PACIO Advance Directive Interoperability Implementation Guide
0.1.0 - STU 1 Ballot

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## Resource Profile: PADIDocumentReference - XML Profile

XML representation of the PADI-DocumentReference resource profile.

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    <StructureDefinition xmlns="http://hl7.org/fhir">
      <id value="PADI-DocumentReference"/>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the the element can appear in the instance">Card.</a></th><th style="width: 100px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the element">Description &amp; Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: white; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-PADI-DocumentReference-definitions.html#DocumentReference">DocumentReference</a><a name="DocumentReference"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/us/core/STU4/StructureDefinition-us-core-documentreference.html">USCoreDocumentReferenceProfile</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">A reference to a document</span></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-PADI-DocumentReference-definitions.html#DocumentReference.type">type</a><a name="DocumentReference.type"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Advance Directive Categories</td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-PADI-DocumentReference-definitions.html#DocumentReference.category">category</a><a name="DocumentReference.category"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Categorization of document</span><br/><span style="font-weight:bold">Binding: </span><a href="http://hl7.org/fhir/us/core/STU4/ValueSet-us-core-documentreference-category.html">US Core DocumentReference Category</a> (<a href="http://hl7.org/fhir/R4/terminologies.html#extensible" title="To be conformant, the concept in this element SHALL be from the specified value set if any of the codes within the value set can apply to the concept being communicated.  If the value set does not cover the concept (based on human review), alternate codings (or, data type allowing, text) may be included instead.">extensible</a>)</td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-PADI-DocumentReference-definitions.html#DocumentReference.subject">subject</a><a name="DocumentReference.subject"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/references.html">Reference</a>(<a style="opacity: 0.5" href="http://hl7.org/fhir/us/core/STU4/StructureDefinition-us-core-patient.html">US Core Patient Profile</a>)</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Patient</td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-PADI-DocumentReference-definitions.html#DocumentReference.author">author</a><a name="DocumentReference.author"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/references.html">Reference</a>(<a href="http://hl7.org/fhir/us/core/STU4/StructureDefinition-us-core-practitioner.html">US Core Practitioner Profile</a> | <a href="http://hl7.org/fhir/us/core/STU4/StructureDefinition-us-core-organization.html">US Core Organization Profile</a> | <a href="http://hl7.org/fhir/us/core/STU4/StructureDefinition-us-core-patient.html">US Core Patient Profile</a>)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">legalAuthenticator</td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-PADI-DocumentReference-definitions.html#DocumentReference.custodian">custodian</a><a name="DocumentReference.custodian"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/references.html">Reference</a>(<a href="http://hl7.org/fhir/us/core/STU4/StructureDefinition-us-core-organization.html">US Core Organization Profile</a>)</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Organization which maintains the document</span></td></tr>
    <tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
      </text>
      <url
           value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/PADI-DocumentReference"/>
      <version value="0.1.0"/>
      <name value="PADIDocumentReference"/>
      <title value="PACIO ADI Document Reference"/>
      <status value="active"/>
      <date value="2021-12-06T20:50:55+00:00"/>
      <publisher value="HL7 Patient Empowerment Working Group"/>
      <contact>
        <name value="HL7 Patient Empowerment Working Group"/>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/patientempowerment"/>
        </telecom>
        <telecom>
          <system value="email"/>
          <value value="patients@lists.HL7.org"/>
        </telecom>
      </contact>
      <description
                   value="This profile defines constraints that represent the information needed to register an advance directive information document on a FHIR server."/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="US"/>
        </coding>
      </jurisdiction>
      <fhirVersion value="4.0.1"/>
      <mapping>
        <identity value="workflow"/>
        <uri value="http://hl7.org/fhir/workflow"/>
        <name value="Workflow Pattern"/>
      </mapping>
      <mapping>
        <identity value="fhircomposition"/>
        <uri value="http://hl7.org/fhir/composition"/>
        <name value="FHIR Composition"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <uri value="http://hl7.org/v3"/>
        <name value="RIM Mapping"/>
      </mapping>
      <mapping>
        <identity value="cda"/>
        <uri value="http://hl7.org/v3/cda"/>
        <name value="CDA (R2)"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <uri value="http://hl7.org/fhir/fivews"/>
        <name value="FiveWs Pattern Mapping"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <uri value="http://hl7.org/v2"/>
        <name value="HL7 v2 Mapping"/>
      </mapping>
      <mapping>
        <identity value="xds"/>
        <uri value="http://ihe.net/xds"/>
        <name value="XDS metadata equivalent"/>
      </mapping>
      <kind value="resource"/>
      <abstract value="false"/>
      <type value="DocumentReference"/>
      <baseDefinition
                      value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"/>
      <derivation value="constraint"/>
      <snapshot>
        <element id="DocumentReference">
          <path value="DocumentReference"/>
          <short value="A reference to a document"/>
          <definition
                      value="This is a basic constraint on DocumentRefernce for use in the US Core IG."/>
          <comment
                   value="Usually, this is used for documents other than those defined by FHIR."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <constraint>
            <key value="dom-2"/>
            <severity value="error"/>
            <human
                   value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
            <expression value="contained.contained.empty()"/>
            <xpath value="not(parent::f:contained and f:contained)"/>
            <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-3"/>
            <severity value="error"/>
            <human
                   value="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"/>
            <expression
                        value="contained.where(((&#39;#&#39;+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = &#39;#&#39;).exists() or descendants().where(as(canonical) = &#39;#&#39;).exists() or descendants().where(as(canonical) = &#39;#&#39;).exists()).not()).trace(&#39;unmatched&#39;, id).empty()"/>
