Consumers SHOULD support the following contentTypes:

• application/pdf
• text/html
• image/tiff (no longer supported and is not recommended for web use)
• image/jpeg
• image/png (currently not supported in Interweave Portal, however it is on the roadmap)

(This list may be added to by request and discussion)

Other contentTypes should only be used with caution, as not all Data Consumers may be able to view them.

Must Support fields

In addition the following fields are “Must Support” - ie they must be populated if relevant and known:

1. Identifier - a Local document id should be provided (non-version-specific), such that could be quoted if manually getting in touch to find out more
2. Author - This is very useful as it provides a person to speak to if more information about the document is needed. Preferably we want exactly one author - the main practitioner involved who should be contacted. (The profile is, however, left open to allow for other more collaborative models of document creation in future).
3. Context - Encounter - If relevant and possible then it is very useful to link documents back to the Encounter they relate to
4. Context - Period - A document may related to a period of time (eg a care plan for the coming 6 months). Where this is the case then this field must be populated

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. Points of note include:

• Master Identifier - FHIR also makes provision for both a “master identifier” (version specific). Generally this will link with a Data Provider’s in-house document management system, and is therefore an internal implementation detail and of limited relevance for external sharing. If provided then Data Consumers should exercise caution in relying upon it.
• Class - This provides a higher-level categorisation over-and-above the document “type”
• Authenticator - More likely to be relevant for internal records management rather than external sharing, but may be populated if desired
• Description - May be used if there is additional “title” or summary “description” information about the document which is useful to provide. It is not necessary to populate with a repeat of the document “type” - instead feel free to omit if there is nothing additional to add.
• Additional Context Fields - These include the Event, Facility Type, and Practice Setting. There is also the sourcePatientInfo which may be useful to populate with a version-specific pointer to the patient record at the time the document was created.

Discouraged or Removed fields

• Created - Whilst this is a field often used currently, its use is deprecated in FHIR R4, so in the longer term a reliance on it may not be wise
  • Note that the Exchange has a “docxsort” feature to allow sorting by created date where known, or else indexed date. However as noted, the direction of FHIR is towards a simpler approach based on indexed date only.
• Custodian - this information is instead provided by the provenance tags
• Relates To - This is a potentially useful field that may be used to record relationships between documents. However it is not used as-yet, and there is unlikely to be any behaviour in consumer systems to honour it. Please get in touch for further discussion if planning to use it.
• Content - Related - This provides the opportunity to link to other types of resources – in addition to Encounters. It is anticipated that additional guidance on the use of this field may be added in future, based on specific document types and use-cases. Please get in touch if planning to use this field meanwhile.
• Security Label - This field is not used and will not be honoured. All data published to the Interweave Exchange will be shared with other participants. (It is possible that additional security mechanisms may be added in future, however this would be subject to further consultation at the time).

Approaches to document content

The DocumentReference this offers three different ways to transmit the document content and it is important to understand the details of this. The sections below cover each option in turn.

• (1) Embedded document (only supported for messaging NOT online query)

  This is the “simplest” approach, as the document content is embedded directly into the DocumentReference. Note that the contentType (mime-type) is provided so that the consumer is able to judge whether it has the ability to display this format of document eg PDF, etc. (This is the same for all three approaches).

  For example the “content” section of a DocumentReference would look like:

"content": [{​​​​​
       "attachment": {​​​​​
           "contentType": "text/html",
       "data":"PGRpdiB4123ucz0iaHR0cDovL123dy53My5vcmcvMTk5OS94aHRtbCI ... etc..."
       }​​​​​​​​​​​​
   }​​​​​​​​​​​​]

This embedded approach is often suitable for messaging, where a relevant document is being specifically sent (eg Ambulance Transfer of Care). However for online query it has the significant disadvantage of making the DocumentReference resources very large - as the whole document is transferred even when just viewing the list of documents available. Typically there may be many documents about a patient, but only one or two which are relevant for the user to actually view. It is very inefficient (and slow) to transfer the entirety of the documents when a user is only perusing the list.

(NB: Despite this limitation, GP Connect is an important use-case which returns embedded document content. However GP Connect documents are not returned from ordinary online queries and instead must be specifically requested from a screen developed to meet NHSD accreditation requirements. The reason for embedding is that, having requested a patient’s GP Record, it is almost always going to be desired to view the document content).

• (2) Linked document (recommended)

  This replaces the content in the DocumentReference with a link. For example:

"content": [{​​​​​​​​​​​​
       "attachment": {​​​​​​​​​​​​
           "contentType": "text/html",
           "url": "https://my.server.com/documents/21f51e78-a46d-402c-aa22-dd43e0fec530"
       }​​​​​​​​​​​​
   }​​​​​​​​​​​​]

This is clearly much more efficient. This list of DocumentReferences contains only metadata about the documents, and if the user wants to open the document then it is a case of following the link to download it. This performs a simple binary download of the document bytes – as would be provided by hosting the document on any standard web server.

Note that InterWeave Connect offers a proxy service to avoid the need for point-to-point networking for document downloads. Instead the urls in the DocumentReference are automatically rewritten to point at a central hub which in turn connects to the Data Provider and streams document downloads.

• (3) FHIR Binary Resource (only recommended if implemented comprehensively)

  Yet another possible approach is to replace the content in the DocumentReference with a link to a FHIR Binary Resource http://hl7.org/fhir/stu3/binary.html. This is similar in principle to the Linked document approach, but adds an extra layer of wrappings and complexity to the Data Provider’s implementation. For that reason it is not recommended unless a Data Provider is working with a local system which already exposes documents in this way. Note: that the contentType of the document reference must be the mime type of the document encoded by the binary resource (see GET behaviour below)

  The “content” section of a DocumentReference with a linked Binary Resource would now look like this:

     "content": [{​​​​​​​​​​​​
       "attachment": {​​​​​​​​​​​​
           "contentType": "text/html",
           "url": "https://my.server.com/fhirpath/Binary/21f51e78-a46d-402c-aa22-dd43e0fec530"
       }​​​​​​​​​​​​
     }​​​​​​​​​​​​]

When the link is followed then it again returns the binary content – as would be provided by hosting the document on any standard web server.

(This is because of a feature of the FHIR specification that treats Binary resources differently from any other resource. When a FHIR server receives a GET request for a Binary resource then it MUST return the binary document content rather than the Binary resource. However the FHIR specification also requires that this behaviour can be overridden by a consumer by inserting the HTTP Accept header with value “application/fhir+json” (or even “application/fhir+xml”). This then returns a more complete FHIR data structure with the document content embedded – although for document viewing purposes it is difficult to envisage why a consumer would desire this)

Summary of Requirements for DocumentReference content

• Data Providers SHOULD use the “linked document” mechanism when publishing documents for on-demand retrieval

  • This is (2) above, which is recommended as a simple and efficient approach.

  • Data Providers MUST NOT embed documents for on-demand retrieval, as this is inefficient

  • Data Providers MAY publish documents as FHIR Binary Resources. This is equivalent from a Data Consumer perspective as it provides a link to follow to download the document. However it is not recommended due to the additional complexity for a Data Provider. If this option is chosen then the Data Provider MUST fully support the FHIR specification.

• Data Consumers MUST support viewing of documents via a DocumentReference resource which contains a link for downloading the actual document content

  • This covers both of (2) and (3) above as, in practice, both contain a link to download the document content

• Data Consumers MAY leave the HTTP “Accept” header blank, and SHOULD NOT populate it with anything other than the mime-type advertised by the Data Provider in the DocumentReference

  • There is no expectation of Data Providers being able to offer translation capabilities between mime-types

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

This structure is derived from CareConnect-DocumentReference-1

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	CareConnect-DocumentReference-1	A reference to a document
id	S	0..1	id	Logical id of this artifact
meta
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for identifier		0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:system
identifier:localIdentifier	S	0..1	Identifier	Other identifiers for the document
system	S	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-documentreference-identifier
value	S	1..1	string	The Local documentreference Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
period		0..0
status	S	1..1	code	current | superseded | entered-in-error
docStatus	S	1..1	code	preliminary | final | appended | amended | entered-in-error
type	S	1..1	CodeableConcept	Type of document Binding: Interweave Document Type (preferred)
subject	S	1..1	Reference(CareConnectPatient1)	Who is the subject of the document
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
created		0..1	dateTime	DISCOURAGED - deprecated in R4
indexed	S	1..1	instant	When this document reference was created
author	S	0..*	Reference(Device | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1 | CareConnectPatient1 | CareConnect-Organization-1)	Who and/or what authored the document. NB: For most use-cases this should contain a single practitioner who is the main contact for any further questions
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
custodian		0..1	Reference(CareConnect-Organization-1)	DISCOURAGED - this information is already covered by the provenance tags
relatesTo		0..*	BackboneElement	DISCOURAGED - use with great caution as consumer systems are likely to display a simple list of documents, and may not interpret these relationships
description		0..1	string	Human-readable description (title). Useful to populate, but acceptable to omit if nothing to add over-and-above the 'type'
securityLabel		0..*	CodeableConcept	DISCOURAGED - unlikely to be honoured by consumers
content	S	1..*	BackboneElement	Document referenced
attachment	S	1..1	Attachment	Where to access the document
contentType	S	1..1	code	Mime type of the content, with charset etc.
context
encounter	S	0..1	Reference(CareConnect-Encounter-1)	Context of the document content
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
period	S	0..1	Period	Time of service that is being documented
related		0..*	BackboneElement	DISCOURAGED - see above for linkage to Encounter. Other linkages may be defined in future only if use-cases arise
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
DocumentReference.type	preferred	Interweave Document Type

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	CareConnect-DocumentReference-1	A reference to a document
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
identifier:localIdentifier	SΣ	0..1	Identifier	Other identifiers for the document
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-documentreference-identifier
value	SΣ	1..1	string	The Local documentreference Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	SΣ	1..1	code	preliminary | final | appended | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	SΣ	1..1	CodeableConcept	Type of document Binding: Interweave Document Type (preferred)
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who is the subject of the document
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
created	Σ	0..1	dateTime	DISCOURAGED - deprecated in R4
indexed	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Device | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1 | CareConnectPatient1 | CareConnect-Organization-1)	Who and/or what authored the document. NB: For most use-cases this should contain a single practitioner who is the main contact for any further questions
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
custodian	Σ	0..1	Reference(CareConnect-Organization-1)	DISCOURAGED - this information is already covered by the provenance tags
relatesTo	?!Σ	0..*	BackboneElement	DISCOURAGED - use with great caution as consumer systems are likely to display a simple list of documents, and may not interpret these relationships
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(CareConnect-DocumentReference-1)	Target of the relationship
description	Σ	0..1	string	Human-readable description (title). Useful to populate, but acceptable to omit if nothing to add over-and-above the 'type'
securityLabel	Σ	0..*	CodeableConcept	DISCOURAGED - unlikely to be honoured by consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	1..*	BackboneElement	Document referenced
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
attachment	SΣ	1..1	Attachment	Where to access the document
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: mimetypes (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
context	Σ	0..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
encounter	SΣ	0..1	Reference(CareConnect-Encounter-1)	Context of the document content
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
period	SΣ	0..1	Period	Time of service that is being documented
related	Σ	0..*	BackboneElement	DISCOURAGED - see above for linkage to Encounter. Other linkages may be defined in future only if use-cases arise
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DocumentReference.meta.security	extensible	All Security Labels
DocumentReference.meta.tag	example	Common Tags
DocumentReference.meta.tag:Source	example	Common Tags
DocumentReference.meta.tag:Provenance	example	Common Tags
DocumentReference.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier.use	required	IdentifierUse
DocumentReference.identifier:localIdentifier.use	required	IdentifierUse
DocumentReference.status	required	DocumentReferenceStatus
DocumentReference.docStatus	required	CompositionStatus
DocumentReference.type	preferred	Interweave Document Type
DocumentReference.relatesTo.code	required	DocumentRelationshipType
DocumentReference.securityLabel	extensible	All Security Labels
DocumentReference.content.attachment.contentType	required	http://hl7.org/fhir/ValueSet/mimetypes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
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 : contained.where(('#'+id in %resource.descendants().reference).not()).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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	CareConnect-DocumentReference-1	A reference to a document
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
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
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
Slices for identifier	Σ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	Other identifiers for the document
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-documentreference-identifier
value	SΣ	1..1	string	The Local documentreference Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	SΣ	1..1	code	preliminary | final | appended | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	SΣ	1..1	CodeableConcept	Type of document Binding: Interweave Document Type (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
class	Σ	0..1	CodeableConcept	Categorization of document Binding: Document Class Value Set (example): High-level kind of a clinical document at a macro level.
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who is the subject of the document
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
created	Σ	0..1	dateTime	DISCOURAGED - deprecated in R4
indexed	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Device | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1 | CareConnectPatient1 | CareConnect-Organization-1)	Who and/or what authored the document. NB: For most use-cases this should contain a single practitioner who is the main contact for any further questions
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
authenticator	Σ	0..1	Reference(CareConnect-Practitioner-1 | CareConnect-Organization-1)	Who/what authenticated the document
custodian	Σ	0..1	Reference(CareConnect-Organization-1)	DISCOURAGED - this information is already covered by the provenance tags
relatesTo	?!Σ	0..*	BackboneElement	DISCOURAGED - use with great caution as consumer systems are likely to display a simple list of documents, and may not interpret these relationships
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(CareConnect-DocumentReference-1)	Target of the relationship
description	Σ	0..1	string	Human-readable description (title). Useful to populate, but acceptable to omit if nothing to add over-and-above the 'type'
securityLabel	Σ	0..*	CodeableConcept	DISCOURAGED - unlikely to be honoured by consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	1..*	BackboneElement	Document referenced
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
attachment	SΣ	1..1	Attachment	Where to access the document
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: mimetypes (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data		0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	uri	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	Σ	0..1	Coding	Format/content rules for the document Binding: DocumentReference Format Code Set (preferred): Document Format Codes.
context	Σ	0..1	BackboneElement	Clinical context of document
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
encounter	SΣ	0..1	Reference(CareConnect-Encounter-1)	Context of the document content
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
event	Σ	0..*	CodeableConcept	Main clinical acts documented Binding: ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time of service that is being documented
facilityType	Σ	0..1	CodeableConcept	Kind of facility where patient was seen Binding: Facility Type Code Value Set (example): XDS Facility Type.
practiceSetting	Σ	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: Care Connect Care Setting Type (preferred): Care setting type of the document
sourcePatientInfo	Σ	0..1	Reference(CareConnectPatient1)	Patient demographics from source
related	Σ	0..*	BackboneElement	DISCOURAGED - see above for linkage to Encounter. Other linkages may be defined in future only if use-cases arise
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..1	Identifier	Identifier of related objects or events
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
ref	Σ	0..1	Reference(Resource)	Related Resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DocumentReference.meta.security	extensible	All Security Labels
DocumentReference.meta.tag	example	Common Tags
DocumentReference.meta.tag:Source	example	Common Tags
DocumentReference.meta.tag:Provenance	example	Common Tags
DocumentReference.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.masterIdentifier.use	required	IdentifierUse
DocumentReference.masterIdentifier.type	extensible	Identifier Type Codes
DocumentReference.identifier.use	required	IdentifierUse
DocumentReference.identifier.type	extensible	Identifier Type Codes
DocumentReference.identifier:localIdentifier.use	required	IdentifierUse
DocumentReference.identifier:localIdentifier.type	extensible	Identifier Type Codes
DocumentReference.status	required	DocumentReferenceStatus
DocumentReference.docStatus	required	CompositionStatus
DocumentReference.type	preferred	Interweave Document Type
DocumentReference.class	example	Document Class Value Set
DocumentReference.relatesTo.code	required	DocumentRelationshipType
DocumentReference.securityLabel	extensible	All Security Labels
DocumentReference.content.attachment.contentType	required	http://hl7.org/fhir/ValueSet/mimetypes
DocumentReference.content.attachment.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	preferred	DocumentReference Format Code Set
DocumentReference.context.event	example	v3 Code System ActCode
DocumentReference.context.facilityType	example	Facility Type Code Value Set
DocumentReference.context.practiceSetting	preferred	Care Connect Care Setting Type
DocumentReference.context.related.identifier.use	required	IdentifierUse
DocumentReference.context.related.identifier.type	extensible	Identifier Type Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())

