Dissolve-E: AWMF Guideline Registry
0.2.0 - ci-build

Dissolve-E: AWMF Guideline Registry - Local Development build (v0.2.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Resource Profile: Guideline Attachment

Official URL: http://fhir.awmf.org/awmf.ig/StructureDefinition/guideline-attachment | Version: 0.2.0
Draft as of 2026-01-29 | Computable Name: GuidelineAttachment

Attachment to a Clinical Practice Guideline

### Guidance

This profile represents a Guideline Attachment – a document or file attached to a clinical practice guideline, such as PDF versions, slide decks, patient information, or visual abstracts.

#### Overview

Guidelines often have multiple associated documents beyond the main text. This profile provides a standardized way to attach and categorize these supplementary materials.

#### Key Elements

##### Type (Required)

The `type` element is fixed to identify the resource as an attachment:

    * type = $cs-ebm-ig#attachments "Attachments"

##### Category (Required)

The `category` element specifies what type of content the attachment represents. Multiple categories can be assigned:

    * category[+] = cs-guideline-sections#long-version "Long Version"
    * category[+] = cs-guideline-sections#patient-version "Patient Version"
    * category[+] = cs-guideline-sections#visual-abstract "Visual Abstract"
    * category[+] = cs-guideline-sections#slide-deck "Slide Deck"

Common categories include:

- `long-version` – Full guideline document
- `short-version` – Abbreviated version
- `guideline-report` – Methods/evidence report
- `evidence-report` – Systematic review evidence
- `implementation-guidance` – Implementation tools
- `decision-support` – Decision support materials
- `patient-version` – Patient-friendly version
- `slide-deck` – Presentation slides
- `visual-abstract` – Graphical summary

##### Status (Required)

The document status:

    * status = #current

##### Content

The actual attachment with its metadata:

    * content
      * attachment
        * title = "Patient Information Brochure"
        * language = #de
        * contentType = #application/pdf
        * url = "https://example.org/guideline-patient-version.pdf"

##### Tagging for Searchability

Use `meta.tag` to add keywords or topics for easier discovery:

    * meta
      * tag[+].display = "Cardiovascular Disease"
      * tag[+].display = "Diabetes"

#### Usage in Guideline Registry Records

Attachments are referenced from the guideline's attachment section:

    // In the guideline:
    * section[attachments]
      * section[longVersion]
        * entry = Reference(MyLongVersionAttachment)
      * section[patientVersion]
        * entry = Reference(MyPatientVersionAttachment)

#### Example Usage

    Instance: PatientVersionPDF
    InstanceOf: guideline-attachment
    Usage: #example
    * status = #current
    * category[+] = cs-guideline-sections#patient-version "Patient Version"
    * content
      * attachment
        * title = "Patienteninformation zur Leitlinie"
        * language = #de
        * contentType = #application/pdf
        * url = "https://register.awmf.org/assets/guidelines/XXX-XXX_Patienten.pdf"

This profile of a FHIR DocumentReference is derived from the DocumentReference FHIR resource.

Usages:

- Refer to this Profile: Guideline Registry Record
- Examples for this Profile: DocumentReference/Guideline-020-013-GuidelineReport, DocumentReference/Guideline-020-013-ImplementationGuidance, DocumentReference/Guideline-020-013-LongVersion, DocumentReference/Guideline-020-013-PatientVersion... Show 4 more, DocumentReference/Guideline-020-013-ShortVersion, DocumentReference/Guideline-020-013-SlideDeck, DocumentReference/guideline-attachment-example and DocumentReference/guideline-attachment-patient-version-example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | DocumentReference | A reference to a document Constraints: docRef-1, docRef-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
contained |  | 0..* | Resource | Contained, inline Resources
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
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.
type | Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document. 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: https://fevir.net/resources/CodeSystem/179423
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachments
display |  | 1..1 | string | Representation defined by the system Fixed Value: Attachments
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
category | Σ | 1..* | CodeableConcept | Categorization of document Binding: Content Types (preferred)
context | Σ C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Encounter the document reference is part of
content | Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | Σ | 1..1 | Attachment | Where to access the document
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.docStatus | Base | required | Composition Status | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.category | Base | preferred | Content Types | 📦0.2.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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())`

