This page is part of the Argonaut Data Query Implementation Guide (v1.0.0: Release) based on FHIR R2. This is the current published version. For a full list of available versions, see the Directory of published versions 
D.4.1 StructureDefinition-argo-documentreference
#### U.S. Argonaut DocumentReference Profile
Scope and Usage
This profile sets minimum expectations for searching and fetching patient documents using the DocumentReference Resource. It is inspired by ITI-68 in IHE MHD specification. It identifies the mandatory core elements, extensions, vocabularies and value sets which SHALL be present in the DocumentReference resource when using this profile.
Example Usage Scenarios:
The following are example usage scenarios for the Argonaut AllergyIntolerance
profile:
- Query for all documents belonging to a Patient
- Query for clinical summary information about a patient (access a patient’s Continuity of Care Document (CCD))
Mandatory Data Elements and Terminology
The following data-elements are mandatory (i.e data MUST be present). These are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.
Each DocumentReference must have:
- a patient
- a code describing the type of document
- when the reference was created
- a status
- an https address where the document can be retrieved
- a code identifying the specific details about the format of the document — over and above the content’s MIME type
In addition it should have ( if available) :
- an identifier
- a document creation date
- the patient encounter date that is being referenced
Profile specific implementation guidance:
For a C-CDA Clinical Summary of Care (CCD):
- The document type code is the LOINC code 34133-9 Summary of episode note.
- The format code is
urn:hl7-org:sdwg:ccda-structuredBody:2.1
- The https address may refer to a FHIR Binary Resource (i.e. [base]/Binary/[id]) address on the server
- The https address may have a parameter that identifies the patient (e.g. GET [url]?patient=[id]). Argonaut servers SHOULD not require this parameter, but for IHE compatibility reasons SHALL allow it to be provided, and SHALL check that it is correct if it is provided.
Examples
D.4.1.1
Formal Views of Profile Content
The official URL for this profile is:
http://fhir.org/guides/argonaut/StructureDefinition/argo-documentreference
This profile builds on DocumentReference.
This profile was published on Tue Oct 18 00:00:00 AEDT 2016 as a draft by Argonaut Project.
Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.
Summary of the Mandatory Requirements
- One reference to a patient in
DocumentReference.subject
- One document type code in
DocumentReference.type which is bound to Document Type Value Set
- One dateTime value in
DocumentReference.indexed
- One status in
DocumentReference.status
- One url of the document in
DocumentReference.content.attachment
- a mime type in
DocumentReference.content.attachment.contentType which is bound to MimeType value set (code set)
- a url of the document in
DocumentReference.content.attachment.url
- One format code in
DocumentReference.content.format with an extensible binding to DocumentReference Format Code Set
SHOULD have:
- One identifier in
DocumentReference.identifier
- One dateTime value in
DocumentReference.created
- One time period value in
DocumentReference.context.period
| Name | Flags | Card. | Type | Description & Constraints |
|---|
  DocumentReference | | 0..* | | Argonaut DocumentReference Profile |
  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: IETF BCP-47 (required) |
| text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
 contained | | 0..* | Resource | Contained, inline Resources |
 extension | | 0..* | Extension | Additional Content defined by implementations |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| masterIdentifier | Σ | 0..1 | Identifier | Master Version Specific Identifier |
| identifier | S | 0..1 | Identifier | Other identifiers for the document |
 subject | S | 1..1 | Reference(Argonaut Patient Profile) | Who/what is the subject of the document |
| type | S | 1..1 | CodeableConcept | Kind of document (LOINC if possible)
Binding: Document Type Value Set (required) |
| class | Σ | 0..1 | CodeableConcept | Categorization of document
Binding: Document Class Value Set (example) |
| author | Σ | 0..* | Reference(Practitioner), Reference(Organization), Reference(Device), Reference(Patient), Reference(RelatedPerson) | Who and/or what authored the document |
| custodian | Σ | 0..1 | Reference(Organization) | Organization which maintains the document |
| authenticator | Σ | 0..1 | Reference(Practitioner), Reference(Organization) | Who/what authenticated the document |
| created | S | 0..1 | dateTime | Document creation time |
| indexed | S | 1..1 | instant | When this document reference created |
| status | ?!S | 1..1 | code | current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required) |
| docStatus | Σ | 0..1 | CodeableConcept | preliminary | final | appended | amended | entered-in-error
Binding: CompositionStatus (required) |
| relatesTo | ?!Σ | 0..* | BackboneElement | Relationships to other documents |
 id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| code | Σ | 1..1 | code | replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required) |
 target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship |
| description | Σ | 0..1 | string | Human-readable description (title) |
| securityLabel | Σ | 0..* | CodeableConcept | Document security-tags
Binding: All Security Labels (extensible) |
| content | S | 1..1 | BackboneElement | Document referenced |
| id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| attachment | S | 1..1 | Attachment | Where to access the document |
| id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| contentType | S | 1..1 | code | Mime type of the content, with charset etc.