            <xpath
                   value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat(&#39;#&#39;, $contained/*/id/@value) or descendant::f:reference[@value=&#39;#&#39;])]))"/>
            <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-4"/>
            <severity value="error"/>
            <human
                   value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
            <expression
                        value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
            <xpath
                   value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/>
            <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-5"/>
            <severity value="error"/>
            <human
                   value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
            <expression value="contained.meta.security.empty()"/>
            <xpath value="not(exists(f:contained/*/f:meta/f:security))"/>
            <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
              <valueBoolean value="true"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
              <valueMarkdown
                             value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/>
            </extension>
            <key value="dom-6"/>
            <severity value="warning"/>
            <human value="A resource should have narrative for robust management"/>
            <expression value="text.`div`.exists()"/>
            <xpath value="exists(f:text/h:div)"/>
            <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="Entity. Role, or Act"/>
          </mapping>
          <mapping>
            <identity value="workflow"/>
            <map value="Event"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="when describing a Composition"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="Document[classCode=&quot;DOC&quot; and moodCode=&quot;EVN&quot;]"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="when describing a CDA"/>
          </mapping>
        </element>
        <element id="DocumentReference.id">
          <path value="DocumentReference.id"/>
          <short value="Logical id of this artifact"/>
          <definition
                      value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
          <comment
                   value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="true"/>
        </element>
        <element id="DocumentReference.meta">
          <path value="DocumentReference.meta"/>
          <short value="Metadata about the resource"/>
          <definition
                      value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.meta"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Meta"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
        </element>
        <element id="DocumentReference.implicitRules">
          <path value="DocumentReference.implicitRules"/>
          <short value="A set of rules under which this content was created"/>
          <definition
                      value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc."/>
          <comment
                   value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it&#39;s narrative along with other profiles, value sets, etc."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.implicitRules"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="uri"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it&#39;s meaning or interpretation"/>
          <isSummary value="true"/>
        </element>
        <element id="DocumentReference.language">
          <path value="DocumentReference.language"/>
          <short value="Language of the resource content"/>
          <definition value="The base language in which the resource is written."/>
          <comment
                   value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.language"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
              <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="Language"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
              <valueBoolean value="true"/>
            </extension>
            <strength value="preferred"/>
            <description value="A human language."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
          </binding>
        </element>
        <element id="DocumentReference.text">
          <path value="DocumentReference.text"/>
          <short value="Text summary of the resource, for human interpretation"/>
          <definition
                      value="A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/>
          <comment
                   value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded information is added later."/>
          <alias value="narrative"/>
          <alias value="html"/>
          <alias value="xhtml"/>
          <alias value="display"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DomainResource.text"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Narrative"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="Act.text?"/>
          </mapping>
        </element>
        <element id="DocumentReference.contained">
          <path value="DocumentReference.contained"/>
          <short value="Contained, inline Resources"/>
          <definition
                      value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope."/>
          <comment
                   value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels."/>
          <alias value="inline resources"/>
          <alias value="anonymous resources"/>
          <alias value="contained resources"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.contained"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Resource"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.extension">
          <path value="DocumentReference.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.modifierExtension">
          <path value="DocumentReference.modifierExtension"/>
          <short value="Extensions that cannot be ignored"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <requirements
                        value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.masterIdentifier">
          <path value="DocumentReference.masterIdentifier"/>
          <short value="Master Version Specific Identifier"/>
          <definition
                      value="Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document."/>
          <comment value="CDA Document Id extension and root."/>
          <requirements
                        value="The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form &quot;oid^extension&quot;, where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the &#39;^&#39; character shall not be included.)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.masterIdentifier"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Identifier"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.identifier"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.identifier"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.identifier"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-12"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".id"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.uniqueId"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/id"/>
          </mapping>
        </element>
        <element id="DocumentReference.identifier">
