HL7 Europe Patient Summary
1.0.0-ballot - ci-build 150

HL7 Europe Patient Summary - Downloaded Version 1.0.0-ballot See the Directory of published versions

## Resource Profile: DiagnosticReport (EPS)

Official URL: http://hl7.eu/fhir/eps/StructureDefinition/diagnosticReport-eu-eps | Version: 1.0.0-ballot
Standards status: Draft | Maturity Level: 1 | Computable Name: DiagnosticReportEuEps
Copyright/Legal: Copyright HL7 Europe. Licensed under creative commons public domain (CC0 1.0).

This profile constrains the DiagnosticReport resource in the scope of the European Patient Summary.

Usages:

- Use this Profile: Bundle (EPS)
- Refer to this Profile: Composition (EPS)

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReportEuCore | Diagnostic Report EU core This profile also imposes the profile DiagnosticReport (IPS)
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:DiagnosticReportCompositionR5 |  | 0..1 | (Complex) | Associated Composition URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition"
value[x] |  | 1..1 | Reference(Composition (EU core)) | Reference to a Composition resource for the DiagnosticReport structure
extension:note |  | 0..* | (Complex) | R5: Comments about the diagnostic report (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note"
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | Status of the Report Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
code | O Σ | 1..1 | CodeableConcept | Type of Diagnostic Report Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports.
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
subject | O Σ | 1..1 | Reference(Patient (EU core) | Group) | Who and/or what this report is about
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
reference | O Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
Slices for effective[x] | O Σ | 1..1 |  | Clinically relevant time/time-period for report. Slice: Unordered, Closed by type:$this
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
effective[x]:effectiveDateTime | O Σ | 0..1 | dateTime | Clinically relevant time/time-period for report.
Obligations | Actor
SHOULD:able-to-populate | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
effective[x]:effectivePeriod | Σ | 0..1 | Period | Effective period of the report
Slices for performer | O Σ | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Responsible Diagnostic Service. Slice: Unordered, Open by profile:$this
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
performer:organization | Σ | 0..* | Reference(Organization (EU core)) | The organization producer of this report
Slices for resultsInterpreter | Σ | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Primary result interpreter Slice: Unordered, Open by profile:resolve()
resultsInterpreter:author | Σ | 0..* | Reference(PractitionerRole (EU core)) | Primary result interpreter
Slices for result |  | 0..* | Reference(Observation) | results Slice: Unordered, Open by profile:resolve()
result:observation-results | O | 0..* | Reference(Observation: Medical Test Result (EU core)) | results
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📍4.0.1 | FHIR Std.
DiagnosticReport.code | Base | preferred | LOINC Diagnostic Report Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | 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 | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | DiagnosticReport.extension:DiagnosticReportCompositionR5, DiagnosticReport.extension:note, DiagnosticReport.modifierExtension | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from DiagnosticReportEuCore

