R6 Checklist for DocumentReference

Artifact DocumentReference (DocumentReference)

Urgent Item Checklist

Confirm workgroup disposition vote has been recorded and sent to FMG!
CodeSystem: composition-attestation-mode (CompositionAttestationMode) referenced by ValueSet composition-attestation-mode bound to element DocumentReference.attester.mode is never bound to a code-type element. Should it move to THO?
CodeSystem: document-relationship-type (DocumentRelationshipType) referenced by ValueSet document-relationship-type bound to element DocumentReference.relatesTo.code is never bound to a code-type element. Should it move to THO?

All Analysis Information

The following content was generated to assist in the review of this artifact for R6 compliance.

Information Page

General Information:

Page File Name	`documentreference-introduction.xml`
Responsible Workgroup	`oo`
Maturity Label	`Active`
Maturity Level	`5`
Standards Status	`normative`
Management Comments
Workgroup Comments
Exists In `publish.ini`	`No`
Exists In Source Directory	`Yes`
'`deprecated`' Literal Count	`0`
Zulip Link Count	`0`
Confluence Link Count	`0`

Conformance Language Summary

'Conformant' conformance language appears in all-upper case. 'Non-conformant' covers all other cases appearing in the content.

Literal	Conformant	Non-Conformant
SHALL	0	0
SHALL NOT	0	0
SHOULD	0	1
SHOULD NOT	0	0
MAY	0	5
MAY NOT	0	0

Possibly Removed FHIR Artifact Literals Found on Page

Word	Artifact Class
`DocumentReference.bodySite`	Element

Unknown Words Found on Page

Word	Known Typo
`DICOM`	No
`IHE`	No
`MP3)`	No
`MP4,`	No
`RetrieveDocumentSet`	No
`WAV,`	No
`WMV)`	No
`presentedForm`	No

Images with Issues

Source	Missing Alt Text	Not In Figure Tag

Possible Incomplete Markers Found on Page

Reader Review Notes Found on Page

Balloters

Notes Page

General Information:

Page File Name	`documentreference-notes.xml`
Responsible Workgroup	`oo`
Maturity Label	`Active`
Maturity Level	`5`
Standards Status	`normative`
Management Comments
Workgroup Comments
Exists In `publish.ini`	`No`
Exists In Source Directory	`Yes`
'`deprecated`' Literal Count	`0`
Zulip Link Count	`0`
Confluence Link Count	`0`

Conformance Language Summary

'Conformant' conformance language appears in all-upper case. 'Non-conformant' covers all other cases appearing in the content.

Literal	Conformant	Non-Conformant
SHALL	0	1
SHALL NOT	0	0
SHOULD	0	2
SHOULD NOT	0	0
MAY	0	4
MAY NOT	0	0

Possibly Removed FHIR Artifact Literals Found on Page

Word	Artifact Class

Unknown Words Found on Page

Word	Known Typo
`DICOM`	No
`IHE`	No
`IHE:`	No

Images with Issues

Source	Missing Alt Text	Not In Figure Tag

Possible Incomplete Markers Found on Page

Reader Review Notes Found on Page

Element Review

Path	Is Required	Max Cardinality	Trial Use	Has fixed[x]	Has pattern[x]	Required Binding	External Required Binding	Check `meaningWhenMissing`	Is Modifier
`DocumentReference`		`*`
`DocumentReference.identifier`		`*`
`DocumentReference.version`		`1`
`DocumentReference.basedOn`		`*`
`DocumentReference.status`	X	`1`				NO 'other' or 'unknown'			X
`DocumentReference.docStatus`		`1`				optional - Has 'unknown'		X	X
`DocumentReference.modality`		`*`
`DocumentReference.type`		`1`
`DocumentReference.category`		`*`
`DocumentReference.subject`		`1`
`DocumentReference.context`		`*`
`DocumentReference.event`		`*`
`DocumentReference.related`		`*`
`DocumentReference.bodyStructure`		`*`
`DocumentReference.facilityType`		`1`
`DocumentReference.practiceSetting`		`1`
`DocumentReference.period`		`1`
`DocumentReference.date`		`1`
`DocumentReference.author`		`*`
`DocumentReference.attester`		`*`
`DocumentReference.attester.mode`	X	`1`
`DocumentReference.attester.time`		`1`
`DocumentReference.attester.party`		`1`
`DocumentReference.custodian`		`1`
`DocumentReference.relatesTo`		`*`
`DocumentReference.relatesTo.code`	X	`1`
`DocumentReference.relatesTo.target`	X	`1`
`DocumentReference.description`		`1`
`DocumentReference.securityLabel`		`*`
`DocumentReference.content`	X	`*`
`DocumentReference.content.attachment`	X	`1`
`DocumentReference.content.profile`		`*`
`DocumentReference.content.profile.value[x]`	X	`1`