          <path value="DocumentReference.identifier"/>
          <short value="Other identifiers for the document"/>
          <definition
                      value="Other identifiers associated with the document, including version independent identifiers."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.identifier"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Identifier"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.identifier"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.identifier"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-16?"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".id / .setId"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.entryUUID"/>
          </mapping>
        </element>
        <element id="DocumentReference.status">
          <path value="DocumentReference.status"/>
          <short value="current | superseded | entered-in-error"/>
          <definition value="The status of this document reference."/>
          <comment
                   value="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."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.status"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="true"/>
          <isModifierReason
                            value="This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid"/>
          <isSummary value="true"/>
          <binding>
            <strength value="required"/>
            <valueSet value="http://hl7.org/fhir/ValueSet/document-reference-status"/>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.status"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.status"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-19"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="interim: .completionCode=&quot;IN&quot; &amp; ./statusCode[isNormalDatatype()]=&quot;active&quot;;  final: .completionCode=&quot;AU&quot; &amp;&amp;  ./statusCode[isNormalDatatype()]=&quot;complete&quot; and not(./inboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()]/source[subsumesCode(&quot;ActClass#CACT&quot;) and moodCode=&quot;EVN&quot; and domainMember(&quot;ReviseDocument&quot;, code) and isNormalAct()]);  amended: .completionCode=&quot;AU&quot; &amp;&amp;  ./statusCode[isNormalDatatype()]=&quot;complete&quot; and ./inboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()]/source[subsumesCode(&quot;ActClass#CACT&quot;) and moodCode=&quot;EVN&quot; and domainMember(&quot;ReviseDocument&quot;, code) and isNormalAct() and statusCode=&quot;completed&quot;];  withdrawn : .completionCode=NI &amp;&amp;  ./statusCode[isNormalDatatype()]=&quot;obsolete&quot;"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.availabilityStatus"/>
          </mapping>
        </element>
        <element id="DocumentReference.docStatus">
          <path value="DocumentReference.docStatus"/>
          <short value="preliminary | final | amended | entered-in-error"/>
          <definition value="The status of the underlying document."/>
          <comment
                   value="The document that is pointed to might be in various lifecycle states."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.docStatus"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ReferredDocumentStatus"/>
            </extension>
            <strength value="required"/>
            <description value="Status of the underlying document."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/composition-status|4.0.1"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.status"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.status"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-17"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".statusCode"/>
          </mapping>
        </element>
        <element id="DocumentReference.type">
          <path value="DocumentReference.type"/>
          <short value="Advance Directive Categories"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.type"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-minValueSet">
              <valueCanonical
                              value="http://hl7.org/fhir/us/core/ValueSet/us-core-clinical-note-type"/>
            </extension>
            <strength value="required"/>
            <description
                         value="All LOINC  values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept &#39;unknown&#39;"/>
            <valueSet
                      value="http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type"/>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.code"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.class"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.type"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-2"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.type"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="ClinicalDocument/code/@code

    The typeCode should be mapped from the ClinicalDocument/code element to a set of document type codes configured in the affinity domain. One suggested coding system to use for typeCode is LOINC, in which case the mapping step can be omitted."/>
          </mapping>
        </element>
        <element id="DocumentReference.category">
          <path value="DocumentReference.category"/>
          <short value="Categorization of document"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="claxs"/>
          <min value="1"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.category"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <strength value="extensible"/>
            <valueSet
                      value="http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.class"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.class"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.class"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="Derived from a mapping of /ClinicalDocument/code/@code to an Affinity Domain specified coded value to use and coding system. Affinity Domains are encouraged to use the appropriate value for Type of Service, based on the LOINC Type of Service (see Page 53 of the LOINC User&#39;s Manual). Must be consistent with /ClinicalDocument/code/@code"/>
          </mapping>
        </element>
        <element id="DocumentReference.subject">
          <path value="DocumentReference.subject"/>
          <short value="Patient"/>
          <definition
                      value="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)."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.subject"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.subject"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.subject[x]"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.subject"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map
                 value="PID-3 (No standard way to define a Practitioner or Group subject in HL7 v2 MDM message)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;SBJ&quot;].role[typeCode=&quot;PAT&quot;]"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.patientId"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/recordTarget/"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.subject"/>
          </mapping>
        </element>
        <element id="DocumentReference.date">
          <path value="DocumentReference.date"/>
          <short value="When this document reference was created"/>
          <definition value="When the document reference was created."/>