Binding: IETF BCP-13 (required)
Example General': text/plain; charset=UTF-8, image/png |
| language | Σ | 0..1 | code | Human language of the content (BCP-47)
Binding: IETF BCP-47 (required)
Example General': en-AU |
| data | Σ | 0..1 | base64Binary | Data inline, base64ed |
| url | S | 1..1 | uri | https address
Example General': http://www.acme.com/logo-small.png |
| size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided) |
| hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed) |
| title | Σ | 0..1 | string | Label to display in place of the data
Example General': Official Corporate Logo |
| creation | Σ | 0..1 | dateTime | Date attachment was first created |
| format | S | 1..1 | Coding | Format/content rules for the document
Binding: DocumentReference Format Code Set (extensible) |
| context | S | 0..1 | BackboneElement | Clinical context of document |
 id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| encounter | Σ | 0..1 | Reference(Encounter) | Context of the document content |
| event | Σ | 0..* | CodeableConcept | Main Clinical Acts Documented
Binding: v3 Code System ActCode (example) |
| period | S | 0..1 | Period | Time of service that is being documented |
| facilityType | Σ | 0..1 | CodeableConcept | Kind of facility where patient was seen
Binding: Facility Type Code Value Set (example) |
| practiceSetting | Σ | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty)
Binding: Practice Setting Code Value Set (example) |
| sourcePatientInfo | Σ | 0..1 | Reference(Patient) | Patient demographics from source |
| related | Σ | 0..* | BackboneElement | Related identifiers or resources |
| id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | Σ | 0..1 | Identifier | Identifier of related objects or events |
| ref | Σ | 0..1 | Reference(Resource) | Related Resource |
Documentation for this format |
Summary of the Mandatory Requirements
- One reference to a patient in
DocumentReference.subject
- One document type code in
DocumentReference.type which is bound to Document Type Value Set
- One dateTime value in
DocumentReference.indexed
- One status in
DocumentReference.status
- One url of the document in
DocumentReference.content.attachment
- a mime type in
DocumentReference.content.attachment.contentType which is bound to MimeType value set (code set)
- a url of the document in
DocumentReference.content.attachment.url
- One format code in
DocumentReference.content.format with an extensible binding to DocumentReference Format Code Set
SHOULD have:
- One identifier in
DocumentReference.identifier
- One dateTime value in
DocumentReference.created
- One time period value in
DocumentReference.context.period
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|
| DocumentReference | | 0..* | | Argonaut DocumentReference Profile |
| 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: IETF BCP-47 (required) |
| text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
| contained | | 0..* | Resource | Contained, inline Resources |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| masterIdentifier | Σ | 0..1 | Identifier | Master Version Specific Identifier |
| identifier | S | 0..1 | Identifier | Other identifiers for the document |
| subject | S | 1..1 | Reference(Argonaut Patient Profile) | Who/what is the subject of the document |
| type | S | 1..1 | CodeableConcept | Kind of document (LOINC if possible)
Binding: Document Type Value Set (required) |
| class | Σ | 0..1 | CodeableConcept | Categorization of document
Binding: Document Class Value Set (example) |
| author | Σ | 0..* | Reference(Practitioner), Reference(Organization), Reference(Device), Reference(Patient), Reference(RelatedPerson) | Who and/or what authored the document |
| custodian | Σ | 0..1 | Reference(Organization) | Organization which maintains the document |
| authenticator | Σ | 0..1 | Reference(Practitioner), Reference(Organization) | Who/what authenticated the document |
| created | S | 0..1 | dateTime | Document creation time |
| indexed | S | 1..1 | instant | When this document reference created |
| status | ?!S | 1..1 | code | current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required) |
| docStatus | Σ | 0..1 | CodeableConcept | preliminary | final | appended | amended | entered-in-error
Binding: CompositionStatus (required) |
| relatesTo | ?!Σ | 0..* | BackboneElement | Relationships to other documents |
| id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| code | Σ | 1..1 | code | replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required) |
| target | Σ | 1..1 | Reference(DocumentReference) | Target of the relationship |
| description | Σ | 0..1 | string | Human-readable description (title) |
| securityLabel | Σ | 0..* | CodeableConcept | Document security-tags
Binding: All Security Labels (extensible) |
| content | S | 1..1 | BackboneElement | Document referenced |
| id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| attachment | S | 1..1 | Attachment | Where to access the document |
| id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| contentType | S | 1..1 | code | Mime type of the content, with charset etc.
