# US Core DiagnosticReport Profile for Laboratory Results Reporting - US Core Implementation Guide v9.0.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core DiagnosticReport Profile for Laboratory Results Reporting**

## Resource Profile: US Core DiagnosticReport Profile for Laboratory Results Reporting 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab | *Version*:9.0.0 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](changes-between-versions.md#us-core-maturity-levels): 5 | *Computable Name*:USCoreDiagnosticReportProfileLaboratoryReporting |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.20 | | |

 
The US Core DiagnosticReport Profile for Laboratory Results Reporting inherits from the FHIR [DiagnosticReport](https://hl7.org/fhir/R4/diagnosticreport.html) resource; refer to it for scope and usage definitions. Laboratory results are grouped and summarized using the DiagnosticReport resource, which typically references Observation resource(s). Each Observation resource represents an individual laboratory test and result value or component result values or a nested panel (such as a microbial susceptibility panel) that references other observations. Laboratory results can also be presented in report form or as free text. This profile sets minimum expectations for the DiagnosticReport resource to record, search, and fetch laboratory results associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. 

**Example Usage Scenarios:**

The following are example usage scenarios for the US Core DiagnosticReport Profile for Laboratory Results Reporting:

* Query for lab reports belonging to a Patient
* [Record or update](us-core-roadmap.md#future-candidate-requirements-under-consideration) a lab report for a specific Patient

### Mandatory and Must Support Data Elements

The following data elements must always be present ([Mandatory](must-support.md) definition) or must be supported if the data is present in the sending system ([Must Support](must-support.md) definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The [Formal Views](#profile) below provides the formal summary, definitions, and terminology requirements.

**Each DiagnosticReport Must Have:**

1. a status
1. a category code of 'LAB'
1. a code (preferably a LOINC code) which tells you what is being measured
1. a patient
1. the diagnostically relevant time (known as the "effective time" and typically the time of specimen collection)1
1. when the report was released1

**Each DiagnosticReport Must Support:**

1. a timestamp when the resource last changed2
1. encounter associated with DiagnosticReport
1. who issues the report3
1. a results interpreter3
1. a result

1,2,3 see guidance below

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

* 1`DiagnosticReport.effective[x]` and `DiagnosticReport.issued` have the following constraints: **SHALL** be present if status is 'partial', 'preliminary', 'final', 'amended', 'corrected', or 'appended'.[§](requirements.md#CONF-0356),[§](requirements.md#CONF-0357)
* The [CLIA/USCDI/HL7 Elements Crossmapping Table](https://confluence.hl7.org/spaces/OO/pages/256515226/US+-+CLIA+Elements+mapping+to+HL7+data+elements) provides a crosswalk of [Clinical Laboratory Improvement Amendments (CLIA)](http://www.cdc.gov/clia/) data elements to corresponding FHIR fields, terminology standards, and naming conventions used in HL7 CDA and HL7 V2 standards. Implementers can use this mapping to help comply with CLIA requirements when using the US Core Laboratory Result Observation Profile.
* Additional codes that translate or map to the DiagnosticReport codes or category codes are allowed. For example: 
* providing both a local system code and a LOINC code that it maps to
* providing a more specific category code to the "LAB" category code, such as "CH" (chemistry), in an additional coding element.
 

* 3The profile elements `DiagnosticReport.performer and DiagnosticReport.resultsInterpreter` communicate the [individual level provenance](basic-provenance.md#individual-level-provenance) author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.
* Results that are free text or report form are represented using the `DiagnosticReport.presentedForm` element.
* 2See the US Core General Guidance page for [Searching Using lastUpdated](general-guidance.md#searching-using-lastupdated). Updates to `.meta.lastUpdated` **SHOULD** reflect: 
* New laboratory reports[§](requirements.md#CONF-0358)
* Changes in the status of laboratory reports, including events that trigger the same status (e.g., amended → amended).[§](requirements.md#CONF-0359)
 
* The `DiagnosticReport.basedOn` element connects the DiagnosticReport to the originating order in the EHR. Systems that initiate the lab order **SHOULD** use this element when reporting the results.[§](requirements.md#CONF-0836)

**Usages:**

* Examples for this Profile: [DiagnosticReport/cbc](DiagnosticReport-cbc.md) and [DiagnosticReport/metabolic-panel](DiagnosticReport-metabolic-panel.md)
* CapabilityStatements using this Profile: [US Core Client CapabilityStatement](CapabilityStatement-us-core-client.md) and [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.fhir.us.core|current/StructureDefinition/StructureDefinition-us-core-diagnosticreport-lab.json)

**Changes since version 8.0.1:**

* The resource metadata has changed (copyright)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-diagnosticreport-lab.csv), [Excel](StructureDefinition-us-core-diagnosticreport-lab.xlsx), [Schematron](StructureDefinition-us-core-diagnosticreport-lab.sch) 

### Notes:

-------

**Quick Start**  

-------

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md) for a complete list of supported RESTful interactions for this IG.

