Name	Flags	Card.	Type	Description & Constraints
DocumentReference	C	0..*	ImIheMhdDocumentReference	A reference to a document docRef-1: facilityType SHALL only be present if context is not an encounter docRef-2: practiceSetting SHALL only be present if context is not present dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
Slices for identifier	Σ	1..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:system ele-1: All FHIR elements must have a @value or children
identifier:entry-uuid	Σ	1..1	IheMhdEntryUUIDIdentifier	Business identifiers for the document ele-1: All FHIR elements must have a @value or children
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. ele-1: All FHIR elements must have a @value or children
modality	Σ	1..*	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance. ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: HL7 EU Imaging Report Types (preferred) ele-1: All FHIR elements must have a @value or children
Slices for category	Σ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by value:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. ele-1: All FHIR elements must have a @value or children
category:imaging	Σ	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18748-4
display		1..1	string	Representation defined by the system Fixed Value: Diagnostic imaging study
subject	Σ	1..1	Reference(Resource)	Who/what is the subject of the document ele-1: All FHIR elements must have a @value or children
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content ele-1: All FHIR elements must have a @value or children
custodian		0..1	Reference(Organization (EU base))	Organization that manages the Imaging Report ele-1: All FHIR elements must have a @value or children
content	Σ	1..1	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	Σ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children
contentType	ΣC	1..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) ele-1: All FHIR elements must have a @value or children Example General: text/plain; charset=UTF-8, image/png
Slices for profile	Σ	1..*	BackboneElement	Content profile rules for the document Slice: Unordered, Open by value:value ele-1: All FHIR elements must have a @value or children
profile:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes. ele-1: All FHIR elements must have a @value or children
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
profile:hl7eu-imaging-report	Σ	1..1	BackboneElement	Content profile rules for the document ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for value[x]	Σ	1..1		Code|uri|canonical Slice: Unordered, Open by type:$this Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes. ele-1: All FHIR elements must have a @value or children
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
value[x]:valueCanonical	Σ	0..1	canonical()	Code|uri|canonical ele-1: All FHIR elements must have a @value or children Required Pattern: http://hl7.eu/fhir/imaging-r5/StructureDefinition/ImReport
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0 from the FHIR Standard
DocumentReference.modality	extensible	​Modality (missing link) http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html from this IG
DocumentReference.type	preferred	ImImagingReportTypesEuVS http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS from this IG
DocumentReference.category	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.category:imaging	example	Pattern: LOINC Code 18748-4("Diagnostic imaging study") http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.content.attachment.contentType	required	MimeTypes (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|5.0.0 from the FHIR Standard
DocumentReference.content.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
DocumentReference.content.profile:hl7eu-imaging-report.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter : facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present : practiceSetting.empty() or context.where(resolve() is Encounter).empty()
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()

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	ImIheMhdDocumentReference	A reference to a document
modality		1..*	CodeableConcept	Imaging modality used
type		1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: HL7 EU Imaging Report Types (preferred)
Slices for category		1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by value:$this
category:imaging		1..1	CodeableConcept	Categorization of document Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18748-4
display		1..1	string	Representation defined by the system Fixed Value: Diagnostic imaging study
subject		1..1	Reference(Resource)	Who/what is the subject of the document
custodian		0..1	Reference(Organization (EU base))	Organization that manages the Imaging Report
content
Slices for profile		1..*	BackboneElement	Content profile rules for the document Slice: Unordered, Open by value:value
profile:hl7eu-imaging-report		1..1	BackboneElement	Content profile rules for the document
Slices for value[x]		1..1	Coding, uri, canonical()	Code|uri|canonical Slice: Unordered, Open by type:$this
value[x]:valueCanonical		0..1	canonical()	Code|uri|canonical Required Pattern: http://hl7.eu/fhir/imaging-r5/StructureDefinition/ImReport
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.type	preferred	ImImagingReportTypesEuVS http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS from this IG