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  |  | DiagnosticReportEuCore | This profile also imposes the profile DiagnosticReport (IPS)
code | O | 1..1 | CodeableConcept | Type of Diagnostic Report
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
subject | O | 1..1 | Reference(Patient (EU core) | Group) | Who and/or what this report is about
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
reference | O | 1..1 | string | Literal reference, Relative, internal or absolute URL
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
effective[x] | O | 1..1 | dateTime, Period | Clinically relevant time/time-period for report.
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
Slices for effective[x] |  |  |  | Content/Rules for all slices
effective[x]:effectiveDateTime | O | 0..1 | dateTime | Clinically relevant time/time-period for report.
Obligations | Actor
SHOULD:able-to-populate | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
performer | O | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Responsible Diagnostic Service.
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
Slices for result |  | 0..* | Reference(Observation) | results Slice: Unordered, Open by profile:resolve()
result:observation-results | O | 0..* | Reference(Observation: Medical Test Result (EU core)) | results
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReportEuCore | Diagnostic Report EU core This profile also imposes the profile DiagnosticReport (IPS)
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the diagnostic report content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:DiagnosticReportCompositionR5 |  | 0..1 | (Complex) | Associated Composition URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition"
value[x] |  | 1..1 | Reference(Composition (EU core)) | Reference to a Composition resource for the DiagnosticReport structure
extension:note |  | 0..* | (Complex) | R5: Comments about the diagnostic report (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note"
value[x] |  | 0..1 | Annotation | Comments about the diagnostic report
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
extension:annotation-type |  | 0..* | (Complex) | The type of annotation URL: http://hl7.org/fhir/StructureDefinition/annotationType
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/annotationType"
value[x] |  | 1..1 | CodeableConcept | Type of note Binding: v2 Comment type (example)
author[x] | Σ | 0..1 |  | Individual responsible for the annotation
authorReference |  |  | Reference(Practitioner | Patient | RelatedPerson | Organization) |
authorString |  |  | string |
time | Σ | 0..1 | dateTime | When the annotation was made
text | Σ | 1..1 | markdown | The annotation - text content (as markdown)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for report
basedOn |  | 0..* | Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | What was requested
status | ?!Σ | 1..1 | code | Status of the Report Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
category | Σ | 0..* | CodeableConcept | Service category Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
code | O Σ | 1..1 | CodeableConcept | Type of Diagnostic Report Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports.
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
subject | O Σ | 1..1 | Reference(Patient (EU core) | Group) | Who and/or what this report is about
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | O Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
encounter | Σ | 0..1 | Reference(Encounter) | The healthcare event which this Diagnostic Report is about (when test ordered).
Slices for effective[x] | O Σ | 1..1 |  | Clinically relevant time/time-period for report. Slice: Unordered, Closed by type:$this
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
effective[x]:effectiveDateTime | O Σ | 0..1 | dateTime | Clinically relevant time/time-period for report.
Obligations | Actor
SHOULD:able-to-populate | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
effective[x]:effectivePeriod | Σ | 0..1 | Period | Effective period of the report
issued | Σ | 0..1 | instant | Date and time this report was issued
Slices for performer | O Σ | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Responsible Diagnostic Service. Slice: Unordered, Open by profile:$this
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
performer:organization | Σ | 0..* | Reference(Organization (EU core)) | The organization producer of this report
Slices for resultsInterpreter | Σ | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Primary result interpreter Slice: Unordered, Open by profile:resolve()
resultsInterpreter:author | Σ | 0..* | Reference(PractitionerRole (EU core)) | Primary result interpreter
specimen |  | 0..* | Reference(Specimen) | Specimens this report is based on.
Slices for result |  | 0..* | Reference(Observation) | results Slice: Unordered, Open by profile:resolve()
result:observation-results | O | 0..* | Reference(Observation: Medical Test Result (EU core)) | results
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
imagingStudy |  | 0..* | Reference(ImagingStudy) | Study subject to this report
media | Σ | 0..* | BackboneElement | Additional data (like images, diagrams or documents) associated with this report
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
comment |  | 0..1 | string | Comment about the image or data (e.g. explanation)
link | Σ | 1..1 | Reference(Media) | Reference to the image or data
conclusion |  | 0..1 | string | Clinical conclusion (interpretation) of test results
conclusionCode |  | 0..* | CodeableConcept | Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm |  | 0..* | Attachment | Entire report as issued (pdf recommended)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DiagnosticReport.extension:note.​value[x].extension:annotation-type.​value[x] | Base | example | v2 Comment type | 📦2.9 | FHIR Std.
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📍4.0.1 | FHIR Std.
DiagnosticReport.category | Base | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.code | Base | preferred | LOINC Diagnostic Report Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.subject.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
DiagnosticReport.conclusionCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | 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 | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from DiagnosticReportEuCore

Summary

Mandatory: 2 elements

Structures

This structure refers to these other structures:

- Patient (EU core) (http://hl7.eu/fhir/base/StructureDefinition/patient-eu-core)
- Observation: Medical Test Result (EU core) (http://hl7.eu/fhir/base/StructureDefinition/medicalTestResult-eu-core)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of DiagnosticReport.result