          <comment
                   value="Referencing/indexing time is used for tracking, organizing versions and searching."/>
          <alias value="indexed"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.date"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="instant"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.occurrence[x]"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.recorded"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.date"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".availabilityTime[type=&quot;TS&quot;]"/>
          </mapping>
        </element>
        <element id="DocumentReference.author">
          <path value="DocumentReference.author"/>
          <short value="legalAuthenticator"/>
          <definition
                      value="Identifies who is responsible for adding the information to the document."/>
          <comment
                   value="Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant)."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.author"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.performer.actor"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.author"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map
                 value="TXA-9 (No standard way to indicate a Device in HL7 v2 MDM message)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;AUT&quot;].role[classCode=&quot;ASSIGNED&quot;]"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.author"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/author"/>
          </mapping>
        </element>
        <element id="DocumentReference.authenticator">
          <path value="DocumentReference.authenticator"/>
          <short value="Who/what authenticated the document"/>
          <definition
                      value="Which person or organization authenticates that this document is valid."/>
          <comment
                   value="Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.authenticator"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Organization"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.performer.actor"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.witness"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.attester"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-10"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;AUTHEN&quot;].role[classCode=&quot;ASSIGNED&quot;]"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.legalAuthenticator"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/legalAuthenticator"/>
          </mapping>
        </element>
        <element id="DocumentReference.custodian">
          <path value="DocumentReference.custodian"/>
          <short value="Organization which maintains the document"/>
          <definition
                      value="Identifies the organization or group who is responsible for ongoing maintenance of and access to the document."/>
          <comment
                   value="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 delegated to the management of some other organization."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.custodian"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.performer.actor"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.custodian"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;RCV&quot;].role[classCode=&quot;CUST&quot;].scoper[classCode=&quot;ORG&quot; and determinerCode=&quot;INST&quot;]"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo">
          <path value="DocumentReference.relatesTo"/>
          <short value="Relationships to other documents"/>
          <definition
                      value="Relationships that this document has with other document references that already exist."/>
          <comment
                   value="This element is labeled as a modifier because documents that append to other documents are incomplete on their own."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.relatesTo"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.relatesTo"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry Associations"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.id">
          <path value="DocumentReference.relatesTo.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.extension">
          <path value="DocumentReference.relatesTo.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.modifierExtension">
          <path value="DocumentReference.relatesTo.modifierExtension"/>
          <short value="Extensions that cannot be ignored even if unrecognized"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <requirements
                        value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.code">
          <path value="DocumentReference.relatesTo.code"/>
          <short value="replaces | transforms | signs | appends"/>
          <definition
                      value="The type of relationship that this document has with anther document."/>
          <comment
                   value="If this document appends another document, then the document cannot be fully understood without also accessing the referenced document."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.relatesTo.code"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentRelationshipType"/>
            </extension>
            <strength value="required"/>
            <description value="The type of relationship between documents."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.relatesTo.code"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship.typeCode"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry Associations type"/>
          </mapping>
        </element>
        <element id="DocumentReference.relatesTo.target">
          <path value="DocumentReference.relatesTo.target"/>
          <short value="Target of the relationship"/>
          <definition value="The target document of this relationship."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.relatesTo.target"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.relatesTo.target"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".target[classCode=&quot;DOC&quot;, moodCode=&quot;EVN&quot;].id"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry Associations reference"/>
          </mapping>
        </element>
        <element id="DocumentReference.description">
          <path value="DocumentReference.description"/>
          <short value="Human-readable description"/>
          <definition value="Human-readable description of the source document."/>
          <comment
                   value="What the document is about,  a terse summary of the document."/>
          <requirements
                        value="Helps humans to assess whether the document is of interest."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.description"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-25"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".outboundRelationship[typeCode=&quot;SUBJ&quot;].target.text"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.comments"/>
          </mapping>
        </element>
        <element id="DocumentReference.securityLabel">
          <path value="DocumentReference.securityLabel"/>
          <short value="Document security-tags"/>
          <definition
