Introduction

A DocumentReference resource is used to describe a document that is made available to a healthcare system. A document is some sequence of bytes that is identifiable, establishes its own context (e.g., what subject, author, etc. can be displayed to the user), and has defined update management. The DocumentReference resource can be used with any document format that has a recognized mime type and that conforms to this definition.

Typically, DocumentReference resources are used in document indexing systems, such as IHE XDS , and are used to refer to:

• CDA documents in FHIR systems
• FHIR documents stored elsewhere (i.e. registry/repository following the XDS model)
• PDF documents , and even digital records of faxes where sufficient information is available
• Other kinds of documents, such as records of prescriptions

Scope and Usage

In scope of the eHealth infrastructure the primary use of the DocumentReference resource is to contain or refer to information material used in relation to PlanDefinition and Questionnaire. This information material can be in the form of embedded material (of limited size) or references to videos, PDF-files or printed material.

See eHealth-plandefinition for further details.

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

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints
DocumentReference			DocumentReference
type		0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Document Type (required)
category		0..1	CodeableConcept	Categorization of document Binding: Document Class (required)
subject		0..1	Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r}	Who/what is the subject of the document
author		0..*	Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r}	Who and/or what authored the document
authenticator		0..1	Reference(ehealth-practitioner | ehealth-organization) {r}	Who/what authenticated the document
custodian		0..1	Reference(ehealth-organization) {r}	Organization which maintains the document
relatesTo
target		1..1	Reference(ehealth-documentreference)	Target of the relationship
content
format		0..1	Coding	Format/content rules for the document Binding: FormatCodes (required)
context
event		0..*	CodeableConcept	Main clinical acts documented Binding: Event Type Codes (required)
facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: Facility Type Codes (required)
practiceSetting		0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Codes (required)
sourcePatientInfo		0..1	Reference(ehealth-patient)	Patient demographics from source
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.type	required	DocumentType http://ehealth.sundhed.dk/vs/document-type from this IG
DocumentReference.category	required	DocumentClass http://ehealth.sundhed.dk/vs/document-class from this IG
DocumentReference.content.format	required	FormatCodes http://ehealth.sundhed.dk/vs/format-codes from this IG
DocumentReference.context.event	required	EventTypeCodes http://ehealth.sundhed.dk/vs/event-type-codes from this IG
DocumentReference.context.facilityType	required	FacilityTypeCodes http://ehealth.sundhed.dk/vs/facility-type-codes from this IG
DocumentReference.context.practiceSetting	required	PracticeSettingCodes http://ehealth.sundhed.dk/vs/practice-setting-codes from this IG

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type	Σ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Document Type (required)
category	Σ	0..1	CodeableConcept	Categorization of document Binding: Document Class (required)
subject	Σ	0..1	Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r}	Who/what is the subject of the document
author	Σ	0..*	Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r}	Who and/or what authored the document
authenticator		0..1	Reference(ehealth-practitioner | ehealth-organization) {r}	Who/what authenticated the document
custodian		0..1	Reference(ehealth-organization) {r}	Organization which maintains the document
content	Σ	1..*	BackboneElement	Document referenced
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
format	Σ	0..1	Coding	Format/content rules for the document Binding: FormatCodes (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.type	required	DocumentType http://ehealth.sundhed.dk/vs/document-type from this IG
DocumentReference.category	required	DocumentClass http://ehealth.sundhed.dk/vs/document-class from this IG
DocumentReference.content.format	required	FormatCodes http://ehealth.sundhed.dk/vs/format-codes from this IG

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
identifier	Σ	0..*	Identifier	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	Σ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Document Type (required)
category	Σ	0..1	CodeableConcept	Categorization of document Binding: Document Class (required)
subject	Σ	0..1	Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r}	Who/what is the subject of the document
date	Σ	0..1	instant	When this document reference was created
author	Σ	0..*	Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r}	Who and/or what authored the document
authenticator		0..1	Reference(ehealth-practitioner | ehealth-organization) {r}	Who/what authenticated the document
custodian		0..1	Reference(ehealth-organization) {r}	Organization which maintains the document
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(ehealth-documentreference)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
format	Σ	0..1	Coding	Format/content rules for the document Binding: FormatCodes (required)
context	Σ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter		0..*	Reference(Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: Event Type Codes (required)
period	Σ	0..1	Period	Time of service that is being documented
facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: Facility Type Codes (required)
practiceSetting		0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Codes (required)
sourcePatientInfo		0..1	Reference(ehealth-patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
DocumentReference.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
DocumentReference.type	required	DocumentType http://ehealth.sundhed.dk/vs/document-type from this IG
DocumentReference.category	required	DocumentClass http://ehealth.sundhed.dk/vs/document-class from this IG
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.format	required	FormatCodes http://ehealth.sundhed.dk/vs/format-codes from this IG
DocumentReference.context.event	required	EventTypeCodes http://ehealth.sundhed.dk/vs/event-type-codes from this IG
DocumentReference.context.facilityType	required	FacilityTypeCodes http://ehealth.sundhed.dk/vs/facility-type-codes from this IG
DocumentReference.context.practiceSetting	required	PracticeSettingCodes http://ehealth.sundhed.dk/vs/practice-setting-codes from this IG

