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

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Resource Profile: Discharge Summary

The ALEX Discharge Summary that utilises the DocumentResource resource

Usages:

• Derived from this Profile: Discharge Summary IPS Profile
• Use this Profile: Discharge Summary Bundle
• Examples for this Profile: DocumentReference/dischargeSummary-full-example and DocumentReference/dischargeSummary-min-example

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: dischargeSummary-subject-display-validation, dischargeSummary-author-display-validation, dischargeSummary-description-validation
meta	Σ	0..1	Meta	Metadata about the resource
lastUpdated	SΣ	0..1	instant	When the resource version last changed
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: Definition of Confidentiality Value Set (required)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comment	C	0..1	string	Extension URL: https://alexapi.medtechglobal.com.au/fhir/StructureDefinition/comment Constraints: comment-length
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Other identifiers for the document
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
value	SΣ	0..1	string	The value that is unique Example General: 123456
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. Required Pattern: current
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
subject	SΣ	1..1	Reference(Patient | Practitioner | Group | Device)	Who/what is the subject of the document
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
description	SΣ	0..1	string	Human-readable description
content	SΣ	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
contentType	SΣ	0..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
data	S	0..1	base64Binary	Data inline, base64ed
url	SΣ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	required	ConfidentialityVS https://alexapi.medtechglobal.com.au/fhir/ValueSet/confidentiality From this IG
DocumentReference.identifier.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.status	required	Pattern Value: current http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 From the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types(a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
comment-length	error	DocumentReference.extension:comment	Comment size validation : value.exists().not() or value.length() <= 200
dischargeSummary-author-display-validation	error	DocumentReference	Author display must not exceed 35 characters : author.display.empty() or author.display.length() <= 35
dischargeSummary-description-validation	error	DocumentReference	Description must not exceed 50 characters : description.empty() or description.length() <= 50
dischargeSummary-subject-display-validation	error	DocumentReference	Subject display must not exceed 25 characters : subject.display.empty() or subject.display.length() <= 25
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: dischargeSummary-subject-display-validation, dischargeSummary-author-display-validation, dischargeSummary-description-validation
meta
lastUpdated	S	0..1	instant	When the resource version last changed
security		0..*	Coding	Security Labels applied to this resource Binding: Definition of Confidentiality Value Set (required)
implicitRules		0..0
language		0..0
contained		0..0
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comment		0..1	string	Extension URL: https://alexapi.medtechglobal.com.au/fhir/StructureDefinition/comment
identifier	S	0..*	Identifier	Other identifiers for the document
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
type
coding
system		0..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/v2-0203
code		0..1	code	Symbol in syntax defined by the system Required Pattern: FILL
value	S	0..1	string	The value that is unique
status		1..1	code	current | superseded | entered-in-error Required Pattern: current
docStatus		0..0
type	S	1..1	CodeableConcept	Kind of document (LOINC if possible)
coding
system		0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code		0..1	code	Symbol in syntax defined by the system Required Pattern: 34109-9
display		0..1	string	Representation defined by the system Required Pattern: Note
category		0..0
subject	S	1..1	Reference(Patient | Practitioner | Group | Device)	Who/what is the subject of the document
date	S	1..1	instant	When this document reference was created
author	S	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
authenticator		0..0
custodian		0..0
relatesTo		0..0
description	S	0..1	string	Human-readable description
securityLabel		0..0
content	S	1..*	BackboneElement	Document referenced
attachment
contentType	S	0..1	code	Mime type of the content, with charset etc.
data	S	0..1	base64Binary	Data inline, base64ed
url	S	0..1	url	Uri where the data can be found
context		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.meta.security	required	ConfidentialityVS https://alexapi.medtechglobal.com.au/fhir/ValueSet/confidentiality From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dischargeSummary-author-display-validation	error	DocumentReference	Author display must not exceed 35 characters : author.display.empty() or author.display.length() <= 35
dischargeSummary-description-validation	error	DocumentReference	Description must not exceed 50 characters : description.empty() or description.length() <= 50
dischargeSummary-subject-display-validation	error	DocumentReference	Subject display must not exceed 25 characters : subject.display.empty() or subject.display.length() <= 25

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: dischargeSummary-subject-display-validation, dischargeSummary-author-display-validation, dischargeSummary-description-validation
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: Definition of Confidentiality Value Set (required)
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comment	C	0..1	string	Extension URL: https://alexapi.medtechglobal.com.au/fhir/StructureDefinition/comment Constraints: comment-length
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
identifier	SΣ	0..*	Identifier	Other identifiers for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
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.
id		0..1	string	Unique id for inter-element referencing
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	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/v2-0203
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: FILL
display	Σ	0..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
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	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(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. Required Pattern: current
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: 34109-9
display	Σ	0..1	string	Representation defined by the system Required Pattern: Note
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
subject	SΣ	1..1	Reference(Patient | Practitioner | Group | Device)	Who/what is the subject of the document
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
description	SΣ	0..1	string	Human-readable description
content	SΣ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	0..1	code	Mime type of the content, with charset etc. Binding: Mime Types (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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	0..1	base64Binary	Data inline, base64ed
url	SΣ	0..1	url	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: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	required	ConfidentialityVS https://alexapi.medtechglobal.com.au/fhir/ValueSet/confidentiality From this IG
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
DocumentReference.identifier.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
DocumentReference.status	required	Pattern Value: current http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 From the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types(a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	preferred	DocumentReferenceFormatCodeSet(a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes From the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes From the FHIR Standard
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
comment-length	error	DocumentReference.extension:comment	Comment size validation : value.exists().not() or value.length() <= 200
dischargeSummary-author-display-validation	error	DocumentReference	Author display must not exceed 35 characters : author.display.empty() or author.display.length() <= 35
dischargeSummary-description-validation	error	DocumentReference	Description must not exceed 50 characters : description.empty() or description.length() <= 50
dischargeSummary-subject-display-validation	error	DocumentReference	Subject display must not exceed 25 characters : subject.display.empty() or subject.display.length() <= 25
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from DocumentReference

Summary

Mandatory: 3 elements
Must-Support: 12 elements
Prohibited: 10 elements

Extensions

This structure refers to these extensions:

• https://alexapi.medtechglobal.com.au/fhir/StructureDefinition/comment

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: dischargeSummary-subject-display-validation, dischargeSummary-author-display-validation, dischargeSummary-description-validation
meta	Σ	0..1	Meta	Metadata about the resource
lastUpdated	SΣ	0..1	instant	When the resource version last changed
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: Definition of Confidentiality Value Set (required)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comment	C	0..1	string	Extension URL: https://alexapi.medtechglobal.com.au/fhir/StructureDefinition/comment Constraints: comment-length
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Other identifiers for the document
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
value	SΣ	0..1	string	The value that is unique Example General: 123456
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. Required Pattern: current
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
subject	SΣ	1..1	Reference(Patient | Practitioner | Group | Device)	Who/what is the subject of the document
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
description	SΣ	0..1	string	Human-readable description
content	SΣ	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
contentType	SΣ	0..1	code	Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
data	S	0..1	base64Binary	Data inline, base64ed
url	SΣ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	required	ConfidentialityVS https://alexapi.medtechglobal.com.au/fhir/ValueSet/confidentiality From this IG
DocumentReference.identifier.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.status	required	Pattern Value: current http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 From the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types(a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
comment-length	error	DocumentReference.extension:comment	Comment size validation : value.exists().not() or value.length() <= 200
dischargeSummary-author-display-validation	error	DocumentReference	Author display must not exceed 35 characters : author.display.empty() or author.display.length() <= 35
dischargeSummary-description-validation	error	DocumentReference	Description must not exceed 50 characters : description.empty() or description.length() <= 50
dischargeSummary-subject-display-validation	error	DocumentReference	Subject display must not exceed 25 characters : subject.display.empty() or subject.display.length() <= 25
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: dischargeSummary-subject-display-validation, dischargeSummary-author-display-validation, dischargeSummary-description-validation
meta
lastUpdated	S	0..1	instant	When the resource version last changed
security		0..*	Coding	Security Labels applied to this resource Binding: Definition of Confidentiality Value Set (required)
implicitRules		0..0
language		0..0
contained		0..0
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comment		0..1	string	Extension URL: https://alexapi.medtechglobal.com.au/fhir/StructureDefinition/comment
identifier	S	0..*	Identifier	Other identifiers for the document
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
type
coding
system		0..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/v2-0203
code		0..1	code	Symbol in syntax defined by the system Required Pattern: FILL
value	S	0..1	string	The value that is unique
status		1..1	code	current | superseded | entered-in-error Required Pattern: current
docStatus		0..0
type	S	1..1	CodeableConcept	Kind of document (LOINC if possible)
coding
system		0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code		0..1	code	Symbol in syntax defined by the system Required Pattern: 34109-9
display		0..1	string	Representation defined by the system Required Pattern: Note
category		0..0
subject	S	1..1	Reference(Patient | Practitioner | Group | Device)	Who/what is the subject of the document
date	S	1..1	instant	When this document reference was created
author	S	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
authenticator		0..0
custodian		0..0
relatesTo		0..0
description	S	0..1	string	Human-readable description
securityLabel		0..0
content	S	1..*	BackboneElement	Document referenced
attachment
contentType	S	0..1	code	Mime type of the content, with charset etc.
data	S	0..1	base64Binary	Data inline, base64ed
url	S	0..1	url	Uri where the data can be found
context		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.meta.security	required	ConfidentialityVS https://alexapi.medtechglobal.com.au/fhir/ValueSet/confidentiality From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dischargeSummary-author-display-validation	error	DocumentReference	Author display must not exceed 35 characters : author.display.empty() or author.display.length() <= 35
dischargeSummary-description-validation	error	DocumentReference	Description must not exceed 50 characters : description.empty() or description.length() <= 50
dischargeSummary-subject-display-validation	error	DocumentReference	Subject display must not exceed 25 characters : subject.display.empty() or subject.display.length() <= 25