                      value="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 &quot;reference&quot; to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to."/>
          <comment
                   value="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."/>
          <requirements
                        value="Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.securityLabel"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="SecurityLabels"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
              <valueBoolean value="true"/>
            </extension>
            <strength value="extensible"/>
            <description
                         value="Security Labels from the Healthcare Privacy and Security Classification System."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/security-labels"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.confidentiality, Composition.meta.security"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-18"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".confidentialityCode"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.confidentialityCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/confidentialityCode/@code"/>
          </mapping>
        </element>
        <element id="DocumentReference.content">
          <path value="DocumentReference.content"/>
          <short value="Document referenced"/>
          <definition
                      value="The document and format referenced. There may be multiple content element repetitions, each with a different format."/>
          <min value="1"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.content"/>
            <min value="1"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Bundle(Composition+*)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="document.text"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.id">
          <path value="DocumentReference.content.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.extension">
          <path value="DocumentReference.content.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.modifierExtension">
          <path value="DocumentReference.content.modifierExtension"/>
          <short value="Extensions that cannot be ignored even if unrecognized"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <requirements
                        value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment">
          <path value="DocumentReference.content.attachment"/>
          <short value="Where to access the document"/>
          <definition
                      value="The document or URL of the document along with critical metadata to prove content has integrity."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.content.attachment"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Attachment"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="us-core-6"/>
            <severity value="error"/>
            <human
                   value="DocumentReference.content.attachment.url or  DocumentReference.content.attachment.data or both SHALL be present."/>
            <expression value="url.exists() or data.exists()"/>
            <xpath value="f:url or f:content"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.language,
    Composition.title,
    Composition.date"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="TXA-3 for mime type"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="document.text"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map
                 value="DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.id">
          <path value="DocumentReference.content.attachment.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.extension">
          <path value="DocumentReference.content.attachment.extension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <description value="Extensions are always sliced by (at least) url"/>
            <rules value="open"/>
          </slicing>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.contentType">
          <path value="DocumentReference.content.attachment.contentType"/>
          <short value="Mime type of the content, with charset etc."/>
          <definition
                      value="Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate."/>
          <requirements
                        value="Processors of the data need to be able to know how to interpret the data."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Attachment.contentType"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <example>
            <label value="General"/>
            <valueCode value="text/plain; charset=UTF-8, image/png"/>
          </example>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="MimeType"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
              <valueBoolean value="true"/>
            </extension>
            <strength value="required"/>
            <description
                         value="The mime type of an attachment. Any valid mime type is allowed."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/mimetypes|4.0.1"/>
          </binding>
          <mapping>
            <identity value="v2"/>
            <map
                 value="ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./mediaType, ./charset"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.language">
          <path value="DocumentReference.content.attachment.language"/>
          <short value="Human language of the content (BCP-47)"/>
          <definition
                      value="The human language of the content. The value can be any valid value according to BCP 47."/>
          <requirements
                        value="Users need to be able to choose between the languages in a set of attachments."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Attachment.language"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <example>
            <label value="General"/>
            <valueCode value="en-AU"/>
          </example>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
              <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="Language"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
              <valueBoolean value="true"/>
            </extension>
            <strength value="preferred"/>
            <description value="A human language."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
          </binding>
          <mapping>
            <identity value="rim"/>
            <map value="./language"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.data">
          <path value="DocumentReference.content.attachment.data"/>
          <short value="Data inline, base64ed"/>
          <definition
                      value="The actual data of the attachment - a sequence of bytes, base64 encoded."/>
          <comment
                   value="The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON."/>
          <requirements value="The data needs to able to be transmitted inline."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Attachment.data"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="base64Binary"/>
          </type>
          <condition value="us-core-6"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="v2"/>
            <map value="ED.5"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./data"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.url">
          <path value="DocumentReference.content.attachment.url"/>