Operations

Id	Name	Publication Status	FMM	Standards Status	IsExperimental	Workgroup	Description
`DocumentReference-docref`	`Docref`	Active	3	normative	False	oo	This operation is used to return all the references to documents related to a patient. The operation requires a patient id and takes the optional input parameters: - start date - end date - document type - on demand - profile and returns a [Bundle](http://hl7.org/fhir/R6/bundle.html) of type "searchset" containing [DocumentReference](http://hl7.org/fhir/R6/documentreference.html) resources for the patient. If the server has or can create documents that are related to the patient, and that are available for the given user, the server returns the DocumentReference resources needed to support the records. The principle intended use for this operation is to provide a provider or patient with access to their available document information. This operation is different from a search by patient and type and date range because: 1. It is used to request a server to generate a document based on the specified parameters. 1. If no parameters are specified, the server SHALL return a DocumentReference to the patient's most current summary 1. If the server cannot generate a document based on the specified parameters, the operation will return an empty search bundle. Unless the client indicates they are only interested in 'on-demand' documents using the on-demand parameter, the server SHOULD return DocumentReference instances for existing documents that meet the request parameters. In this regard, this operation is similar to a FHIR RESTful query.

Search Parameters

Id	Name	Publication Status	FMM	Standards Status	IsExperimental	WorkGroup	Search Type	Description
`DocumentReference-attester`	`attester`	Active		normative	False	oo	reference	Who attested the document
`DocumentReference-author`	`author`	Active		normative	False	oo	reference	Who and/or what authored the document
`DocumentReference-based-on`	`based-on`	Active		normative	False	oo	reference	Procedure that caused this media to be created
`DocumentReference-body-structure`	`body-structure`	Active		normative	False	oo	token	The body structure studied
`DocumentReference-body-structure-reference`	`body-structure-reference`	Active		normative	False	oo	reference	The body structure studied
`DocumentReference-category`	`category`	Active		normative	False	oo	token	Categorization of document
`DocumentReference-contenttype`	`contenttype`	Active		normative	False	oo	token	Mime type of the content, with charset etc.
`DocumentReference-context`	`context`	Active		normative	False	oo	reference	Context of the document content
`DocumentReference-creation`	`creation`	Active		normative	False	oo	date	Date attachment was first created
`DocumentReference-custodian`	`custodian`	Active		normative	False	oo	reference	Organization which maintains the document
`DocumentReference-description`	`description`	Active		normative	False	oo	string	Human-readable description
`DocumentReference-doc-status`	`doc-status`	Active		normative	False	oo	token	preliminary \| final \| amended \| entered-in-error
`DocumentReference-event-code`	`event-code`	Active		normative	False	oo	token	Main clinical acts documented
`DocumentReference-event-reference`	`event-reference`	Active		normative	False	oo	reference	Main clinical acts documented
`DocumentReference-facility`	`facility`	Active		normative	False	oo	token	Kind of facility where patient was seen
`DocumentReference-format-canonical`	`format-canonical`	Active		normative	False	oo	uri	Profile canonical content rules for the document
`DocumentReference-format-code`	`format-code`	Active		normative	False	oo	token	Format code content rules for the document
`DocumentReference-format-uri`	`format-uri`	Active		normative	False	oo	uri	Profile URI content rules for the document
`DocumentReference-language`	`language`	Active		normative	False	oo	token	Human language of the content (BCP-47)
`DocumentReference-location`	`location`	Active		normative	False	oo	uri	Uri where the data can be found
`DocumentReference-modality`	`modality`	Active		normative	False	oo	token	The modality used