Name	Flags	Card.	Type	Description & Constraints
DocumentReference	C	0..*	ImIheMhdDocumentReference	A reference to a document docRef-1: facilityType SHALL only be present if context is not an encounter docRef-2: practiceSetting SHALL only be present if context is not present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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
Slices for identifier	Σ	1..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:system
identifier:entry-uuid	Σ	1..1	IheMhdEntryUUIDIdentifier	Business identifiers for the document
version	Σ	0..1	string	An explicitly assigned identifer of a variation of the content in the DocumentReference
basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
modality	Σ	1..*	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type	Σ	1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: HL7 EU Imaging Report Types (preferred)
Slices for category	Σ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by value:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
category:imaging	Σ	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18748-4
display		1..1	string	Representation defined by the system Fixed Value: Diagnostic imaging study
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	Σ	1..1	Reference(Resource)	Who/what is the subject of the document
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableReference()	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite	Σ	0..*	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	C	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).
period	Σ	0..1	Period	Time of service that is being documented
date	Σ	0..1	instant	When this document reference was created
author	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document
attester		0..*	BackboneElement	Attests to accuracy of the 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
mode		1..1	CodeableConcept	personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
time		0..1	dateTime	When the document was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the document
custodian		0..1	Reference(Organization (EU base))	Organization that manages the Imaging Report
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	CodeableConcept	The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	markdown	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	ΣC	1..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language. Additional Bindings Purpose CommonLanguages Starter Example General: en-AU
data	C	0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	integer64	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
height		0..1	positiveInt	Height of the image in pixels (photo/video)
width		0..1	positiveInt	Width of the image in pixels (photo/video)
frames		0..1	positiveInt	Number of frames if > 1 (photo)
duration		0..1	decimal	Length in seconds (audio / video)
pages		0..1	positiveInt	Number of printed pages
Slices for profile	Σ	1..*	BackboneElement	Content profile rules for the document Slice: Unordered, Open by value:value
profile:All Slices				Content/Rules for all slices
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
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
profile:hl7eu-imaging-report	Σ	1..1	BackboneElement	Content profile rules for the 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
Slices for value[x]	Σ	1..1		Code|uri|canonical Slice: Unordered, Open by type:$this Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
value[x]:valueCanonical	Σ	0..1	canonical()	Code|uri|canonical Required Pattern: http://hl7.eu/fhir/imaging-r5/StructureDefinition/ImReport
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0 from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|5.0.0 from the FHIR Standard
DocumentReference.modality	extensible	​Modality (missing link) http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html from this IG
DocumentReference.type	preferred	ImImagingReportTypesEuVS http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS from this IG
DocumentReference.category	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.category:imaging	example	Pattern: LOINC Code 18748-4("Diagnostic imaging study") http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
DocumentReference.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard
DocumentReference.attester.mode	preferred	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode from the FHIR Standard
DocumentReference.relatesTo.code	extensible	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type from the FHIR Standard
DocumentReference.securityLabel	example	SecurityLabelExamples http://hl7.org/fhir/ValueSet/security-label-examples from the FHIR Standard
DocumentReference.content.attachment.contentType	required	MimeTypes (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|5.0.0 from the FHIR Standard
DocumentReference.content.attachment.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.content.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
DocumentReference.content.profile:hl7eu-imaging-report.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter : facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present : practiceSetting.empty() or context.where(resolve() is Encounter).empty()
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()

Summary

Mandatory: 7 elements

Structures

This structure refers to these other structures:

• Organization (EU base) (http://hl7.eu/fhir/base-r5/StructureDefinition/organization-eu)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.category
• The element 1 is sliced based on the value of DocumentReference.content.profile
• The element 1 is sliced based on the value of DocumentReference.content.profile.value[x]

Maturity: 1

Name	Flags	Card.	Type	Description & Constraints
DocumentReference	C	0..*	ImIheMhdDocumentReference	A reference to a document docRef-1: facilityType SHALL only be present if context is not an encounter docRef-2: practiceSetting SHALL only be present if context is not present dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
Slices for identifier	Σ	1..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:system ele-1: All FHIR elements must have a @value or children
identifier:entry-uuid	Σ	1..1	IheMhdEntryUUIDIdentifier	Business identifiers for the document ele-1: All FHIR elements must have a @value or children
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. ele-1: All FHIR elements must have a @value or children
modality	Σ	1..*	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance. ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: HL7 EU Imaging Report Types (preferred) ele-1: All FHIR elements must have a @value or children
Slices for category	Σ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by value:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. ele-1: All FHIR elements must have a @value or children
category:imaging	Σ	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18748-4
display		1..1	string	Representation defined by the system Fixed Value: Diagnostic imaging study
subject	Σ	1..1	Reference(Resource)	Who/what is the subject of the document ele-1: All FHIR elements must have a @value or children
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content ele-1: All FHIR elements must have a @value or children
custodian		0..1	Reference(Organization (EU base))	Organization that manages the Imaging Report ele-1: All FHIR elements must have a @value or children
content	Σ	1..1	BackboneElement	Document referenced ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
attachment	Σ	1..1	Attachment	Where to access the document ele-1: All FHIR elements must have a @value or children
contentType	ΣC	1..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) ele-1: All FHIR elements must have a @value or children Example General: text/plain; charset=UTF-8, image/png
Slices for profile	Σ	1..*	BackboneElement	Content profile rules for the document Slice: Unordered, Open by value:value ele-1: All FHIR elements must have a @value or children
profile:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes. ele-1: All FHIR elements must have a @value or children
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
profile:hl7eu-imaging-report	Σ	1..1	BackboneElement	Content profile rules for the document ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for value[x]	Σ	1..1		Code|uri|canonical Slice: Unordered, Open by type:$this Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes. ele-1: All FHIR elements must have a @value or children
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
value[x]:valueCanonical	Σ	0..1	canonical()	Code|uri|canonical ele-1: All FHIR elements must have a @value or children Required Pattern: http://hl7.eu/fhir/imaging-r5/StructureDefinition/ImReport
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0 from the FHIR Standard
DocumentReference.modality	extensible	​Modality (missing link) http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html from this IG
DocumentReference.type	preferred	ImImagingReportTypesEuVS http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS from this IG
DocumentReference.category	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.category:imaging	example	Pattern: LOINC Code 18748-4("Diagnostic imaging study") http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.content.attachment.contentType	required	MimeTypes (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|5.0.0 from the FHIR Standard
DocumentReference.content.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
DocumentReference.content.profile:hl7eu-imaging-report.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter : facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present : practiceSetting.empty() or context.where(resolve() is Encounter).empty()
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()