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	A reference to a document Constraints: dischargeSummary-subject-display-validation, dischargeSummary-author-display-validation, dischargeSummary-description-validation
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: Definition of Confidentiality Value Set (required)
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:comment	C	0..1	string	Extension URL: https://alexapi.medtechglobal.com.au/fhir/StructureDefinition/comment Constraints: comment-length
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
identifier	SΣ	0..*	Identifier	Other identifiers for the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
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.
id		0..1	string	Unique id for inter-element referencing
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	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/v2-0203
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: FILL
display	Σ	0..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
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	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(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. Required Pattern: current
type	SΣ	1..1	CodeableConcept	Kind of document (LOINC if possible) Binding: DocumentTypeValueSet (preferred): Precise type of clinical document.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: 34109-9
display	Σ	0..1	string	Representation defined by the system Required Pattern: Note
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
subject	SΣ	1..1	Reference(Patient | Practitioner | Group | Device)	Who/what is the subject of the document
date	SΣ	1..1	instant	When this document reference was created
author	SΣ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)	Who and/or what authored the document
description	SΣ	0..1	string	Human-readable description
content	SΣ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	0..1	code	Mime type of the content, with charset etc. Binding: Mime Types (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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	0..1	base64Binary	Data inline, base64ed
url	SΣ	0..1	url	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: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	required	ConfidentialityVS https://alexapi.medtechglobal.com.au/fhir/ValueSet/confidentiality From this IG
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
DocumentReference.identifier.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
DocumentReference.status	required	Pattern Value: current http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 From the FHIR Standard
DocumentReference.type	preferred	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types(a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	preferred	DocumentReferenceFormatCodeSet(a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes From the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes From the FHIR Standard
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
comment-length	error	DocumentReference.extension:comment	Comment size validation : value.exists().not() or value.length() <= 200
dischargeSummary-author-display-validation	error	DocumentReference	Author display must not exceed 35 characters : author.display.empty() or author.display.length() <= 35
dischargeSummary-description-validation	error	DocumentReference	Description must not exceed 50 characters : description.empty() or description.length() <= 50
dischargeSummary-subject-display-validation	error	DocumentReference	Subject display must not exceed 25 characters : subject.display.empty() or subject.display.length() <= 25
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from DocumentReference

Summary

Mandatory: 3 elements
Must-Support: 12 elements
Prohibited: 10 elements

Extensions

This structure refers to these extensions:

• https://alexapi.medtechglobal.com.au/fhir/StructureDefinition/comment

Other representations of profile: CSV, Excel, Schematron