Maturity: 1

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReportEuCore | Diagnostic Report EU core This profile also imposes the profile DiagnosticReport (IPS)
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:DiagnosticReportCompositionR5 |  | 0..1 | (Complex) | Associated Composition URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition"
value[x] |  | 1..1 | Reference(Composition (EU core)) | Reference to a Composition resource for the DiagnosticReport structure
extension:note |  | 0..* | (Complex) | R5: Comments about the diagnostic report (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note Constraints: ext-1
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note"
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | Status of the Report Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
code | O Σ | 1..1 | CodeableConcept | Type of Diagnostic Report Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports.
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
subject | O Σ | 1..1 | Reference(Patient (EU core) | Group) | Who and/or what this report is about
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
reference | O Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
Slices for effective[x] | O Σ | 1..1 |  | Clinically relevant time/time-period for report. Slice: Unordered, Closed by type:$this
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
effective[x]:effectiveDateTime | O Σ | 0..1 | dateTime | Clinically relevant time/time-period for report.
Obligations | Actor
SHOULD:able-to-populate | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
effective[x]:effectivePeriod | Σ | 0..1 | Period | Effective period of the report
Slices for performer | O Σ | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Responsible Diagnostic Service. Slice: Unordered, Open by profile:$this
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
performer:organization | Σ | 0..* | Reference(Organization (EU core)) | The organization producer of this report
Slices for resultsInterpreter | Σ | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Primary result interpreter Slice: Unordered, Open by profile:resolve()
resultsInterpreter:author | Σ | 0..* | Reference(PractitionerRole (EU core)) | Primary result interpreter
Slices for result |  | 0..* | Reference(Observation) | results Slice: Unordered, Open by profile:resolve()
result:observation-results | O | 0..* | Reference(Observation: Medical Test Result (EU core)) | results
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📍4.0.1 | FHIR Std.
DiagnosticReport.code | Base | preferred | LOINC Diagnostic Report Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | 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 | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | DiagnosticReport.extension:DiagnosticReportCompositionR5, DiagnosticReport.extension:note, DiagnosticReport.modifierExtension | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