Name	Flags	Card.	Type	Description & Constraints
DocumentReference		0..*	ImIheMhdDocumentReference	A reference to a document
modality		1..*	CodeableConcept	Imaging modality used
type		1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: HL7 EU Imaging Report Types (preferred)
Slices for category		1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by value:$this
category:imaging		1..1	CodeableConcept	Categorization of document Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18748-4
display		1..1	string	Representation defined by the system Fixed Value: Diagnostic imaging study
subject		1..1	Reference(Resource)	Who/what is the subject of the document
custodian		0..1	Reference(Organization (EU base))	Organization that manages the Imaging Report
content
Slices for profile		1..*	BackboneElement	Content profile rules for the document Slice: Unordered, Open by value:value
profile:hl7eu-imaging-report		1..1	BackboneElement	Content profile rules for the document
Slices for value[x]		1..1	Coding, uri, canonical()	Code|uri|canonical Slice: Unordered, Open by type:$this
value[x]:valueCanonical		0..1	canonical()	Code|uri|canonical Required Pattern: http://hl7.eu/fhir/imaging-r5/StructureDefinition/ImReport
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.type	preferred	ImImagingReportTypesEuVS http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS from this IG

Name	Flags	Card.	Type	Description & Constraints
DocumentReference	C	0..*	ImIheMhdDocumentReference	A reference to a document docRef-1: facilityType SHALL only be present if context is not an encounter docRef-2: practiceSetting SHALL only be present if context is not present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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
Slices for identifier	Σ	1..*	Identifier	Business identifiers for the document Slice: Unordered, Open by value:system
identifier:entry-uuid	Σ	1..1	IheMhdEntryUUIDIdentifier	Business identifiers for the document
version	Σ	0..1	string	An explicitly assigned identifer of a variation of the content in the DocumentReference
basedOn		0..*	Reference(Appointment | AppointmentResponse | CarePlan | Claim | CommunicationRequest | Contract | CoverageEligibilityRequest | DeviceRequest | EnrollmentRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | RequestOrchestration | ServiceRequest | SupplyRequest | VisionPrescription)	Procedure that caused this media to be created
status	?!Σ	1..1	code	current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown Binding: CompositionStatus (required): Status of the underlying document.
modality	Σ	1..*	CodeableConcept	Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type	Σ	1..1	CodeableConcept	Type of Imaging Diagnostic Report Binding: HL7 EU Imaging Report Types (preferred)
Slices for category	Σ	1..*	CodeableConcept	Categorization of document Slice: Unordered, Open by value:$this Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level.
category:imaging	Σ	1..1	CodeableConcept	Categorization of document Binding: ReferencedItemCategoryValueSet (example): High-level kind of document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18748-4
display		1..1	string	Representation defined by the system Fixed Value: Diagnostic imaging study
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	Σ	1..1	Reference(Resource)	Who/what is the subject of the document
context	C	0..*	Reference(Appointment | Encounter | EpisodeOfCare)	Context of the document content
event		0..*	CodeableReference()	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
bodySite	Σ	0..*	CodeableReference(BodyStructure)	Body part included Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
facilityType	C	0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting	C	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).
period	Σ	0..1	Period	Time of service that is being documented
date	Σ	0..1	instant	When this document reference was created
author	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam)	Who and/or what authored the document
attester		0..*	BackboneElement	Attests to accuracy of the 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
mode		1..1	CodeableConcept	personal | professional | legal | official Binding: CompositionAttestationMode (preferred): The way in which a person authenticated a document.
time		0..1	dateTime	When the document was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the document
custodian		0..1	Reference(Organization (EU base))	Organization that manages the Imaging Report
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	CodeableConcept	The relationship type with another document Binding: DocumentRelationshipType (extensible): The type of relationship between the documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	Σ	0..1	markdown	Human-readable description
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: SecurityLabelExamples (example): Example Security Labels from the Healthcare Privacy and Security Classification System.
content	Σ	1..1	BackboneElement	Document referenced