Differential View

This structure is derived from CareConnect-DocumentReference-1

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	CareConnect-DocumentReference-1	A reference to a document
id	S	0..1	id	Logical id of this artifact
meta
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for identifier		0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:system
identifier:localIdentifier	S	0..1	Identifier	Other identifiers for the document
system	S	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-documentreference-identifier
value	S	1..1	string	The Local documentreference Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
period		0..0
status	S	1..1	code	current | superseded | entered-in-error
docStatus	S	1..1	code	preliminary | final | appended | amended | entered-in-error
type	S	1..1	CodeableConcept	Type of document Binding: Interweave Document Type (preferred)
subject	S	1..1	Reference(CareConnectPatient1)	Who is the subject of the document
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
created		0..1	dateTime	DISCOURAGED - deprecated in R4
indexed	S	1..1	instant	When this document reference was created
author	S	0..*	Reference(Device | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1 | CareConnectPatient1 | CareConnect-Organization-1)	Who and/or what authored the document. NB: For most use-cases this should contain a single practitioner who is the main contact for any further questions
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
custodian		0..1	Reference(CareConnect-Organization-1)	DISCOURAGED - this information is already covered by the provenance tags
relatesTo		0..*	BackboneElement	DISCOURAGED - use with great caution as consumer systems are likely to display a simple list of documents, and may not interpret these relationships
description		0..1	string	Human-readable description (title). Useful to populate, but acceptable to omit if nothing to add over-and-above the 'type'
securityLabel		0..*	CodeableConcept	DISCOURAGED - unlikely to be honoured by consumers
content	S	1..*	BackboneElement	Document referenced
attachment	S	1..1	Attachment	Where to access the document
contentType	S	1..1	code	Mime type of the content, with charset etc.
context
encounter	S	0..1	Reference(CareConnect-Encounter-1)	Context of the document content
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
period	S	0..1	Period	Time of service that is being documented
related		0..*	BackboneElement	DISCOURAGED - see above for linkage to Encounter. Other linkages may be defined in future only if use-cases arise
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
DocumentReference.type	preferred	Interweave Document Type

