PACIO Advance Directive Interoperability Implementation Guide
0.1.0 - STU 1 Ballot

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## Resource Profile: PACIO ADI Document Reference

Defining URL: | http://hl7.org/fhir/us/pacio-adi/StructureDefinition/PADI-DocumentReference
Version: | 0.1.0
Name: | PADIDocumentReference
Title: | PACIO ADI Document Reference
Status: | Active as of 12/6/21 8:50 PM
Definition: | This profile defines constraints that represent the information needed to register an advance directive information document on a FHIR server.
Publisher: | HL7 Patient Empowerment Working Group
Source Resource: | XML / JSON / Turtle

The official URL for this profile is:

    http://hl7.org/fhir/us/pacio-adi/StructureDefinition/PADI-DocumentReference

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Text Summary
- Differential Table
- Snapshot Table
- Snapshot Table (Must Support)
- All

This structure is derived from USCoreDocumentReferenceProfile

Summary

Must-Support: 1 element

Structures

This structure refers to these other structures:

- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

This structure is derived from USCoreDocumentReferenceProfile

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile | A reference to a document
type |  | 1..1 | CodeableConcept | Advance Directive Categories
category |  | 1..* | CodeableConcept | Categorization of document Binding: US Core DocumentReference Category (extensible)
subject |  | 1..1 | Reference(US Core Patient Profile) | Patient
author |  | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile) | legalAuthenticator
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile | A reference to a document
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | Σ | 0..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type | S Σ | 1..1 | CodeableConcept | Advance Directive Categories Binding: US Core DocumentReference Type (required) Min Binding: US Core Clinical Note Type: All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
category | S Σ | 1..* | CodeableConcept | Categorization of document Binding: US Core DocumentReference Category (extensible)
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Patient
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile) | legalAuthenticator
authenticator |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Who/what authenticated the document
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..* | BackboneElement | Document referenced
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ I | 1..1 | Attachment | Where to access the document us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. Example General: en-AU
data | S I | 0..1 | base64Binary | Data inline, base64ed
url | S Σ I | 0..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
creation | Σ | 0..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..1 | Reference(US Core Encounter Profile) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
facilityType |  | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting |  | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo |  | 0..1 | Reference(Patient) | Patient demographics from source
related |  | 0..* | Reference(Resource) | Related identifiers or resources
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile | A reference to a document
identifier | Σ | 0..* | Identifier | Other identifiers for the document
status | ?!Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
type | Σ | 1..1 | CodeableConcept | Advance Directive Categories Binding: US Core DocumentReference Type (required) Min Binding: US Core Clinical Note Type: All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
category | Σ | 1..* | CodeableConcept | Categorization of document Binding: US Core DocumentReference Category (extensible)
subject | Σ | 1..1 | Reference(US Core Patient Profile) | Patient
date | Σ | 0..1 | instant | When this document reference was created
author | Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile) | legalAuthenticator
custodian |  | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
content | Σ | 1..* | BackboneElement | Document referenced
attachment | Σ I | 1..1 | Attachment | Where to access the document us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
contentType | Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.
data | I | 0..1 | base64Binary | Data inline, base64ed
url | Σ I | 0..1 | url | Uri where the data can be found
format | Σ | 0..1 | Coding | Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
context | Σ | 0..1 | BackboneElement | Clinical context of document
encounter |  | 0..1 | Reference(US Core Encounter Profile) | Context of the document content
period | Σ | 0..1 | Period | Time of service that is being documented
Documentation for this format

This structure is derived from USCoreDocumentReferenceProfile

Summary

Must-Support: 1 element

Structures

This structure refers to these other structures:

- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

Differential View

This structure is derived from USCoreDocumentReferenceProfile

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile | A reference to a document
type |  | 1..1 | CodeableConcept | Advance Directive Categories
category |  | 1..* | CodeableConcept | Categorization of document Binding: US Core DocumentReference Category (extensible)
subject |  | 1..1 | Reference(US Core Patient Profile) | Patient
author |  | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile) | legalAuthenticator
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | USCoreDocumentReferenceProfile | A reference to a document
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
masterIdentifier | Σ | 0..1 | Identifier | Master Version Specific Identifier
identifier | S Σ | 0..* | Identifier | Other identifiers for the document
status | ?!S Σ | 1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required)
docStatus | Σ | 0..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type | S Σ | 1..1 | CodeableConcept | Advance Directive Categories Binding: US Core DocumentReference Type (required) Min Binding: US Core Clinical Note Type: All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'
category | S Σ | 1..* | CodeableConcept | Categorization of document Binding: US Core DocumentReference Category (extensible)
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Patient
date | S Σ | 0..1 | instant | When this document reference was created
author | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile) | legalAuthenticator
authenticator |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Who/what authenticated the document
custodian | S | 0..1 | Reference(US Core Organization Profile) | Organization which maintains the document
relatesTo | Σ | 0..* | BackboneElement | Relationships to other documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship
description | Σ | 0..1 | string | Human-readable description
securityLabel | Σ | 0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content | S Σ | 1..* | BackboneElement | Document referenced
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | S Σ I | 1..1 | Attachment | Where to access the document us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
contentType | S Σ | 1..1 | code | Mime type of the content, with charset etc. Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language | Σ | 0..1 | code | Human language of the content (BCP-47) Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. Example General: en-AU
data | S I | 0..1 | base64Binary | Data inline, base64ed
url | S Σ I | 0..1 | url | Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided)
hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed)
title | Σ | 0..1 | string | Label to display in place of the data Example General: Official Corporate Logo
creation | Σ | 0..1 | dateTime | Date attachment was first created
format | S Σ | 0..1 | Coding | Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (extensible)
context | S Σ | 0..1 | BackboneElement | Clinical context of document
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
encounter | S | 0..1 | Reference(US Core Encounter Profile) | Context of the document content
event |  | 0..* | CodeableConcept | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period | S Σ | 0..1 | Period | Time of service that is being documented
facilityType |  | 0..1 | CodeableConcept | Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting |  | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
sourcePatientInfo |  | 0..1 | Reference(Patient) | Patient demographics from source
related |  | 0..* | Reference(Resource) | Related identifiers or resources
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet
DocumentReference.language | preferred | CommonLanguages Max Binding: AllLanguages
DocumentReference.status | required | DocumentReferenceStatus
DocumentReference.docStatus | required | CompositionStatus
DocumentReference.type | required | USCoreDocumentReferenceType Min Binding: US Core Clinical Note Type
DocumentReference.category | extensible | USCoreDocumentReferenceCategory
DocumentReference.relatesTo.code | required | DocumentRelationshipType
DocumentReference.securityLabel | extensible | All Security Labels
DocumentReference.content.attachment.contentType | required | Mime Types
DocumentReference.content.attachment.language | preferred | CommonLanguages Max Binding: AllLanguages
DocumentReference.content.format | extensible | DocumentReferenceFormatCodeSet
DocumentReference.context.event | example | ActCode
DocumentReference.context.facilityType | example | FacilityTypeCodeValueSet
DocumentReference.context.practiceSetting | example | PracticeSettingCodeValueSet

#### Constraints

Id | Path | Details | Requirements
us-core-6 | DocumentReference.content.attachment | DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. : url.exists() or data.exists() |