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.

Document identifiers usually assigned by the source of the document, or other business identifiers such as XDS DocumentEntry.uniqueId and DocumentEntry.entryUUID. These identifiers are specific to this instance of the document.

The structure and format of this Id shall identifier would be consistent with the specification corresponding to the formatCode attribute. format of the document. (e.g. for a DICOM standard document document, a 64-character numeric UID, UID; for an HL7 CDA format a serialization of format, the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the extension).

An explicitly assigned identifer of a 16 UTF-8 char max. If variation of the OID is coded without content in the extension then DocumentReference.

CDA Document Id extension While each resource, including the DocumentReference itself, has its own version identifier, this is a formal identifier for the logical version of the DocumentReference as a whole. It would remain constant if the resources were moved to a new server, and root. all got new individual resource versions, for example.

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.

Imaging modality used. This may include both acquisition and non-acquisition modalities.

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 anatomic structures included in the document.

Identifies the organization or group who is responsible for ongoing maintenance The kind of and access to facility where the document. patient was seen.

The type of relationship that this document has with anther document. This property may convey specifics about the practice setting where the 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.

If this document appends another document, then the document cannot This element should be fully understood without also accessing based on a coarse classification system for the referenced document. class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.

The target time period over which the service that is described by the document of this relationship. was provided.

Human-readable description of When the source document. document reference was created.

What the document Referencing/indexing time is about, a terse summary of the document. used for tracking, organizing versions and searching.

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 Identifies who is responsible for adding the "reference" information to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on document.

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

Use of A participant who has authenticated the Health Care Privacy/Security Classification (HCS) system accuracy of security-tag use is recommended. the document.

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 Identifies responsibility for the vocabulary bindings are an administrative domain responsibility. The use accuracy 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. document content.

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. Only list each attester once.

The document and format referenced. There may be multiple content element repetitions, each with a different format. type of attestation the authenticator offers.

Indicates the level of authority of the attestation.

The document or URL of When the document along with critical metadata to prove content has integrity. was attested by the party.

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

An identifier of the document encoding, structure, and template that Who attested the document conforms to beyond the base format indicated in the mimeType. specified way.

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

The clinical context in Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.

These values are primarily added Identifies the logical organization (software system, vendor, or department) to help with searching for interesting/relevant documents. 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 delegated to the management of some other organization.

Describes the clinical encounter or type of care Relationships that the this document content is associated with. has with other document references that already exist.

This element is labeled as a modifier because documents that append to other documents are incomplete on their own.

This list 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 The type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act. of relationship that this document has with anther document.

An event can further specialize the 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 this document appends another document, then the values inherent in document cannot be fully understood without also accessing the class or type elements as such a conflict would create an ambiguous situation. referenced document.

The time period over which the service that is described by the target document was provided. of this relationship.

The kind Human-readable description of facility where the patient was seen. source document.

Helps humans to assess whether the document is of interest.

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

This property A set of Security-Tag codes specifying the 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 convey specifics contain sensitive information, while the DocumentReference is metadata about the practice setting where document and thus might not be as sensitive as the content was created, often reflecting document. For example: a psychotherapy episode may contain highly sensitive information, while the clinical specialty. metadata may simply indicate that some episode happened.

This is an important piece Use of metadata that providers often rely upon to quickly sort and/or filter out to find specific content. the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

This element should The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be based on desirable in a coarse classification system for the class of specialty practice. Recommend 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 classification system for Practice Setting, policy domain such as that described by the Subject Matter XDS Affinity Domain in LOINC. 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.

The Patient Information as known when document and format referenced. If there are multiple content element repetitions, these must all represent the same document was published. May be a reference to a version specific, in different format, or contained. attachment metadata.

Note that .relatesTo may also include references to other DocumentReference with a transforms relationship to represent the same document in multiple formats.

content element shall not contain different versions of the same content. For version handling use multiple DocumentReference with .relatesTo.

Related identifiers The document or resources associated with URL of the DocumentReference. document along with critical metadata to prove content has integrity.

An identifier of the 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.