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	CareConnect-DocumentReference-1	A reference to a document
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
identifier:localIdentifier	SΣ	0..1	Identifier	Other identifiers for the document
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-documentreference-identifier
value	SΣ	1..1	string	The Local documentreference Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	SΣ	1..1	code	preliminary | final | appended | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	SΣ	1..1	CodeableConcept	Type of document Binding: Interweave Document Type (preferred)
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who is the subject of the document
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
created	Σ	0..1	dateTime	DISCOURAGED - deprecated in R4
indexed	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Device | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1 | CareConnectPatient1 | CareConnect-Organization-1)	Who and/or what authored the document. NB: For most use-cases this should contain a single practitioner who is the main contact for any further questions
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
custodian	Σ	0..1	Reference(CareConnect-Organization-1)	DISCOURAGED - this information is already covered by the provenance tags
relatesTo	?!Σ	0..*	BackboneElement	DISCOURAGED - use with great caution as consumer systems are likely to display a simple list of documents, and may not interpret these relationships
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(CareConnect-DocumentReference-1)	Target of the relationship
description	Σ	0..1	string	Human-readable description (title). Useful to populate, but acceptable to omit if nothing to add over-and-above the 'type'
securityLabel	Σ	0..*	CodeableConcept	DISCOURAGED - unlikely to be honoured by consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	1..*	BackboneElement	Document referenced
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
attachment	SΣ	1..1	Attachment	Where to access the document
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: mimetypes (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
context	Σ	0..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
encounter	SΣ	0..1	Reference(CareConnect-Encounter-1)	Context of the document content
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
period	SΣ	0..1	Period	Time of service that is being documented
related	Σ	0..*	BackboneElement	DISCOURAGED - see above for linkage to Encounter. Other linkages may be defined in future only if use-cases arise
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DocumentReference.meta.security	extensible	All Security Labels
DocumentReference.meta.tag	example	Common Tags
DocumentReference.meta.tag:Source	example	Common Tags
DocumentReference.meta.tag:Provenance	example	Common Tags
DocumentReference.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier.use	required	IdentifierUse
DocumentReference.identifier:localIdentifier.use	required	IdentifierUse
DocumentReference.status	required	DocumentReferenceStatus
DocumentReference.docStatus	required	CompositionStatus
DocumentReference.type	preferred	Interweave Document Type
DocumentReference.relatesTo.code	required	DocumentRelationshipType
DocumentReference.securityLabel	extensible	All Security Labels
DocumentReference.content.attachment.contentType	required	http://hl7.org/fhir/ValueSet/mimetypes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
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 : contained.where(('#'+id in %resource.descendants().reference).not()).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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	CareConnect-DocumentReference-1	A reference to a document
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
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
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
Slices for identifier	Σ	0..*	Identifier	Other identifiers for the document Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	Other identifiers for the document
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-documentreference-identifier
value	SΣ	1..1	string	The Local documentreference Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	SΣ	1..1	code	preliminary | final | appended | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	SΣ	1..1	CodeableConcept	Type of document Binding: Interweave Document Type (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
class	Σ	0..1	CodeableConcept	Categorization of document Binding: Document Class Value Set (example): High-level kind of a clinical document at a macro level.
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who is the subject of the document
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
created	Σ	0..1	dateTime	DISCOURAGED - deprecated in R4
indexed	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Device | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1 | CareConnectPatient1 | CareConnect-Organization-1)	Who and/or what authored the document. NB: For most use-cases this should contain a single practitioner who is the main contact for any further questions