Binding: IETF BCP-13 (required)
Example General': text/plain; charset=UTF-8, image/png |
| language | Σ | 0..1 | code | Human language of the content (BCP-47)
Binding: IETF BCP-47 (required)
Example General': en-AU |
| data | Σ | 0..1 | base64Binary | Data inline, base64ed |
| url | S | 1..1 | uri | https address
Example General': http://www.acme.com/logo-small.png |
| size | Σ | 0..1 | unsignedInt | Number of bytes of content (if url provided) |
| hash | Σ | 0..1 | base64Binary | Hash of the data (sha-1, base64ed) |
| title | Σ | 0..1 | string | Label to display in place of the data
Example General': Official Corporate Logo |
| creation | Σ | 0..1 | dateTime | Date attachment was first created |
| format | S | 1..1 | Coding | Format/content rules for the document
Binding: DocumentReference Format Code Set (extensible) |
| context | S | 0..1 | BackboneElement | Clinical context of document |
| id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| encounter | Σ | 0..1 | Reference(Encounter) | Context of the document content |
| event | Σ | 0..* | CodeableConcept | Main Clinical Acts Documented
Binding: v3 Code System ActCode (example) |
| period | S | 0..1 | Period | Time of service that is being documented |
| facilityType | Σ | 0..1 | CodeableConcept | Kind of facility where patient was seen
Binding: Facility Type Code Value Set (example) |
| practiceSetting | Σ | 0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty)
Binding: Practice Setting Code Value Set (example) |
| sourcePatientInfo | Σ | 0..1 | Reference(Patient) | Patient demographics from source |
| related | Σ | 0..* | BackboneElement | Related identifiers or resources |
| id | | 0..1 | id | xml:id (or equivalent in JSON) |
| extension | | 0..* | Extension | Additional Content defined by implementations |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | Σ | 0..1 | Identifier | Identifier of related objects or events |
| ref | Σ | 0..1 | Reference(Resource) | Related Resource |
Documentation for this format |
Downloads: StructureDefinition: (XML, JSON, CSV), Schema: XML Schematron
D.4.1.2 Quick Start
Below is an overview of the required search and read operations for this profile. See the Conformance requirements for the Argonaut Data Query implementation guide server for a complete list of supported RESTful operations and search parameters for this IG.
Typically, DocumentReference resources are used with document indexing systems, such as IHE XDS. However, document references may also may be created “on-the-fly” in response to a Document Query request. In other words there MAY NOT be pre-existing index of references to a patient’s documents at the FHIR endpoint. This results in an empty bundle being returned when searching using a normal FHIR Query. Therefore, the $docref operation has been defined to both create and fetch patient DocumentReference Resources.
The following search criteria describe fetching pre-indexed documents and those created “on-the-fly”.
Searching pre-indexed documents:
GET [base]/DocumentReference?patient=[id]
Example:
GET https://fhir-open-api-dstu2.smarthealthit.org/DocumentReference?patient=2169591
Support: Mandatory to support search by patient.
Implementation Notes: Search for all documents for a patient. Fetches a bundle of all DocumentReference resources for the specified patient (how to search by reference).
Response Class:
- (Status 200): successful operation
- (Status 400): invalid parameter
- (Status 401/4xx): unauthorized request
- (Status 403): insufficient scope
GET [base]/DocumentReference?patient=[id]&type=[type]&period=[date]
Example:
GET https://fhir-open-api-dstu2.smarthealthit.org/DocumentReference?patient=2169591&type=34133-9&period=ge2016-01-01
Support: Optional to support search by patient and type and date range.
Implementation Notes: Fetches a bundle of all DocumentReference resources for the specified patient for a given time period and document type. (how to search by reference), (how to search by token), and (how to search by date).
Response Class:
- (Status 200): successful operation
- (Status 400): invalid parameter
- (Status 401/4xx): unauthorized request
- (Status 403): insufficient scope
Searching documents using the $docref operation:
Functional behavior of Server when responding to the $docref operation:
- SHALL return at least a reference to CCD document, if available, but MAY provide references to other document types as well.
- If a context date range is supplied the server SHOULD provide references to any document that falls within the date range
- If no date range is supplied, then the server SHALL provide references to last or current encounter
GET [base]/DocumentReference/$docref?patient=[id]
Example:
todo
Support: Mandatory to support search by patient.
Implementation Notes: Search for CCD documents from the last encounter and MAY search for other document types from the last encounter as well. Fetches a bundle of DocumentReference resources for the specified patient (how to search by reference).
Response Class:
- (Status 200): successful operation
- (Status 400): invalid parameter
- (Status 401/4xx): unauthorized request
- (Status 403): insufficient scope
Example:
todo
GET [base]/DocumentReference?patient=[id]&type=[type]&period=[date]
Example:
todo
Support: Optional to support search by patient and type and date range.
Implementation Notes: Search for the specified document types from the context period for a patient. Server returns at least CCD document references and MAY search for other document types as well. Fetches a bundle of all DocumentReference resources for the specified patient for a given time period and document type. (how to search by reference), (how to search by token), and (how to search by date).
Response Class:
- (Status 200): successful operation
- (Status 400): invalid parameter
- (Status 401/4xx): unauthorized request
- (Status 403): insufficient scope