This structure is derived from DocumentReference

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | A reference to a document
type |  | 1..1 | CodeableConcept | Kind of document (LOINC if possible) 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: https://fevir.net/resources/CodeSystem/179423
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachments
display |  | 1..1 | string | Representation defined by the system Fixed Value: Attachments
category |  | 1..* | CodeableConcept | Categorization of document Binding: Content Types (preferred)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.category | Base | preferred | Content Types | 📦0.2.0 | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | DocumentReference | A reference to a document Constraints: docRef-1, docRef-2
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifiers for the document
version | Σ | 0..1 | string | An explicitly assigned identifier 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 | 0..* | CodeableConcept | Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type | Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document. 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: https://fevir.net/resources/CodeSystem/179423
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachments
display |  | 1..1 | string | Representation defined by the system Fixed Value: Attachments
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
category | Σ | 1..* | CodeableConcept | Categorization of document Binding: Content Types (preferred)
subject | Σ | 0..1 | Reference(Resource) | Who/what is the subject of the document
context | Σ C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Encounter the document reference is part of
event |  | 0..* | CodeableReference(Resource) | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
related |  | 0..* | Reference(Resource) | Related identifiers or resources associated with the document reference
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 | dateTime | When this document reference was created
author | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam | Group) | 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 | Group) | Who attested the document
custodian |  | 0..1 | Reference(Organization) | Organization which maintains the document
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..* | 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
profile | Σ | 0..* | 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
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) |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | required | All Languages | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.docStatus | Base | required | Composition Status | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.modality | Base | extensible | Modality | ⏿2025.3.20250714 | tx.fhir.org
DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.category | Base | preferred | Content Types | 📦0.2.0 | This IG
DocumentReference.event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v7.0
DocumentReference.bodySite | Base | example | SNOMED CT Body Structures | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.facilityType | Base | example | Facility Type Code Value Set | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.practiceSetting | Base | example | Practice Setting Code Value Set | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.attester.​mode | Base | preferred | Composition Attestation Mode | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.relatesTo.​code | Base | extensible | Document Relationship Type | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.securityLabel | Base | example | Example set of Security Labels | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.content.​profile.value[x] | Base | preferred | HL7 ValueSet of Format Codes for use with Document Sharing | 📦2.1.0 | THO v7.0

#### Constraints

Id | Grade | Path(s) | Description | Expression
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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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())`

This structure is derived from DocumentReference

Summary

Mandatory: 2 elements

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | DocumentReference | A reference to a document Constraints: docRef-1, docRef-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
contained |  | 0..* | Resource | Contained, inline Resources
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
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.
type | Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document. 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: https://fevir.net/resources/CodeSystem/179423
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachments
display |  | 1..1 | string | Representation defined by the system Fixed Value: Attachments
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
category | Σ | 1..* | CodeableConcept | Categorization of document Binding: Content Types (preferred)
context | Σ C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Encounter the document reference is part of
content | Σ | 1..* | BackboneElement | Document referenced
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
attachment | Σ | 1..1 | Attachment | Where to access the document
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.docStatus | Base | required | Composition Status | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.category | Base | preferred | Content Types | 📦0.2.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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())`

Differential View

This structure is derived from DocumentReference

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference |  | 0..* | DocumentReference | A reference to a document
type |  | 1..1 | CodeableConcept | Kind of document (LOINC if possible) 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: https://fevir.net/resources/CodeSystem/179423
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachments
display |  | 1..1 | string | Representation defined by the system Fixed Value: Attachments
category |  | 1..* | CodeableConcept | Categorization of document Binding: Content Types (preferred)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.category | Base | preferred | Content Types | 📦0.2.0 | This IG

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DocumentReference | C | 0..* | DocumentReference | A reference to a document Constraints: docRef-1, docRef-2
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifiers for the document
version | Σ | 0..1 | string | An explicitly assigned identifier 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 | 0..* | CodeableConcept | Imaging modality used Binding: Modality (extensible): Type of acquired data in the instance.
type | Σ | 1..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Precise type of clinical document. 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: https://fevir.net/resources/CodeSystem/179423
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachments
display |  | 1..1 | string | Representation defined by the system Fixed Value: Attachments
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
category | Σ | 1..* | CodeableConcept | Categorization of document Binding: Content Types (preferred)
subject | Σ | 0..1 | Reference(Resource) | Who/what is the subject of the document
context | Σ C | 0..* | Reference(Appointment | Encounter | EpisodeOfCare) | Encounter the document reference is part of
event |  | 0..* | CodeableReference(Resource) | Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
related |  | 0..* | Reference(Resource) | Related identifiers or resources associated with the document reference
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 | dateTime | When this document reference was created
author | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson | CareTeam | Group) | 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 | Group) | Who attested the document
custodian |  | 0..1 | Reference(Organization) | Organization which maintains the document
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..* | 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
profile | Σ | 0..* | 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
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) |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DocumentReference.language | Base | required | All Languages | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.status | Base | required | DocumentReferenceStatus | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.docStatus | Base | required | Composition Status | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.modality | Base | extensible | Modality | ⏿2025.3.20250714 | tx.fhir.org
DocumentReference.type | Base | preferred | FHIR Document Type Codes | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.category | Base | preferred | Content Types | 📦0.2.0 | This IG
DocumentReference.event | Base | example | v3 Code System ActCode | 📦3.0.0 | THO v7.0
DocumentReference.bodySite | Base | example | SNOMED CT Body Structures | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.facilityType | Base | example | Facility Type Code Value Set | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.practiceSetting | Base | example | Practice Setting Code Value Set | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.attester.​mode | Base | preferred | Composition Attestation Mode | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.relatesTo.​code | Base | extensible | Document Relationship Type | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.securityLabel | Base | example | Example set of Security Labels | 📍6.0.0-ballot3 | FHIR Std.
DocumentReference.content.​profile.value[x] | Base | preferred | HL7 ValueSet of Format Codes for use with Document Sharing | 📦2.1.0 | THO v7.0

#### Constraints

Id | Grade | Path(s) | Description | Expression
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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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())`

This structure is derived from DocumentReference

Summary

Mandatory: 2 elements

Other representations of profile: CSV, Excel, Schematron