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
authenticator	Σ	0..1	Reference(CareConnect-Practitioner-1 | CareConnect-Organization-1)	Who/what authenticated the document
custodian	Σ	0..1	Reference(CareConnect-Organization-1)	DISCOURAGED - this information is already covered by the provenance tags
relatesTo	?!Σ	0..*	BackboneElement	DISCOURAGED - use with great caution as consumer systems are likely to display a simple list of documents, and may not interpret these relationships
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(CareConnect-DocumentReference-1)	Target of the relationship
description	Σ	0..1	string	Human-readable description (title). Useful to populate, but acceptable to omit if nothing to add over-and-above the 'type'
securityLabel	Σ	0..*	CodeableConcept	DISCOURAGED - unlikely to be honoured by consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	1..*	BackboneElement	Document referenced
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
attachment	SΣ	1..1	Attachment	Where to access the document
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	Mime type of the content, with charset etc. Binding: mimetypes (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data		0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	uri	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	Σ	0..1	Coding	Format/content rules for the document Binding: DocumentReference Format Code Set (preferred): Document Format Codes.
context	Σ	0..1	BackboneElement	Clinical context of document
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
encounter	SΣ	0..1	Reference(CareConnect-Encounter-1)	Context of the document content
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
event	Σ	0..*	CodeableConcept	Main clinical acts documented Binding: ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time of service that is being documented
facilityType	Σ	0..1	CodeableConcept	Kind of facility where patient was seen Binding: Facility Type Code Value Set (example): XDS Facility Type.
practiceSetting	Σ	0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: Care Connect Care Setting Type (preferred): Care setting type of the document
sourcePatientInfo	Σ	0..1	Reference(CareConnectPatient1)	Patient demographics from source
related	Σ	0..*	BackboneElement	DISCOURAGED - see above for linkage to Encounter. Other linkages may be defined in future only if use-cases arise
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..1	Identifier	Identifier of related objects or events
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
ref	Σ	0..1	Reference(Resource)	Related Resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
DocumentReference.meta.security	extensible	All Security Labels
DocumentReference.meta.tag	example	Common Tags
DocumentReference.meta.tag:Source	example	Common Tags
DocumentReference.meta.tag:Provenance	example	Common Tags
DocumentReference.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.masterIdentifier.use	required	IdentifierUse
DocumentReference.masterIdentifier.type	extensible	Identifier Type Codes
DocumentReference.identifier.use	required	IdentifierUse
DocumentReference.identifier.type	extensible	Identifier Type Codes
DocumentReference.identifier:localIdentifier.use	required	IdentifierUse
DocumentReference.identifier:localIdentifier.type	extensible	Identifier Type Codes
DocumentReference.status	required	DocumentReferenceStatus
DocumentReference.docStatus	required	CompositionStatus
DocumentReference.type	preferred	Interweave Document Type
DocumentReference.class	example	Document Class Value Set
DocumentReference.relatesTo.code	required	DocumentRelationshipType
DocumentReference.securityLabel	extensible	All Security Labels
DocumentReference.content.attachment.contentType	required	http://hl7.org/fhir/ValueSet/mimetypes
DocumentReference.content.attachment.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	preferred	DocumentReference Format Code Set
DocumentReference.context.event	example	v3 Code System ActCode
DocumentReference.context.facilityType	example	Facility Type Code Value Set
DocumentReference.context.practiceSetting	preferred	Care Connect Care Setting Type
DocumentReference.context.related.identifier.use	required	IdentifierUse
DocumentReference.context.related.identifier.type	extensible	Identifier Type Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())

This structure is derived from CareConnect-DocumentReference-1

Summary

Mandatory: 5 elements (9 nested mandatory elements)
Must-Support: 24 elements
Fixed Value: 3 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

• CareConnectPatient1 (https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Patient-1)

Slices

This structure defines the following Slices:

• The element DocumentReference.meta.tag is sliced based on the value of value:system
• The element DocumentReference.identifier is sliced based on the value of value:system