`DocumentReference-period`	`period`	Active		normative	False	oo	date	Time of service that is being documented
`DocumentReference-related`	`related`	Active		normative	False	oo	reference	Related identifiers or resources
`DocumentReference-relatesto`	`relatesto`	Active		normative	False	oo	reference	Target of the relationship
`DocumentReference-relation`	`relation`	Active		normative	False	oo	token	replaces \| transforms \| signs \| appends
`DocumentReference-relationship`	`relationship`	Active		normative	False	oo	composite	Combination of relation and relatesTo
`DocumentReference-security-label`	`security-label`	Active		normative	False	oo	token	Document security-tags
`DocumentReference-setting`	`setting`	Active		normative	False	oo	token	Additional details about where the content was created (e.g. clinical specialty)
`DocumentReference-status`	`status`	Active		normative	False	oo	token	current \| superseded \| entered-in-error
`DocumentReference-subject`	`subject`	Active		normative	False	oo	reference	Who/what is the subject of the document
`DocumentReference-version`	`version`	Active		normative	False	oo	string	The business version identifier
`clinical-date`	`date`	Active		normative	False	pc	date	Multiple Resources: * [AllergyIntolerance](http://hl7.org/fhir/R6/allergyintolerance.html): Date first version of the resource instance was recorded * [Appointment](http://hl7.org/fhir/R6/appointment.html): Appointment date/time. * [AuditEvent](http://hl7.org/fhir/R6/auditevent.html): Time when the event was recorded * [CarePlan](http://hl7.org/fhir/R6/careplan.html): Time period plan covers * [CareTeam](http://hl7.org/fhir/R6/careteam.html): A date within the coverage time period. * [Composition](http://hl7.org/fhir/R6/composition.html): Composition editing time * [Consent](http://hl7.org/fhir/R6/consent.html): When consent was agreed to * [DiagnosticReport](http://hl7.org/fhir/R6/diagnosticreport.html): The clinically relevant time of the report * [DocumentReference](http://hl7.org/fhir/R6/documentreference.html): When this document reference was created * [Encounter](http://hl7.org/fhir/R6/encounter.html): A date within the actualPeriod the Encounter lasted * [EpisodeOfCare](http://hl7.org/fhir/R6/episodeofcare.html): The provided date search value falls within the episode of care's period * [FamilyMemberHistory](http://hl7.org/fhir/R6/familymemberhistory.html): When history was recorded or last updated * [Flag](http://hl7.org/fhir/R6/flag.html): Time period when flag is active * [Immunization](http://hl7.org/fhir/R6/immunization.html): Vaccination (non)-Administration Date * [Invoice](http://hl7.org/fhir/R6/invoice.html): Invoice date / posting date * [List](http://hl7.org/fhir/R6/list.html): When the list was prepared * [MeasureReport](http://hl7.org/fhir/R6/measurereport.html): The date of the measure report * [NutritionIntake](http://hl7.org/fhir/R6/nutritionintake.html): Date when patient was taking (or not taking) the medication * [Observation](http://hl7.org/fhir/R6/observation.html): Clinically relevant time/time-period for observation * [Procedure](http://hl7.org/fhir/R6/procedure.html): When the procedure occurred or is occurring * [ResearchSubject](http://hl7.org/fhir/R6/researchsubject.html): Start and end of participation * [RiskAssessment](http://hl7.org/fhir/R6/riskassessment.html): When was assessment made?
`clinical-identifier`	`identifier`	Active		normative	False	pa	token	Multiple Resources: * [Account](http://hl7.org/fhir/R6/account.html): Account number * [AdverseEvent](http://hl7.org/fhir/R6/adverseevent.html): Business identifier for the event * [AllergyIntolerance](http://hl7.org/fhir/R6/allergyintolerance.html): External ids for this item * [Appointment](http://hl7.org/fhir/R6/appointment.html): An Identifier of the Appointment * [AppointmentResponse](http://hl7.org/fhir/R6/appointmentresponse.html): An Identifier in this appointment response * [Basic](http://hl7.org/fhir/R6/basic.html): Business identifier * [BiologicallyDerivedProduct](http://hl7.org/fhir/R6/biologicallyderivedproduct.html): Identifier * [BodyStructure](http://hl7.org/fhir/R6/bodystructure.html): Bodystructure