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	Σ	1..1	Attachment	Where to access the document
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	ΣC	1..1	code	Mime type of the content, with charset etc. Binding: MimeTypes (required): BCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049) Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Human language of the content (BCP-47) Binding: AllLanguages (required): IETF language tag for a human language. Additional Bindings Purpose CommonLanguages Starter Example General: en-AU
data	C	0..1	base64Binary	Data inline, base64ed
url	Σ	0..1	url	Uri where the data can be found Example General: http://www.acme.com/logo-small.png
size	Σ	0..1	integer64	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
height		0..1	positiveInt	Height of the image in pixels (photo/video)
width		0..1	positiveInt	Width of the image in pixels (photo/video)
frames		0..1	positiveInt	Number of frames if > 1 (photo)
duration		0..1	decimal	Length in seconds (audio / video)
pages		0..1	positiveInt	Number of printed pages
Slices for profile	Σ	1..*	BackboneElement	Content profile rules for the document Slice: Unordered, Open by value:value
profile:All Slices				Content/Rules for all slices
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
value[x]	Σ	1..1		Code|uri|canonical Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
profile:hl7eu-imaging-report	Σ	1..1	BackboneElement	Content profile rules for the 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
Slices for value[x]	Σ	1..1		Code|uri|canonical Slice: Unordered, Open by type:$this Binding: HL7 ValueSet of Format Codes for use with Document Sharing (preferred): Document Format Codes.
valueCoding			Coding
valueUri			uri
valueCanonical			canonical(Any)
value[x]:valueCanonical	Σ	0..1	canonical()	Code|uri|canonical Required Pattern: http://hl7.eu/fhir/imaging-r5/StructureDefinition/ImReport
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|5.0.0 from the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|5.0.0 from the FHIR Standard
DocumentReference.modality	extensible	​Modality (missing link) http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html from this IG
DocumentReference.type	preferred	ImImagingReportTypesEuVS http://hl7.eu/fhir/imaging-r5/ValueSet/ImImagingReportTypesEuVS from this IG
DocumentReference.category	example	ReferencedItemCategoryValueSet http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.category:imaging	example	Pattern: LOINC Code 18748-4("Diagnostic imaging study") http://hl7.org/fhir/ValueSet/referenced-item-category from the FHIR Standard
DocumentReference.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
DocumentReference.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes from the FHIR Standard
DocumentReference.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes from the FHIR Standard
DocumentReference.attester.mode	preferred	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode from the FHIR Standard
DocumentReference.relatesTo.code	extensible	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type from the FHIR Standard
DocumentReference.securityLabel	example	SecurityLabelExamples http://hl7.org/fhir/ValueSet/security-label-examples from the FHIR Standard
DocumentReference.content.attachment.contentType	required	MimeTypes (a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|5.0.0 from the FHIR Standard
DocumentReference.content.attachment.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
DocumentReference.content.profile.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes
DocumentReference.content.profile:hl7eu-imaging-report.value[x]	preferred	HL7FormatCodes http://terminology.hl7.org/ValueSet/v3-HL7FormatCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	DocumentReference	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	DocumentReference	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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	DocumentReference	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	DocumentReference	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	DocumentReference	A resource should have narrative for robust management : text.`div`.exists()
docRef-1	warning	DocumentReference	facilityType SHALL only be present if context is not an encounter : facilityType.empty() or context.where(resolve() is Encounter).empty()
docRef-2	warning	DocumentReference	practiceSetting SHALL only be present if context is not present : practiceSetting.empty() or context.where(resolve() is Encounter).empty()
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()

Summary

Mandatory: 7 elements

Structures

This structure refers to these other structures:

• Organization (EU base) (http://hl7.eu/fhir/base-r5/StructureDefinition/organization-eu)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.category
• The element 1 is sliced based on the value of DocumentReference.content.profile
• The element 1 is sliced based on the value of DocumentReference.content.profile.value[x]

Maturity: 1