* See the [Scopes Format](scopes.md#scopes-format) section for a description of the SMART scopes syntax.
* See the [Search Syntax](general-guidance.md#search-syntax) section for a description of the US Core search syntax.
* See the [General Requirements](general-requirements.md) section for additional rules and expectations when a Server requires status parameters.
* See the [General Guidance](general-guidance.md) section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to laboratory data **SHALL** support these [US Core SMART Scopes](scopes.md#smart-scopes):

* [resource level scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#scopes-for-requesting-clinical-data): `<patient|user|system>/DiagnosticReport.rs` [§](requirements.md#CONF-0138)

-------

#### Mandatory Search Parameters:

The following search parameters and search parameter combinations **SHALL** be supported:

1. **SHALL** support searching for all diagnosticreports for a patient using the [patient](SearchParameter-us-core-diagnosticreport-patient.md) search parameter`GET [base]/DiagnosticReport?patient={Patient/}[id]`Example:
> 
1. GET [base]/DiagnosticReport?patient=Patient/1137192

**Implementation Notes**: Fetches a bundle of all US Core DiagnosticReport Profile for Laboratory Results Reporting resources for the specified patient ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference)).
1. **SHALL** support searching for all Observations using the combination of the [patient](SearchParameter-us-core-diagnosticreport-patient.md) and [category](SearchParameter-us-core-diagnosticreport-category.md) search parameters`GET [base]/DiagnosticReport?patient={Patient/}[id]&category={system|}[search_code]`Example:
> 
1. GET [base]/DiagnosticReport?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/v2-0074|LAB

**Implementation Notes**: Fetches a bundle of all US Core DiagnosticReport Profile for Laboratory Results Reporting resources for the specified patient and a category code = "LAB" ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHALL** support searching for all Observations by code using the combination of the [patient](SearchParameter-us-core-diagnosticreport-patient.md) and [code](SearchParameter-us-core-diagnosticreport-code.md) search parameters
* Including optional support **OR** search on `code` (e.g.`code={system|}[code],{system|}[code],...`)
`GET [base]/DiagnosticReport?patient={Patient/}[id]&code={system|}[search_code]{,{system|}[code],...}`Example:
> 
1. GET [base]/DiagnosticReport?patient=Patient/1137192&code=http://loinc.org|24323-8

**Implementation Notes**: Fetches a bundle of all US Core DiagnosticReport Profile for Laboratory Results Reporting resources for the specified patient and report code(s). SHOULD support search by multiple report codes. ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHALL** support searching for all Observations by date using the combination of the [patient](SearchParameter-us-core-diagnosticreport-patient.md) and [category](SearchParameter-us-core-diagnosticreport-category.md) and [date](SearchParameter-us-core-diagnosticreport-date.md) search parameters
* Including optional support for **AND** search on `date` (e.g.`date=[date]&date=[date]&...`)
* Including support for these `date` comparators: "gt", "lt", "ge", "le"
`GET [base]/DiagnosticReport?patient={Patient/}[id]&category={system|}[search_code]&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}`Example:
> 
1. GET [base]/DiagnosticReport?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/v2-0074|LAB&date=ge2010-01-14T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core DiagnosticReport Profile for Laboratory Results Reporting resources for the specified patient and date and a category code = "LAB" ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).

#### Optional Search Parameters:

The following search parameters and search parameter combinations **SHOULD** be supported

1. **SHOULD** support searching for all Observations for a patient for a given status (for example completed reports ) using the combination of the [patient](SearchParameter-us-core-diagnosticreport-patient.md) and [status](SearchParameter-us-core-diagnosticreport-status.md) search parameters
* Including support **OR** search on `status` (e.g.`status={system|}[code],{system|}[code],...`)
`GET [base]/DiagnosticReport?patient={Patient/}[id]&status={system|}[search_code]{,{system|}[code],...}`Example:
> 
1. GET [base]/DiagnosticReport?patient=Patient/1137192&status=completed