identifier * [CarePlan](http://hl7.org/fhir/R6/careplan.html): External Ids for this plan * [CareTeam](http://hl7.org/fhir/R6/careteam.html): External Ids for this team * [Claim](http://hl7.org/fhir/R6/claim.html): The primary identifier of the financial resource * [ClaimResponse](http://hl7.org/fhir/R6/claimresponse.html): The identity of the ClaimResponse * [Communication](http://hl7.org/fhir/R6/communication.html): Unique identifier * [CommunicationRequest](http://hl7.org/fhir/R6/communicationrequest.html): Unique identifier * [Composition](http://hl7.org/fhir/R6/composition.html): Version-independent identifier for the Composition * [Condition](http://hl7.org/fhir/R6/condition.html): A unique identifier of the condition record * [Consent](http://hl7.org/fhir/R6/consent.html): Identifier for this record (external references) * [Contract](http://hl7.org/fhir/R6/contract.html): The identity of the contract * [Coverage](http://hl7.org/fhir/R6/coverage.html): The primary identifier of the insured and the coverage * [CoverageEligibilityRequest](http://hl7.org/fhir/R6/coverageeligibilityrequest.html): The business identifier of the Eligibility * [CoverageEligibilityResponse](http://hl7.org/fhir/R6/coverageeligibilityresponse.html): The business identifier * [DetectedIssue](http://hl7.org/fhir/R6/detectedissue.html): Unique id for the detected issue * [DeviceRequest](http://hl7.org/fhir/R6/devicerequest.html): Business identifier for request/order * [DiagnosticReport](http://hl7.org/fhir/R6/diagnosticreport.html): An identifier for the report * [DocumentReference](http://hl7.org/fhir/R6/documentreference.html): Identifier of the attachment binary * [Encounter](http://hl7.org/fhir/R6/encounter.html): Identifier(s) by which this encounter is known * [EnrollmentRequest](http://hl7.org/fhir/R6/enrollmentrequest.html): The business identifier of the Enrollment * [EpisodeOfCare](http://hl7.org/fhir/R6/episodeofcare.html): Business Identifier(s) relevant for this EpisodeOfCare * [ExplanationOfBenefit](http://hl7.org/fhir/R6/explanationofbenefit.html): The business identifier of the Explanation of Benefit * [FamilyMemberHistory](http://hl7.org/fhir/R6/familymemberhistory.html): A search by a record identifier * [Flag](http://hl7.org/fhir/R6/flag.html): Business identifier * [Goal](http://hl7.org/fhir/R6/goal.html): External Ids for this goal * [GuidanceResponse](http://hl7.org/fhir/R6/guidanceresponse.html): The identifier of the guidance response * [ImagingSelection](http://hl7.org/fhir/R6/imagingselection.html): Identifiers for the imaging selection * [ImagingStudy](http://hl7.org/fhir/R6/imagingstudy.html): Identifiers for the Study, such as DICOM Study Instance UID * [Immunization](http://hl7.org/fhir/R6/immunization.html): Business identifier * [Invoice](http://hl7.org/fhir/R6/invoice.html): Business Identifier for item * [List](http://hl7.org/fhir/R6/list.html): Business identifier * [MeasureReport](http://hl7.org/fhir/R6/measurereport.html): External identifier of the measure report to be returned * [Medication](http://hl7.org/fhir/R6/medication.html): Returns medications with this external identifier * [MedicationAdministration](http://hl7.org/fhir/R6/medicationadministration.html): Return administrations with this external identifier * [MedicationDispense](http://hl7.org/fhir/R6/medicationdispense.html): Returns dispenses with this external identifier * [MedicationRequest](http://hl7.org/fhir/R6/medicationrequest.html): Return prescriptions with this external identifier * [MedicationStatement](http://hl7.org/fhir/R6/medicationstatement.html): Return statements with this external identifier * [NutritionIntake](http://hl7.org/fhir/R6/nutritionintake.html): Return statements with this external identifier * [NutritionOrder](http://hl7.org/fhir/R6/nutritionorder.html): Return nutrition orders with this external identifier * [Observation](http://hl7.org/fhir/R6/observation.html): The unique id for a particular observation * [Person](http://hl7.org/fhir/R6/person.html): A person Identifier * [Procedure](http://hl7.org/fhir/R6/procedure.html): A unique