          <short value="Uri where the data can be found"/>
          <definition value="A location where the data can be accessed."/>
          <comment
                   value="If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data."/>
          <requirements value="The data needs to be transmitted by reference."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Attachment.url"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="url"/>
          </type>
          <example>
            <label value="General"/>
            <valueUrl value="http://www.acme.com/logo-small.png"/>
          </example>
          <condition value="us-core-6"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="RP.1+RP.2 - if they refer to a URL (see v2.6)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./reference/literal"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.size">
          <path value="DocumentReference.content.attachment.size"/>
          <short value="Number of bytes of content (if url provided)"/>
          <definition
                      value="The number of bytes of data that make up this attachment (before base64 encoding, if that is done)."/>
          <comment
                   value="The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference."/>
          <requirements
                        value="Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Attachment.size"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="unsignedInt"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A (needs data type R3 proposal)"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.hash">
          <path value="DocumentReference.content.attachment.hash"/>
          <short value="Hash of the data (sha-1, base64ed)"/>
          <definition
                      value="The calculated hash of the data using SHA-1. Represented using base64."/>
          <comment
                   value="The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see [Provenance.signature](http://hl7.org/fhir/R4/provenance-definitions.html#Provenance.signature) for mechanism to protect a resource with a digital signature."/>
          <requirements
                        value="Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Attachment.hash"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="base64Binary"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".integrityCheck[parent::ED/integrityCheckAlgorithm=&quot;SHA-1&quot;]"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.title">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
            <valueBoolean value="true"/>
          </extension>
          <path value="DocumentReference.content.attachment.title"/>
          <short value="Label to display in place of the data"/>
          <definition
                      value="A label or set of text to display in place of the data."/>
          <requirements
                        value="Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Attachment.title"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <example>
            <label value="General"/>
            <valueString value="Official Corporate Logo"/>
          </example>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="./title/data"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.attachment.creation">
          <path value="DocumentReference.content.attachment.creation"/>
          <short value="Date attachment was first created"/>
          <definition value="The date that the attachment was first created."/>
          <requirements
                        value="This is often tracked as an integrity issue for use of the attachment."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Attachment.creation"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="dateTime"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A (needs data type R3 proposal)"/>
          </mapping>
        </element>
        <element id="DocumentReference.content.format">
          <path value="DocumentReference.content.format"/>
          <short value="Format/content rules for the document"/>
          <definition
                      value="An identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType."/>
          <comment
                   value="Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.content.format"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Coding"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <strength value="extensible"/>
            <valueSet value="http://hl7.org/fhir/ValueSet/formatcodes"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.meta.profile"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="document.text"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.formatCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="derived from the IHE Profile or Implementation Guide templateID"/>
          </mapping>
        </element>
        <element id="DocumentReference.context">
          <path value="DocumentReference.context"/>
          <short value="Clinical context of document"/>
          <definition
                      value="The clinical context in which the document was prepared."/>
          <comment
                   value="These values are primarily added to help with searching for interesting/relevant documents."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.context"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map
                 value="outboundRelationship[typeCode=&quot;SUBJ&quot;].target[classCode&lt;&#39;ACT&#39;]"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.id">
          <path value="DocumentReference.context.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.extension">
          <path value="DocumentReference.context.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.modifierExtension">
          <path value="DocumentReference.context.modifierExtension"/>
          <short value="Extensions that cannot be ignored even if unrecognized"/>
          <definition
                      value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <requirements
                        value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.encounter">
          <path value="DocumentReference.context.encounter"/>
          <short value="Context of the document  content"/>
          <definition
                      value="Describes the clinical encounter or type of care that the document content is associated with."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.context.encounter"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.context"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.context"/>
          </mapping>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.encounter"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="unique(highest(./outboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()], priorityNumber)/target[moodCode=&quot;EVN&quot; and classCode=(&quot;ENC&quot;, &quot;PCPR&quot;) and isNormalAct])"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.event">
          <path value="DocumentReference.context.event"/>
          <short value="Main clinical acts documented"/>
          <definition
                      value="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 type Code, such as a &quot;History and Physical Report&quot; in which the procedure being documented is necessarily a &quot;History and Physical&quot; act."/>
          <comment