Differential View

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints
DocumentReference			DocumentReference
type		0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Document Type (required)
category		0..1	CodeableConcept	Categorization of document Binding: Document Class (required)
subject		0..1	Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r}	Who/what is the subject of the document
author		0..*	Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r}	Who and/or what authored the document
authenticator		0..1	Reference(ehealth-practitioner | ehealth-organization) {r}	Who/what authenticated the document
custodian		0..1	Reference(ehealth-organization) {r}	Organization which maintains the document
relatesTo
target		1..1	Reference(ehealth-documentreference)	Target of the relationship
content
format		0..1	Coding	Format/content rules for the document Binding: FormatCodes (required)
context
event		0..*	CodeableConcept	Main clinical acts documented Binding: Event Type Codes (required)
facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: Facility Type Codes (required)
practiceSetting		0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Codes (required)
sourcePatientInfo		0..1	Reference(ehealth-patient)	Patient demographics from source
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.type	required	DocumentType http://ehealth.sundhed.dk/vs/document-type from this IG
DocumentReference.category	required	DocumentClass http://ehealth.sundhed.dk/vs/document-class from this IG
DocumentReference.content.format	required	FormatCodes http://ehealth.sundhed.dk/vs/format-codes from this IG
DocumentReference.context.event	required	EventTypeCodes http://ehealth.sundhed.dk/vs/event-type-codes from this IG
DocumentReference.context.facilityType	required	FacilityTypeCodes http://ehealth.sundhed.dk/vs/facility-type-codes from this IG
DocumentReference.context.practiceSetting	required	PracticeSettingCodes http://ehealth.sundhed.dk/vs/practice-setting-codes from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
type	Σ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Document Type (required)
category	Σ	0..1	CodeableConcept	Categorization of document Binding: Document Class (required)
subject	Σ	0..1	Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r}	Who/what is the subject of the document
author	Σ	0..*	Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r}	Who and/or what authored the document
authenticator		0..1	Reference(ehealth-practitioner | ehealth-organization) {r}	Who/what authenticated the document
custodian		0..1	Reference(ehealth-organization) {r}	Organization which maintains the document
content	Σ	1..*	BackboneElement	Document referenced
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
format	Σ	0..1	Coding	Format/content rules for the document Binding: FormatCodes (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.type	required	DocumentType http://ehealth.sundhed.dk/vs/document-type from this IG
DocumentReference.category	required	DocumentClass http://ehealth.sundhed.dk/vs/document-class from this IG
DocumentReference.content.format	required	FormatCodes http://ehealth.sundhed.dk/vs/format-codes from this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	DocumentReference	A reference to a document
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
identifier	Σ	0..*	Identifier	Other identifiers for the document
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	Σ	0..1	CodeableConcept	Kind of document (LOINC if possible) Binding: Document Type (required)
category	Σ	0..1	CodeableConcept	Categorization of document Binding: Document Class (required)
subject	Σ	0..1	Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r}	Who/what is the subject of the document
date	Σ	0..1	instant	When this document reference was created
author	Σ	0..*	Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r}	Who and/or what authored the document
authenticator		0..1	Reference(ehealth-practitioner | ehealth-organization) {r}	Who/what authenticated the document
custodian		0..1	Reference(ehealth-organization) {r}	Organization which maintains the document
relatesTo	Σ	0..*	BackboneElement	Relationships to other documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(ehealth-documentreference)	Target of the relationship
description	Σ	0..1	string	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..*	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
format	Σ	0..1	Coding	Format/content rules for the document Binding: FormatCodes (required)
context	Σ	0..1	BackboneElement	Clinical context of document
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter		0..*	Reference(Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableConcept	Main clinical acts documented Binding: Event Type Codes (required)
period	Σ	0..1	Period	Time of service that is being documented
facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: Facility Type Codes (required)
practiceSetting		0..1	CodeableConcept	Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Codes (required)
sourcePatientInfo		0..1	Reference(ehealth-patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
DocumentReference.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
DocumentReference.type	required	DocumentType http://ehealth.sundhed.dk/vs/document-type from this IG
DocumentReference.category	required	DocumentClass http://ehealth.sundhed.dk/vs/document-class from this IG
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
DocumentReference.content.format	required	FormatCodes http://ehealth.sundhed.dk/vs/format-codes from this IG
DocumentReference.context.event	required	EventTypeCodes http://ehealth.sundhed.dk/vs/event-type-codes from this IG
DocumentReference.context.facilityType	required	FacilityTypeCodes http://ehealth.sundhed.dk/vs/facility-type-codes from this IG
DocumentReference.context.practiceSetting	required	PracticeSettingCodes http://ehealth.sundhed.dk/vs/practice-setting-codes from this IG

This structure is derived from DocumentReference

Summary

Structures

This structure refers to these other structures:

• ehealth-patient (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-patient)
• ehealth-practitioner (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-practitioner)
• ehealth-device (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-device)
• ehealth-organization (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-organization)
• ehealth-relatedperson (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-relatedperson)
• ehealth-documentreference (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-documentreference)