identifier for a procedure * [QuestionnaireResponse](http://hl7.org/fhir/R6/questionnaireresponse.html): The unique identifier for the questionnaire response * [RelatedPerson](http://hl7.org/fhir/R6/relatedperson.html): An Identifier of the RelatedPerson * [RequestOrchestration](http://hl7.org/fhir/R6/requestorchestration.html): External identifiers for the request orchestration * [ResearchSubject](http://hl7.org/fhir/R6/researchsubject.html): Business Identifier for research subject in a study * [RiskAssessment](http://hl7.org/fhir/R6/riskassessment.html): Unique identifier for the assessment * [ServiceRequest](http://hl7.org/fhir/R6/servicerequest.html): Identifiers assigned to this order * [Specimen](http://hl7.org/fhir/R6/specimen.html): The unique identifier associated with the specimen * [Task](http://hl7.org/fhir/R6/task.html): Search for a task instance by its business identifier * [VisionPrescription](http://hl7.org/fhir/R6/visionprescription.html): Return prescriptions with this external identifier
`clinical-patient`	`patient`	Active		normative	False	pa	reference	Multiple Resources: * [Account](http://hl7.org/fhir/R6/account.html): The entity that caused the expenses * [AdverseEvent](http://hl7.org/fhir/R6/adverseevent.html): Subject impacted by event * [AllergyIntolerance](http://hl7.org/fhir/R6/allergyintolerance.html): Who the sensitivity is for * [Appointment](http://hl7.org/fhir/R6/appointment.html): One of the individuals of the appointment is this patient * [AppointmentResponse](http://hl7.org/fhir/R6/appointmentresponse.html): This Response is for this Patient * [AuditEvent](http://hl7.org/fhir/R6/auditevent.html): Where the activity involved patient data * [Basic](http://hl7.org/fhir/R6/basic.html): Identifies the focus of this resource * [BiologicallyDerivedProduct](http://hl7.org/fhir/R6/biologicallyderivedproduct.html): The patient who underwent the procedure to collect the product * [BodyStructure](http://hl7.org/fhir/R6/bodystructure.html): Who this is about * [CarePlan](http://hl7.org/fhir/R6/careplan.html): Who the care plan is for * [CareTeam](http://hl7.org/fhir/R6/careteam.html): Who care team is for * [Claim](http://hl7.org/fhir/R6/claim.html): Patient receiving the products or services * [ClaimResponse](http://hl7.org/fhir/R6/claimresponse.html): The subject of care * [Communication](http://hl7.org/fhir/R6/communication.html): Focus of message * [CommunicationRequest](http://hl7.org/fhir/R6/communicationrequest.html): Focus of message * [Composition](http://hl7.org/fhir/R6/composition.html): Who and/or what the composition is about * [Condition](http://hl7.org/fhir/R6/condition.html): Who has the condition? * [Consent](http://hl7.org/fhir/R6/consent.html): Who the consent applies to * [Contract](http://hl7.org/fhir/R6/contract.html): The identity of the subject of the contract (if a patient) * [Coverage](http://hl7.org/fhir/R6/coverage.html): Retrieve coverages for a patient * [CoverageEligibilityRequest](http://hl7.org/fhir/R6/coverageeligibilityrequest.html): The reference to the patient * [CoverageEligibilityResponse](http://hl7.org/fhir/R6/coverageeligibilityresponse.html): The reference to the patient * [DetectedIssue](http://hl7.org/fhir/R6/detectedissue.html): Associated patient * [DeviceAssociation](http://hl7.org/fhir/R6/deviceassociation.html): The patient associated with the device * [DeviceRequest](http://hl7.org/fhir/R6/devicerequest.html): Individual the service is ordered for * [DiagnosticReport](http://hl7.org/fhir/R6/diagnosticreport.html): The subject of the report if a patient * [DocumentReference](http://hl7.org/fhir/R6/documentreference.html): Who/what is the subject of the document * [Encounter](http://hl7.org/fhir/R6/encounter.html): The patient present at the encounter * [EnrollmentRequest](http://hl7.org/fhir/R6/enrollmentrequest.html): The party to be enrolled * [EpisodeOfCare](http://hl7.org/fhir/R6/episodeofcare.html): The patient who is the focus of this episode of care * [ExplanationOfBenefit](http://hl7.org/fhir/R6/explanationofbenefit.html): The reference to the patient * [FamilyMemberHistory](http://hl7.org/fhir/R6/familymemberhistory.html): The identity of a subject to list family member history items for * [Flag](http://hl7.org/fhir/R6/flag.html): The identity of a subject to list flags for * [Goal](http://hl7.org/fhir/R6/goal.html): Who this goal is intended for * [GuidanceResponse](http://hl7.org/fhir/R6/guidanceresponse.html): The identity of a patient to search for guidance response results * [ImagingSelection](http://hl7.org/fhir/R6/imagingselection.html): Who the study is about * [ImagingStudy](http://hl7.org/fhir/R6/imagingstudy.html): Who the study is about * [Immunization](http://hl7.org/fhir/R6/immunization.html): The patient for the vaccination record * [Invoice](http://hl7.org/fhir/R6/invoice.html): Recipient(s) of goods and services * [List](http://hl7.org/fhir/R6/list.html): If all resources have the same subject * [MeasureReport](http://hl7.org/fhir/R6/measurereport.html): The identity of a patient to search for individual measure report results for * [MedicationAdministration](http://hl7.org/fhir/R6/medicationadministration.html): The identity of a patient to list administrations for * [MedicationDispense](http://hl7.org/fhir/R6/medicationdispense.html): The identity of a patient to list dispenses for * [MedicationRequest](http://hl7.org/fhir/R6/medicationrequest.html): Returns prescriptions for a specific patient * [MedicationStatement](http://hl7.org/fhir/R6/medicationstatement.html): Returns statements for a specific patient. * [NutritionIntake](http://hl7.org/fhir/R6/nutritionintake.html): Returns statements for a specific patient. * [NutritionOrder](http://hl7.org/fhir/R6/nutritionorder.html): The identity of the individual or set of individuals who requires the diet, formula or nutritional supplement * [Observation](http://hl7.org/fhir/R6/observation.html): The subject that the observation is about (if patient) * [Person](http://hl7.org/fhir/R6/person.html): The Person links to this Patient * [Procedure](http://hl7.org/fhir/R6/procedure.html): Search by subject - a patient * [Provenance](http://hl7.org/fhir/R6/provenance.html): Where the activity involved patient data * [QuestionnaireResponse](http://hl7.org/fhir/R6/questionnaireresponse.html): The patient that is the subject of the questionnaire response * [RelatedPerson](http://hl7.org/fhir/R6/relatedperson.html): The patient this related person is related to * [RequestOrchestration](http://hl7.org/fhir/R6/requestorchestration.html): The identity of a patient to search for request orchestrations * [ResearchSubject](http://hl7.org/fhir/R6/researchsubject.html): Who or what is part of study * [RiskAssessment](http://hl7.org/fhir/R6/riskassessment.html): Who/what does assessment apply to? * [ServiceRequest](http://hl7.org/fhir/R6/servicerequest.html): Search by subject - a patient * [Specimen](http://hl7.org/fhir/R6/specimen.html): The patient the specimen comes from * [Task](http://hl7.org/fhir/R6/task.html): Search by patient * [VisionPrescription](http://hl7.org/fhir/R6/visionprescription.html): The identity of a patient to list dispenses for
`clinical-type`	`type`	Active		normative	False	pa	token	Multiple Resources: * [Account](http://hl7.org/fhir/R6/account.html): E.g. patient, expense, depreciation * [AllergyIntolerance](http://hl7.org/fhir/R6/allergyintolerance.html): allergy \| intolerance - Underlying mechanism (if known) * [Composition](http://hl7.org/fhir/R6/composition.html): Kind of composition (LOINC if possible) * [Coverage](http://hl7.org/fhir/R6/coverage.html): The kind of coverage (health plan, auto, Workers Compensation) * [DocumentReference](http://hl7.org/fhir/R6/documentreference.html): Kind of document (LOINC if possible) * [Encounter](http://hl7.org/fhir/R6/encounter.html): Specific type of encounter * [EpisodeOfCare](http://hl7.org/fhir/R6/episodeofcare.html): Type/class - e.g. specialist referral, disease management * [Invoice](http://hl7.org/fhir/R6/invoice.html): Type of Invoice * [MedicationDispense](http://hl7.org/fhir/R6/medicationdispense.html): Returns dispenses of a specific type * [Specimen](http://hl7.org/fhir/R6/specimen.html): The specimen type