This structure is derived from DiagnosticReportEuCore

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  |  | DiagnosticReportEuCore | This profile also imposes the profile DiagnosticReport (IPS)
code | O | 1..1 | CodeableConcept | Type of Diagnostic Report
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
subject | O | 1..1 | Reference(Patient (EU core) | Group) | Who and/or what this report is about
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
reference | O | 1..1 | string | Literal reference, Relative, internal or absolute URL
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
effective[x] | O | 1..1 | dateTime, Period | Clinically relevant time/time-period for report.
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
Slices for effective[x] |  |  |  | Content/Rules for all slices
effective[x]:effectiveDateTime | O | 0..1 | dateTime | Clinically relevant time/time-period for report.
Obligations | Actor
SHOULD:able-to-populate | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
performer | O | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Responsible Diagnostic Service.
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
Slices for result |  | 0..* | Reference(Observation) | results Slice: Unordered, Open by profile:resolve()
result:observation-results | O | 0..* | Reference(Observation: Medical Test Result (EU core)) | results
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DiagnosticReport |  | 0..* | DiagnosticReportEuCore | Diagnostic Report EU core This profile also imposes the profile DiagnosticReport (IPS)
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the diagnostic report content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:DiagnosticReportCompositionR5 |  | 0..1 | (Complex) | Associated Composition URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition"
value[x] |  | 1..1 | Reference(Composition (EU core)) | Reference to a Composition resource for the DiagnosticReport structure
extension:note |  | 0..* | (Complex) | R5: Comments about the diagnostic report (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note Constraints: ext-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url Constraints: ext-1
url |  | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note"
value[x] |  | 0..1 | Annotation | Comments about the diagnostic report
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
extension:annotation-type |  | 0..* | (Complex) | The type of annotation URL: http://hl7.org/fhir/StructureDefinition/annotationType
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/annotationType"
value[x] |  | 1..1 | CodeableConcept | Type of note Binding: v2 Comment type (example)
author[x] | Σ | 0..1 |  | Individual responsible for the annotation
authorReference |  |  | Reference(Practitioner | Patient | RelatedPerson | Organization) |
authorString |  |  | string |
time | Σ | 0..1 | dateTime | When the annotation was made
text | Σ | 1..1 | markdown | The annotation - text content (as markdown)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for report
basedOn |  | 0..* | Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | What was requested
status | ?!Σ | 1..1 | code | Status of the Report Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
category | Σ | 0..* | CodeableConcept | Service category Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
code | O Σ | 1..1 | CodeableConcept | Type of Diagnostic Report Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports.
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
subject | O Σ | 1..1 | Reference(Patient (EU core) | Group) | Who and/or what this report is about
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | O Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
encounter | Σ | 0..1 | Reference(Encounter) | The healthcare event which this Diagnostic Report is about (when test ordered).
Slices for effective[x] | O Σ | 1..1 |  | Clinically relevant time/time-period for report. Slice: Unordered, Closed by type:$this
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
effective[x]:effectiveDateTime | O Σ | 0..1 | dateTime | Clinically relevant time/time-period for report.
Obligations | Actor
SHOULD:able-to-populate | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
effective[x]:effectivePeriod | Σ | 0..1 | Period | Effective period of the report
issued | Σ | 0..1 | instant | Date and time this report was issued
Slices for performer | O Σ | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Responsible Diagnostic Service. Slice: Unordered, Open by profile:$this
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
performer:organization | Σ | 0..* | Reference(Organization (EU core)) | The organization producer of this report
Slices for resultsInterpreter | Σ | 0..* | Reference(PractitionerRole (EU core) | Practitioner (EU core) | Organization (EU core) | CareTeam) | Primary result interpreter Slice: Unordered, Open by profile:resolve()
resultsInterpreter:author | Σ | 0..* | Reference(PractitionerRole (EU core)) | Primary result interpreter
specimen |  | 0..* | Reference(Specimen) | Specimens this report is based on.
Slices for result |  | 0..* | Reference(Observation) | results Slice: Unordered, Open by profile:resolve()
result:observation-results | O | 0..* | Reference(Observation: Medical Test Result (EU core)) | results
Obligations | Actor
SHALL:populate-if-known | Creator (IPS)
SHALL:handle | Consumer (IPS)
SHOULD:display | Consumer (IPS)
imagingStudy |  | 0..* | Reference(ImagingStudy) | Study subject to this report
media | Σ | 0..* | BackboneElement | Additional data (like images, diagrams or documents) associated with this report
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
comment |  | 0..1 | string | Comment about the image or data (e.g. explanation)
link | Σ | 1..1 | Reference(Media) | Reference to the image or data
conclusion |  | 0..1 | string | Clinical conclusion (interpretation) of test results
conclusionCode |  | 0..* | CodeableConcept | Codes for the clinical conclusion of test results Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
presentedForm |  | 0..* | Attachment | Entire report as issued (pdf recommended)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DiagnosticReport.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DiagnosticReport.extension:note.​value[x].extension:annotation-type.​value[x] | Base | example | v2 Comment type | 📦2.9 | FHIR Std.
DiagnosticReport.status | Base | required | DiagnosticReportStatus | 📍4.0.1 | FHIR Std.
DiagnosticReport.category | Base | example | Diagnostic Service Section Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.code | Base | preferred | LOINC Diagnostic Report Codes | 📍4.0.1 | FHIR Std.
DiagnosticReport.subject.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
DiagnosticReport.conclusionCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DiagnosticReport | 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 | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from DiagnosticReportEuCore

Summary

Mandatory: 2 elements

Structures

This structure refers to these other structures:

- Patient (EU core) (http://hl7.eu/fhir/base/StructureDefinition/patient-eu-core)
- Observation: Medical Test Result (EU core) (http://hl7.eu/fhir/base/StructureDefinition/medicalTestResult-eu-core)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of DiagnosticReport.result

Maturity: 1

Other representations of profile: CSV, Excel, Schematron