**Implementation Notes**: Fetches a bundle of all US Core DiagnosticReport Profile for Laboratory Results Reporting resources for the specified patient and status ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHOULD** support searching using the combination of the [patient](SearchParameter-us-core-diagnosticreport-patient.md) and [category](SearchParameter-us-core-diagnosticreport-category.md) and [_lastUpdated](SearchParameter-us-core-diagnosticreport-lastupdated.md) search parameters
* Including optional support for **AND** search on `_lastUpdated` (e.g.`_lastUpdated=[date]&_lastUpdated=[date]&...`)
* Including support for these `_lastUpdated` comparators: "gt", "lt", "ge", "le"
`GET [base]/DiagnosticReport?patient={Patient/}[id]&category={system|}[search_code]&_lastUpdated=[dateTime]`Example:
> 
1. GET [base]/DiagnosticReport?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/v2-0074|LAB&_lastUpdated=ge2010-01-14T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core DiagnosticReport Profile for Laboratory Results Reporting resources for the specified patient and category = "LAB" and _lastUpdated. See the US Core General Guidance page for [Searching Using lastUpdated](general-guidance.md#searching-using-lastupdated). ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).
1. **SHOULD** support searching for Observations by code and date using the combination of the [patient](SearchParameter-us-core-diagnosticreport-patient.md) and [code](SearchParameter-us-core-diagnosticreport-code.md) and [date](SearchParameter-us-core-diagnosticreport-date.md) search parameters
* Including optional support **OR** search on `code` (e.g.`code={system|}[code],{system|}[code],...`)
* Including optional support for **AND** search on `date` (e.g.`date=[date]&date=[date]&...`)
* Including support for these `date` comparators: "gt", "lt", "ge", "le"
`GET [base]/DiagnosticReport?patient={Patient/}[id]&code={system|}[search_code]{,{system|}[code],...}&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}`Example:
> 
1. GET [base]/DiagnosticReport?patient=Patient/1137192&code=http://loinc.org|24323-8&date=ge2019-01-14T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core DiagnosticReport Profile for Laboratory Results Reporting resources for the specified patient and date and report code(s). SHOULD support search by multiple report codes. ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-diagnosticreport-lab",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 5
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cgp"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.20"
  }],
  "version" : "9.0.0",
  "name" : "USCoreDiagnosticReportProfileLaboratoryReporting",
  "title" : "US Core DiagnosticReport Profile for Laboratory Results Reporting",
  "status" : "active",
  "experimental" : false,
  "date" : "2023-10-17",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [{
    "name" : "HL7 International / Cross-Group Projects",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    },
    {
      "system" : "email",
      "value" : "cgp@lists.HL7.org"
    }]
  }],
  "description" : "The US Core DiagnosticReport Profile for Laboratory Results Reporting inherits from the FHIR [DiagnosticReport](https://hl7.org/fhir/R4/diagnosticreport.html) resource; refer to it for scope and usage definitions. Laboratory results are grouped and summarized using the DiagnosticReport resource, which typically references Observation resource(s). Each Observation resource represents an individual laboratory test and result value or component result values or a nested panel (such as a microbial susceptibility panel) that references other observations. Laboratory results can also be presented in report form or as free text. This profile sets minimum expectations for the DiagnosticReport resource to record, search,  and fetch laboratory results associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "DiagnosticReport",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/DiagnosticReport",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "DiagnosticReport",
      "path" : "DiagnosticReport",
      "alias" : ["Lab Result", "Lab Report"],
      "constraint" : [{
        "key" : "us-core-8",
        "severity" : "error",
        "human" : "effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended'",
        "expression" : "(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()"
      },
      {
        "key" : "us-core-9",
        "severity" : "error",
        "human" : "issued SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended'",
        "expression" : "(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies issued.exists()"
      }],
      "mustSupport" : false
    },
    {
      "id" : "DiagnosticReport.meta",
      "path" : "DiagnosticReport.meta",
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.meta.lastUpdated",
      "path" : "DiagnosticReport.meta.lastUpdated",
      "short" : "When the resource last changed",
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.status",
      "path" : "DiagnosticReport.status",
      "condition" : ["us-core-8", "us-core-9"],
      "mustSupport" : true,
      "binding" : {
        "strength" : "required",
        "valueSet" : "http://hl7.org/fhir/ValueSet/diagnostic-report-status"
      }
    },
    {
      "id" : "DiagnosticReport.category",
      "path" : "DiagnosticReport.category",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "$this"
        }],
        "rules" : "open"
      },
      "min" : 1,
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.category:LaboratorySlice",
      "path" : "DiagnosticReport.category",
      "sliceName" : "LaboratorySlice",
      "min" : 1,
      "max" : "1",
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
          "code" : "LAB"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.code",
      "path" : "DiagnosticReport.code",
      "short" : "US Core Laboratory Report Order Code",
      "definition" : "The test, panel or battery that was ordered.",
      "comment" : "UsageNote= The typical patterns for codes are:  1)  a LOINC code either as an additional coding from a \"local\" code or as a primary code, or 2)  a local code only if no suitable LOINC exists,  or 3)  both the local and the LOINC additional coding.   Systems SHALL be capable of sending the local code if one exists.",
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "description" : "LOINC codes",
        "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-laboratory-test-codes"
      }
    },
    {
      "id" : "DiagnosticReport.subject",
      "path" : "DiagnosticReport.subject",
      "min" : 1,
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/StructureDefinition/Group",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-device",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-location"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.encounter",
      "path" : "DiagnosticReport.encounter",
      "short" : "Encounter associated with DiagnosticReport",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.effective[x]",
      "path" : "DiagnosticReport.effective[x]",
      "short" : "Diagnostically relevant time (typically the time of specimen collection)",
      "type" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "dateTime"
      },
      {
        "code" : "Period"
      }],
      "condition" : ["us-core-8"],
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.issued",
      "path" : "DiagnosticReport.issued",
      "short" : "When the report was released",
      "condition" : ["us-core-9"],
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.performer",
      "path" : "DiagnosticReport.performer",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.resultsInterpreter",
      "path" : "DiagnosticReport.resultsInterpreter",
      "short" : "Who analyzed and reported the conclusions and interpretations",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization",
        "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    },
    {
      "id" : "DiagnosticReport.result",
      "path" : "DiagnosticReport.result",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"]
      }],
      "mustSupport" : true
    }]
  }
}

```
