A reference to a document of any kind for any purpose. Provides metadata about the document so that While the document can be discovered and managed. The scope of term “document” implies a document is more narrow focus, for this resource this "document" encompasses any seralized serialized object with a mime-type, so it includes formal patient centric patient-centric documents (CDA), cliical clinical notes, scanned paper, and non-patient specific documents like policy text. text, as well as a photo, video, or audio recording acquired or used in healthcare. The DocumentReference resource provides metadata about the document so that the document can be discovered and managed. The actual content may be inline base64 encoded data or provided by direct reference.

Usually, this is used for documents other than those defined by FHIR.

Document identifier as assigned by the source of Other business identifiers associated with the document. This identifier is specific to this document, including version of independent identifiers.

The structure and format of this Id shall be consistent with the specification corresponding to Document identifiers usually assigned by the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization source of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, document, or other business identifiers such as XDS DocumentEntry.uniqueId and DocumentEntry.entryUUID. These identifiers are specific to this instance of the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.). document.

The structure and format of this identifier would be consistent with the specification corresponding to the format of the document. (e.g. for a DICOM standard document, a 64-character numeric UID; for an HL7 CDA format, the CDA Document Id extension root and root. extension).

Other identifiers associated with A procedure that is fulfilled in whole or in part by the document, including version independent identifiers. creation of this media.

Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

The status of this document reference.

This is the status of the DocumentReference object, which might be independent from the docStatus element.

This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

The status of the underlying document.

The document that is pointed to might be in various lifecycle states.

Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.

Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.

A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.

Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).

When Describes the clinical encounter or type of care that the document reference was created. content is associated with.

Identifies who This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is responsible for adding inherent in the information to type Code, such as a "History and Physical Report" in which the document. procedure being documented is necessarily a "History and Physical" act.

Not necessarily who did An event can further specialize the actual data entry (i.e. typist) or who act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the source (informant). values inherent in the class or type elements as such a conflict would create an ambiguous situation.

Which person or organization authenticates that this document is valid. The kind of facility where the patient was seen.

Identifies This property may convey specifics about the organization or group who is responsible for ongoing maintenance of and access to practice setting where the document. content was created, often reflecting the clinical specialty.

This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from element should be based on a coarse classification system for the physical location (URL, disk drive, or server) class of specialty practice. Recommend the document, which is the technical location use of the document, which host may be delegated to classification system for Practice Setting, such as that described by the management of some other organization. Subject Matter Domain in LOINC.

Relationships The time period over which the service that this document has with other is described by the document references that already exist. was provided.

The type of relationship that this When the document has with anther document. reference was created.

If this document appends another document, then the document cannot be fully understood without also accessing the referenced document. Referencing/indexing time is used for tracking, organizing versions and searching.

The target document of this relationship. Identifies who is responsible for adding the information to the document.

Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

Human-readable description A participant who has authenticated the accuracy of the source document.

Helps humans to assess whether Identifies responsibility for the document is accuracy of interest. the document content.

What the document is about, a terse summary of the document. Only list each attester once.

A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot The type of attestation the security labels on the document the reference refers to. authenticator offers.

Use of Indicates the Health Care Privacy/Security Classification (HCS) system level of security-tag use is recommended. authority of the attestation.

The When the document and format referenced. There may be multiple content element repetitions, each with a different format. was attested by the party.

Identifies when the information in the document was deemed accurate. (Things may have changed since then.).

The document or URL of Who attested the document along with critical metadata to prove content has integrity. in the specified way.

Identifies who has taken on the responsibility for accuracy of the document content.

An identifier of Identifies the document encoding, structure, organization or group who is responsible for ongoing maintenance of and template that the document conforms access to beyond the base format indicated in the mimeType. document.

Note that while IHE mostly issues URNs for format types, not all documents can Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be identified by a URI. delegated to the management of some other organization.

The clinical context in which the Relationships that this document was prepared. has with other document references that already exist.

These values are primarily added This element is labeled as a modifier because documents that append to help with searching for interesting/relevant documents. other documents are incomplete on their own.

Describes the clinical encounter or The type of care relationship that the this document content is associated with. has with anther document.

If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

This list The target document of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act. this relationship.

The time period over which the service that is described by Human-readable description of the document was provided. source document.

Helps humans to assess whether the document is of interest.

What the document is about, a terse summary of the document.

The kind A set of facility where Security-Tag codes specifying the patient was seen. level of privacy/security of the Document found at DocumentReference.content.attachment.url. Note that DocumentReference.meta.security contains the security labels of the data elements in DocumentReference, while DocumentReference.securityLabel contains the security labels for the document the reference refers to. The distinction recognizes that the document may contain sensitive information, while the DocumentReference is metadata about the document and thus might not be as sensitive as the document. For example: a psychotherapy episode may contain highly sensitive information, while the metadata may simply indicate that some episode happened.

Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce.

In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.

This property may convey specifics about the practice setting where the The document and format referenced. If there are multiple content was created, often reflecting element repetitions, these must all represent the clinical specialty. same document in different format, or attachment metadata.

This is an important piece of metadata Note that providers often rely upon .relatesTo may also include references to quickly sort and/or filter out other DocumentReference with a transforms relationship to find specific content. represent the same document in multiple formats.

This content element should be based on a coarse classification system for the class shall not contain different versions of specialty practice. Recommend the same content. For version handling use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC. multiple DocumentReference with .relatesTo.

The Patient Information as known when document or URL of the document was published. May be a reference along with critical metadata to a version specific, or contained. prove content has integrity.

Related identifiers or resources associated with An identifier of the DocumentReference. document constraints, encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.

May Note that IHE often issues URNs for formatCode codes, not all documents can be identifiers or resources identified by a URI.

For FHIR content, .profile should indicate the structureDefinition profile canonical URI(s) that caused the DocumentReference or referenced content complies with.

Code|uri|canonical.