                   value="An event can further specialize the act inherent in the type, such as  where it is simply &quot;Procedure Report&quot; and the procedure was a &quot;colonoscopy&quot;. If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.context.event"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentEventType"/>
            </extension>
            <strength value="example"/>
            <description
                         value="This list of codes represents the main clinical acts being documented."/>
            <valueSet value="http://terminology.hl7.org/ValueSet/v3-ActCode"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.event.code"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.eventCodeList"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.period">
          <path value="DocumentReference.context.period"/>
          <short value="Time of service that is being documented"/>
          <definition
                      value="The time period over which the service that is described by the document was provided."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.context.period"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Period"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.event.period"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".effectiveTime"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map
                 value="DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="ClinicalDocument/documentationOf/
    serviceEvent/effectiveTime/low/
    @value --&gt; ClinicalDocument/documentationOf/
    serviceEvent/effectiveTime/high/
    @value"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.facilityType">
          <path value="DocumentReference.context.facilityType"/>
          <short value="Kind of facility where patient was seen"/>
          <definition value="The kind of facility where the patient was seen."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.context.facilityType"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentC80FacilityType"/>
            </extension>
            <strength value="example"/>
            <description value="XDS Facility Type."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/c80-facilitycodes"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="usually from a mapping to a local ValueSet"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;LOC&quot;].role[classCode=&quot;DSDLOC&quot;].code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.healthcareFacilityTypeCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map
                 value="usually a mapping to a local ValueSet. Must be consistent with /clinicalDocument/code"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.practiceSetting">
          <path value="DocumentReference.context.practiceSetting"/>
          <short
                 value="Additional details about where the content was created (e.g. clinical specialty)"/>
          <definition
                      value="This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty."/>
          <comment
                   value="This element should be based on a coarse classification system for the 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."/>
          <requirements
                        value="This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.context.practiceSetting"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="DocumentC80PracticeSetting"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Additional details about where the content was created (e.g. clinical specialty)."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/c80-practice-codes"/>
          </binding>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="usually from a mapping to a local ValueSet"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;LOC&quot;].role[classCode=&quot;DSDLOC&quot;].code"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.practiceSettingCode"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="usually from a mapping to a local ValueSet"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.sourcePatientInfo">
          <path value="DocumentReference.context.sourcePatientInfo"/>
          <short value="Patient demographics from source"/>
          <definition
                      value="The Patient Information as known when the document was published. May be a reference to a version specific, or contained."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DocumentReference.context.sourcePatientInfo"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.subject"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".participation[typeCode=&quot;SBJ&quot;].role[typeCode=&quot;PAT&quot;]"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map
                 value="DocumentEntry.sourcePatientInfo, DocumentEntry.sourcePatientId"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/recordTarget/"/>
          </mapping>
        </element>
        <element id="DocumentReference.context.related">
          <path value="DocumentReference.context.related"/>
          <short value="Related identifiers or resources"/>
          <definition
                      value="Related identifiers or resources associated with the DocumentReference."/>
          <comment
                   value="May be identifiers or resources that caused the DocumentReference or referenced Document to be created."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DocumentReference.context.related"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="fhircomposition"/>
            <map value="Composition.event.detail"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="./outboundRelationship[typeCode=&quot;PERT&quot; and isNormalActRelationship()] / target[isNormalAct]"/>
          </mapping>
          <mapping>
            <identity value="xds"/>
            <map value="DocumentEntry.referenceIdList"/>
          </mapping>
          <mapping>
            <identity value="cda"/>
            <map value="ClinicalDocument/relatedDocument"/>
          </mapping>
        </element>
      </snapshot>
      <differential>
        <element id="DocumentReference">
          <path value="DocumentReference"/>
        </element>
        <element id="DocumentReference.type">
          <path value="DocumentReference.type"/>
          <short value="Advance Directive Categories"/>
        </element>
        <element id="DocumentReference.category">
          <path value="DocumentReference.category"/>
          <binding>
            <strength value="extensible"/>
            <valueSet
                      value="http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category"/>
          </binding>
        </element>
        <element id="DocumentReference.subject">
          <path value="DocumentReference.subject"/>
          <short value="Patient"/>
        </element>
        <element id="DocumentReference.author">
          <path value="DocumentReference.author"/>
          <short value="legalAuthenticator"/>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"/>
          </type>
        </element>
        <element id="DocumentReference.custodian">
          <path value="DocumentReference.custodian"/>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
          </type>
          <mustSupport value="true"/>
        </element>
      </differential>
    </StructureDefinition>