DocumentReference

Maturity Level	Security Category	Resource Category
3	Unclassified	Foundation Resources

A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.

Resource Content

Name	Required	Type	Description & Constraints
identifier		Identifier[]	Other identifiers for the document
masterIdentifier		Identifier	Master Version Specific Identifier
status	✓	code	current \| superseded \| entered-in-error
docStatus		code	preliminary \| final \| amended \| entered-in-error
type		CodeableConcept	Kind of document (LOINC if possible)
category		CodeableConcept[]	Categorization of document
subject		Reference<Patient\|Practitioner\|Group\|Device>	Who/what is the subject of the document
date		instant	When this document reference was created
author		Reference<Practitioner\|PractitionerRole\|Organization\|Device\|Patient\|RelatedPerson>[]	Who and/or what authored the document
authenticator		Reference<Practitioner\|PractitionerRole\|Organization>	Who/what authenticated the document
custodian		Reference<Organization>	Organization which maintains the document
relatesTo		BackboneElement[]	Relationships to other documents
└─ code	✓	code	replaces \| transforms \| signs \| appends
└─ target	✓	Reference<DocumentReference>	Target of the relationship
description		string	Human-readable description
securityLabel		CodeableConcept[]	Document security-tags
content	✓	BackboneElement[]	Document referenced
└─ attachment	✓	Attachment	Where to access the document
└─ format		Coding	Format/content rules for the document
context		BackboneElement	Clinical context of document
└─ encounter		Reference<Encounter\|EpisodeOfCare>[]	Context of the document content
└─ event		CodeableConcept[]	Main clinical acts documented
└─ period		Period	Time of service that is being documented
└─ facilityType		CodeableConcept	Kind of facility where patient was seen
└─ practiceSetting		CodeableConcept	Additional details about where the content was created
└─ sourcePatientInfo		Reference<Patient>	Patient demographics from source
└─ related		Reference<Any>[]	Related identifiers or resources

Search Parameters

Name	Type	Description	Expression
identifier	token	Master Version Specific Identifier	`DocumentReference.masterIdentifier \| DocumentReference.identifier`
patient	reference	Who/what is the subject of the document	`DocumentReference.subject.where(resolve() is Patient)`
type	token	Kind of document (LOINC if possible)	`DocumentReference.type`
encounter	reference	Context of the document content	`DocumentReference.context.encounter`
authenticator	reference	Who/what authenticated the document	`DocumentReference.authenticator`
author	reference	Who and/or what authored the document	`DocumentReference.author`
category	token	Categorization of document	`DocumentReference.category`
contenttype	token	Mime type of the content, with charset etc.	`DocumentReference.content.attachment.contentType`
custodian	reference	Organization which maintains the document	`DocumentReference.custodian`
date	date	When this document reference was created	`DocumentReference.date`
description	string	Human-readable description	`DocumentReference.description`
event	token	Main clinical acts documented	`DocumentReference.context.event`
facility	token	Kind of facility where patient was seen	`DocumentReference.context.facilityType`
format	token	Format/content rules for the document	`DocumentReference.content.format`
language	token	Human language of the content (BCP-47)	`DocumentReference.content.attachment.language`
location	uri	Uri where the data can be found	`DocumentReference.content.attachment.url`
period	date	Time of service that is being documented	`DocumentReference.context.period`
related	reference	Related identifiers or resources	`DocumentReference.context.related`
relatesto	reference	Target of the relationship	`DocumentReference.relatesTo.target`
relation	token	replaces \| transforms \| signs \| appends	`DocumentReference.relatesTo.code`
security-label	token	Document security-tags	`DocumentReference.securityLabel`
setting	token	Additional details about where the content was created (e.g. clinical specialty)	`DocumentReference.context.practiceSetting`
status	token	current \| superseded \| entered-in-error	`DocumentReference.status`
subject	reference	Who/what is the subject of the document	`DocumentReference.subject`
relationship	composite	Combination of relation and relatesTo	`DocumentReference.relatesTo`

Scope and Usage

A DocumentReference resource is used to index a document, clinical note, and other binary objects to make them available to a healthcare system. A document is some sequence of bytes that is identifiable, establishes its own context (e.g., what subject, author, etc. can be displayed to the user), and has defined update management. The DocumentReference resource can be used with any document format that has a recognized mime type and that conforms to this definition.

Typically, DocumentReference resources are used in document indexing systems, such as IHE XDS , such as profiled in IHE Mobile access to Health Documents .

DocumentReference is metadata describing a document such as:

CDA documents in FHIR systems
FHIR documents stored elsewhere (i.e. registry/repository following the XDS model)
PDF documents, Scanned Paper, and digital records of faxes
Clinical Notes in various forms
Image files (e.g., JPEG, GIF, TIFF)
Non-Standard formats (e.g., WORD)
Other kinds of documents, such as records of prescriptions or immunizations

Boundaries and Relationships

FHIR defines both a document format and this document reference. FHIR documents are for documents that are authored and assembled in FHIR. This resource is mainly intended for general references to assembled documents.

The document that is a target of the reference can be a reference to a FHIR document served by another server, or the target can be stored in the special FHIR Binary Resource, or the target can be stored on some other server system. The document reference is also able to address documents that are retrieved by a service call such as an XDS.b RetrieveDocumentSet, or a DICOM exchange, or an HL7 v2 message query - though the way each of these service calls works must be specified in some external standard or other documentation.

A DocumentReference describes some other document. This means that there are two sets of provenance information relevant here: the provenance of the document, and the provenance of the document reference. Sometimes, the provenance information is closely related, as when the document producer also produces the document reference, but in other workflows, the document reference is generated later by other actors. In the DocumentReference resource, the meta content refers to the provenance of the reference itself, while the content described below concerns the document it references. Like all resources, there is overlap between the information in the resource directly, and in the general Provenance resource. This is discussed as part of the description of the Provenance resource.

1. List Resource

Manages flat collections of resources
Dynamic nature - items can be added/removed
Supports curation with specific business meaning
References other resources directly

2. Group Resource

Defines collections of specific entities (people, animals, devices)
Can enumerate explicitly or describe qualifying characteristics
Commonly used for:
- Public health (at-risk populations)
- Clinical trials (test subject pools)
- Group-level operations/observations

Referenced Elements

This resource is referenced by: