Overview

The PolarisCoreDocumentReference profile provides a standardized approach for managing clinical documents within the Polaris FHIR ecosystem. This profile acts as a metadata wrapper around clinical documents (typically PDFs), providing indexing, discovery, and clinical context while ensuring secure and reliable document exchange between EMR systems.

Key Design Principles

Inline Content Requirement

All document content MUST be provided inline as base64-encoded data. External URLs are NOT supported. This design ensures:

• Security: No external resource dependencies or access concerns
• Reliability: Documents always available, no broken links
• Simplicity: Single security and access control model
• Compliance: Easier privacy and regulatory compliance
• Point-in-time Data: When data is transmitted and then subsequently changed, sending data inline ensures data integrity.

Immutable Document Pattern

Documents use a "current-only" status approach where updates create new DocumentReference instances rather than modifying existing ones. This ensures:

• Immutable document history
• Simplified conflict resolution
• Clear audit trails
• No complex version chaining

Identifiers

Required Pattern: https://fhir.apps.health/NamingSystem/[organization]-documentreference-identifier

Where [organization] represents the EMR instance identifier.

Examples:

• telus-chr-7e3b9c2a-documentreference-identifier
• oscar-ab5c8d9f-documentreference-identifier
• accuro-2f4e6a8b-documentreference-identifier

Invariants

documentreference-has-polaris-id: At least one identifier must match pattern:

^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-documentreference-identifier$

Document Categorization

Use category (not type) for classification. Multiple categories can be assigned:

Content Management

Base64 Encoding

Documents must be encoded to base64 for inclusion:

Supported MIME Types

• application/pdf - Most common for clinical documents
• text/plain - Simple text documents
• text/markdown - Simple text documents
• text/html - Formatted reports
• image/jpeg - Scanned documents
• image/png - Screenshots, diagrams

See Also

• FHIR R4 DocumentReference
• CA-Core DocumentReference
• PolarisCorePatient
• PolarisCoreOrganization
• PolarisCoreEncounter
• PolarisCorePractitionerRole

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	Clinical document reference with metadata and content Constraints: documentreference-has-polaris-id, attachment-has-data-or-url
meta	Σ	0..1	Meta	Metadata about the resource
source	SΣ	0..1	uri	Identifies EMR instance & pipeline version the resource came from
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
text	S	0..1	Narrative	Human-readable summary of the document reference This profile does not constrain the narrative in regard to content, language, or traceability to data elements
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	1..*	Identifier	Business identifier(s) for document reference Slice: Unordered, Open by pattern:system
identifier:polarisId	SΣ	1..1	Identifier	Polaris Document Reference ID
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
system	Σ	1..1	uri	Polaris documentreference identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-identifier Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The actual Polaris document reference ID value: unique in source system Example General: 123456
identifier:rawCode	SΣ	0..*	Identifier	Source EMR document identifier
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: secondary
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-raw-code Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	Document reference status (current | superseded | entered-in-error) Binding: DocumentReferenceStatus (required): The status of the document reference.
type	Σ	0..1	CodeableConcept	Precise type of document (use category instead) Binding: DocumentTypeValueSet (extensible): LOINC document type codes
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:loinc	Σ	0..1	Coding	LOINC document type code
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:rawCode	Σ	0..*	Coding	Source EMR document type code
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-type-raw-code
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
text	Σ	0..1	string	Plain text representation of document type
category	SΣ	0..*	CodeableConcept	Document categorization (preferred over type) Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	Σ	0..*	Coding	Standard category code (LOINC, SNOMED) if available
system	Σ	1..1	uri	Standard terminology system URI
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:rawCode	SΣ	0..*	Coding	Source EMR category code
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-category-raw-code
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
text	SΣ	0..1	string	Plain text category description
subject	SΣ	1..1	Reference(Polaris Patient Core)	Patient who is the subject of the document
date	SΣ	0..1	instant	When DocumentReference was created (not document date)
author	SΣ	0..*	Reference(Polaris PractitionerRole Core)	Who wrote the document
authenticator	S	0..1	Reference(Polaris PractitionerRole Core)	Practitioner who verified this document
custodian	S	1..1	Reference(Polaris Organization Core)	Organization responsible for document maintenance
description	SΣ	0..1	string	Human-readable description of document content
content	SΣ	1..*	BackboneElement	Document attachment(s) with inline data
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣ	1..1	Attachment	Inline document data (base64-encoded)
contentType	SΣ	1..1	code	MIME type (e.g., 'application/pdf') Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Language of document content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	0..1	base64Binary	Base64-encoded document content (optional if url is provided)
url	SΣ	0..1	url	URI pointing to document in blob storage Example General: http://www.acme.com/logo-small.png
title	SΣ	0..1	string	Document title for display Example General: Official Corporate Logo
creation	Σ	0..1	dateTime	Date/time document was created
context	Σ	0..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..*	Reference(Polaris Encounter Profile Core)	Related clinical encounter(s)
period	SΣ	0..1	Period	Time period of documented service. Only 'start' expected
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.identifier:polarisId.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.identifier:rawCode.use	required	Pattern Value: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 From the FHIR Standard
DocumentReference.type	extensible	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes From the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types(a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
attachment-has-data-or-url	error	DocumentReference	Each attachment must have either inline data (base64) or a url (blob storage URI), or both : content.all(attachment.data.exists() or attachment.url.exists())
documentreference-has-polaris-id	error	DocumentReference	Must have at least one identifier with a canonical Polaris system URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-documentreference-identifier$'))
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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(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()
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()

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	Clinical document reference with metadata and content Constraints: documentreference-has-polaris-id, attachment-has-data-or-url
meta
source	S	0..1	uri	Identifies EMR instance & pipeline version the resource came from
text	S	0..1	Narrative	Human-readable summary of the document reference
Slices for identifier	S	1..*	Identifier	Business identifier(s) for document reference Slice: Unordered, Open by pattern:system
identifier:polarisId	S	1..1	Identifier	Polaris Document Reference ID
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
system		1..1	uri	Polaris documentreference identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-identifier
value		1..1	string	The actual Polaris document reference ID value: unique in source system
identifier:rawCode	S	0..*	Identifier	Source EMR document identifier
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: secondary
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-raw-code
value		1..1	string	The value that is unique
status	S	1..1	code	Document reference status (current | superseded | entered-in-error)
type		0..1	CodeableConcept	Precise type of document (use category instead) Binding: DocumentTypeValueSet (extensible): LOINC document type codes
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:loinc		0..1	Coding	LOINC document type code
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
coding:rawCode		0..*	Coding	Source EMR document type code
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-type-raw-code
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
text		0..1	string	Plain text representation of document type
category	S	0..*	CodeableConcept	Document categorization (preferred over type)
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard		0..*	Coding	Standard category code (LOINC, SNOMED) if available
system		1..1	uri	Standard terminology system URI
code		1..1	code	Symbol in syntax defined by the system
coding:rawCode	S	0..*	Coding	Source EMR category code
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-category-raw-code
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
text	S	0..1	string	Plain text category description
subject	S	1..1	Reference(Polaris Patient Core)	Patient who is the subject of the document
date	S	0..1	instant	When DocumentReference was created (not document date)
author	S	0..*	Reference(Polaris PractitionerRole Core)	Who wrote the document
authenticator	S	0..1	Reference(Polaris PractitionerRole Core)	Practitioner who verified this document
custodian	S	1..1	Reference(Polaris Organization Core)	Organization responsible for document maintenance
description	S	0..1	string	Human-readable description of document content
content	S	1..*	BackboneElement	Document attachment(s) with inline data
attachment	S	1..1	Attachment	Inline document data (base64-encoded)
contentType	S	1..1	code	MIME type (e.g., 'application/pdf')
language		0..1	code	Language of document content
data	S	0..1	base64Binary	Base64-encoded document content (optional if url is provided)
url	S	0..1	url	URI pointing to document in blob storage
title	S	0..1	string	Document title for display
creation		0..1	dateTime	Date/time document was created
context
encounter	S	0..*	Reference(Polaris Encounter Profile Core)	Related clinical encounter(s)
period	S	0..1	Period	Time period of documented service. Only 'start' expected
start	S	1..1	dateTime	Starting time with inclusive boundary
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.type	extensible	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
attachment-has-data-or-url	error	DocumentReference	Each attachment must have either inline data (base64) or a url (blob storage URI), or both : content.all(attachment.data.exists() or attachment.url.exists())
documentreference-has-polaris-id	error	DocumentReference	Must have at least one identifier with a canonical Polaris system URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-documentreference-identifier$'))

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	Clinical document reference with metadata and content Constraints: documentreference-has-polaris-id, attachment-has-data-or-url
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	SΣ	0..1	uri	Identifies EMR instance & pipeline version the resource came from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text	S	0..1	Narrative	Human-readable summary of the document reference 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	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
Slices for identifier	SΣ	1..*	Identifier	Business identifier(s) for document reference Slice: Unordered, Open by pattern:system
identifier:polarisId	SΣ	1..1	Identifier	Polaris Document Reference ID
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	Polaris documentreference identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-identifier Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The actual Polaris document reference ID value: unique in source system Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:rawCode	SΣ	0..*	Identifier	Source EMR document identifier
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: secondary
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-raw-code Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	Document reference status (current | superseded | entered-in-error) Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	Σ	0..1	CodeableConcept	Precise type of document (use category instead) Binding: DocumentTypeValueSet (extensible): LOINC document type codes
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:loinc	Σ	0..1	Coding	LOINC document type code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:rawCode	Σ	0..*	Coding	Source EMR document type code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-type-raw-code
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of document type
category	SΣ	0..*	CodeableConcept	Document categorization (preferred over type) Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	Σ	0..*	Coding	Standard category code (LOINC, SNOMED) if available
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Standard terminology system URI
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:rawCode	SΣ	0..*	Coding	Source EMR category code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-category-raw-code
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text category description
subject	SΣ	1..1	Reference(Polaris Patient Core)	Patient who is the subject of the document
date	SΣ	0..1	instant	When DocumentReference was created (not document date)
author	SΣ	0..*	Reference(Polaris PractitionerRole Core)	Who wrote the document
authenticator	S	0..1	Reference(Polaris PractitionerRole Core)	Practitioner who verified this document
custodian	S	1..1	Reference(Polaris Organization Core)	Organization responsible for document maintenance
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	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	SΣ	0..1	string	Human-readable description of document content
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	1..*	BackboneElement	Document attachment(s) with inline data
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	SΣ	1..1	Attachment	Inline document data (base64-encoded)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	MIME type (e.g., 'application/pdf') Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Language of document content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	0..1	base64Binary	Base64-encoded document content (optional if url is provided)
url	SΣ	0..1	url	URI pointing to document in blob storage 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	SΣ	0..1	string	Document title for display Example General: Official Corporate Logo
creation	Σ	0..1	dateTime	Date/time document was created
format	Σ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
context	Σ	0..1	BackboneElement	Clinical context of 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
encounter	S	0..*	Reference(Polaris Encounter Profile Core)	Related clinical encounter(s)
event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time period of documented service. Only 'start' expected
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting		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).
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
DocumentReference.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier:polarisId.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.identifier:polarisId.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
DocumentReference.identifier:rawCode.use	required	Pattern Value: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.identifier:rawCode.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 From the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 From the FHIR Standard
DocumentReference.type	extensible	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes From the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types(a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	preferred	DocumentReferenceFormatCodeSet(a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes From the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes From the FHIR Standard
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
attachment-has-data-or-url	error	DocumentReference	Each attachment must have either inline data (base64) or a url (blob storage URI), or both : content.all(attachment.data.exists() or attachment.url.exists())
documentreference-has-polaris-id	error	DocumentReference	Must have at least one identifier with a canonical Polaris system URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-documentreference-identifier$'))
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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(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()
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()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	Clinical document reference with metadata and content Constraints: documentreference-has-polaris-id, attachment-has-data-or-url
meta	Σ	0..1	Meta	Metadata about the resource
source	SΣ	0..1	uri	Identifies EMR instance & pipeline version the resource came from
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
text	S	0..1	Narrative	Human-readable summary of the document reference This profile does not constrain the narrative in regard to content, language, or traceability to data elements
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	1..*	Identifier	Business identifier(s) for document reference Slice: Unordered, Open by pattern:system
identifier:polarisId	SΣ	1..1	Identifier	Polaris Document Reference ID
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
system	Σ	1..1	uri	Polaris documentreference identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-identifier Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The actual Polaris document reference ID value: unique in source system Example General: 123456
identifier:rawCode	SΣ	0..*	Identifier	Source EMR document identifier
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: secondary
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-raw-code Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	Document reference status (current | superseded | entered-in-error) Binding: DocumentReferenceStatus (required): The status of the document reference.
type	Σ	0..1	CodeableConcept	Precise type of document (use category instead) Binding: DocumentTypeValueSet (extensible): LOINC document type codes
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:loinc	Σ	0..1	Coding	LOINC document type code
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:rawCode	Σ	0..*	Coding	Source EMR document type code
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-type-raw-code
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
text	Σ	0..1	string	Plain text representation of document type
category	SΣ	0..*	CodeableConcept	Document categorization (preferred over type) Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	Σ	0..*	Coding	Standard category code (LOINC, SNOMED) if available
system	Σ	1..1	uri	Standard terminology system URI
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:rawCode	SΣ	0..*	Coding	Source EMR category code
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-category-raw-code
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
text	SΣ	0..1	string	Plain text category description
subject	SΣ	1..1	Reference(Polaris Patient Core)	Patient who is the subject of the document
date	SΣ	0..1	instant	When DocumentReference was created (not document date)
author	SΣ	0..*	Reference(Polaris PractitionerRole Core)	Who wrote the document
authenticator	S	0..1	Reference(Polaris PractitionerRole Core)	Practitioner who verified this document
custodian	S	1..1	Reference(Polaris Organization Core)	Organization responsible for document maintenance
description	SΣ	0..1	string	Human-readable description of document content
content	SΣ	1..*	BackboneElement	Document attachment(s) with inline data
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
attachment	SΣ	1..1	Attachment	Inline document data (base64-encoded)
contentType	SΣ	1..1	code	MIME type (e.g., 'application/pdf') Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Language of document content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	0..1	base64Binary	Base64-encoded document content (optional if url is provided)
url	SΣ	0..1	url	URI pointing to document in blob storage Example General: http://www.acme.com/logo-small.png
title	SΣ	0..1	string	Document title for display Example General: Official Corporate Logo
creation	Σ	0..1	dateTime	Date/time document was created
context	Σ	0..1	BackboneElement	Clinical context of document
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
encounter	S	0..*	Reference(Polaris Encounter Profile Core)	Related clinical encounter(s)
period	SΣ	0..1	Period	Time period of documented service. Only 'start' expected
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.identifier:polarisId.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.identifier:rawCode.use	required	Pattern Value: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 From the FHIR Standard
DocumentReference.type	extensible	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes From the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types(a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
attachment-has-data-or-url	error	DocumentReference	Each attachment must have either inline data (base64) or a url (blob storage URI), or both : content.all(attachment.data.exists() or attachment.url.exists())
documentreference-has-polaris-id	error	DocumentReference	Must have at least one identifier with a canonical Polaris system URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-documentreference-identifier$'))
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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(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()
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()

Differential View

This structure is derived from DocumentReference

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	Clinical document reference with metadata and content Constraints: documentreference-has-polaris-id, attachment-has-data-or-url
meta
source	S	0..1	uri	Identifies EMR instance & pipeline version the resource came from
text	S	0..1	Narrative	Human-readable summary of the document reference
Slices for identifier	S	1..*	Identifier	Business identifier(s) for document reference Slice: Unordered, Open by pattern:system
identifier:polarisId	S	1..1	Identifier	Polaris Document Reference ID
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
system		1..1	uri	Polaris documentreference identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-identifier
value		1..1	string	The actual Polaris document reference ID value: unique in source system
identifier:rawCode	S	0..*	Identifier	Source EMR document identifier
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: secondary
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-raw-code
value		1..1	string	The value that is unique
status	S	1..1	code	Document reference status (current | superseded | entered-in-error)
type		0..1	CodeableConcept	Precise type of document (use category instead) Binding: DocumentTypeValueSet (extensible): LOINC document type codes
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:loinc		0..1	Coding	LOINC document type code
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
coding:rawCode		0..*	Coding	Source EMR document type code
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-type-raw-code
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
text		0..1	string	Plain text representation of document type
category	S	0..*	CodeableConcept	Document categorization (preferred over type)
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard		0..*	Coding	Standard category code (LOINC, SNOMED) if available
system		1..1	uri	Standard terminology system URI
code		1..1	code	Symbol in syntax defined by the system
coding:rawCode	S	0..*	Coding	Source EMR category code
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-category-raw-code
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
text	S	0..1	string	Plain text category description
subject	S	1..1	Reference(Polaris Patient Core)	Patient who is the subject of the document
date	S	0..1	instant	When DocumentReference was created (not document date)
author	S	0..*	Reference(Polaris PractitionerRole Core)	Who wrote the document
authenticator	S	0..1	Reference(Polaris PractitionerRole Core)	Practitioner who verified this document
custodian	S	1..1	Reference(Polaris Organization Core)	Organization responsible for document maintenance
description	S	0..1	string	Human-readable description of document content
content	S	1..*	BackboneElement	Document attachment(s) with inline data
attachment	S	1..1	Attachment	Inline document data (base64-encoded)
contentType	S	1..1	code	MIME type (e.g., 'application/pdf')
language		0..1	code	Language of document content
data	S	0..1	base64Binary	Base64-encoded document content (optional if url is provided)
url	S	0..1	url	URI pointing to document in blob storage
title	S	0..1	string	Document title for display
creation		0..1	dateTime	Date/time document was created
context
encounter	S	0..*	Reference(Polaris Encounter Profile Core)	Related clinical encounter(s)
period	S	0..1	Period	Time period of documented service. Only 'start' expected
start	S	1..1	dateTime	Starting time with inclusive boundary
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
DocumentReference.type	extensible	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
attachment-has-data-or-url	error	DocumentReference	Each attachment must have either inline data (base64) or a url (blob storage URI), or both : content.all(attachment.data.exists() or attachment.url.exists())
documentreference-has-polaris-id	error	DocumentReference	Must have at least one identifier with a canonical Polaris system URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-documentreference-identifier$'))

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
DocumentReference	C	0..*	DocumentReference	Clinical document reference with metadata and content Constraints: documentreference-has-polaris-id, attachment-has-data-or-url
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	SΣ	0..1	uri	Identifies EMR instance & pipeline version the resource came from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text	S	0..1	Narrative	Human-readable summary of the document reference 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	?!	0..*	Extension	Extensions that cannot be ignored
masterIdentifier	Σ	0..1	Identifier	Master Version Specific Identifier
Slices for identifier	SΣ	1..*	Identifier	Business identifier(s) for document reference Slice: Unordered, Open by pattern:system
identifier:polarisId	SΣ	1..1	Identifier	Polaris Document Reference ID
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	Polaris documentreference identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-identifier Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The actual Polaris document reference ID value: unique in source system Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:rawCode	SΣ	0..*	Identifier	Source EMR document identifier
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: secondary
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-raw-code Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	Document reference status (current | superseded | entered-in-error) Binding: DocumentReferenceStatus (required): The status of the document reference.
docStatus	Σ	0..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document.
type	Σ	0..1	CodeableConcept	Precise type of document (use category instead) Binding: DocumentTypeValueSet (extensible): LOINC document type codes
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:loinc	Σ	0..1	Coding	LOINC document type code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:rawCode	Σ	0..*	Coding	Source EMR document type code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-type-raw-code
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of document type
category	SΣ	0..*	CodeableConcept	Document categorization (preferred over type) Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	Σ	0..*	Coding	Standard category code (LOINC, SNOMED) if available
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Standard terminology system URI
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:rawCode	SΣ	0..*	Coding	Source EMR category code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-documentreference-category-raw-code
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text category description
subject	SΣ	1..1	Reference(Polaris Patient Core)	Patient who is the subject of the document
date	SΣ	0..1	instant	When DocumentReference was created (not document date)
author	SΣ	0..*	Reference(Polaris PractitionerRole Core)	Who wrote the document
authenticator	S	0..1	Reference(Polaris PractitionerRole Core)	Practitioner who verified this document
custodian	S	1..1	Reference(Polaris Organization Core)	Organization responsible for document maintenance
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	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target	Σ	1..1	Reference(DocumentReference)	Target of the relationship
description	SΣ	0..1	string	Human-readable description of document content
securityLabel	Σ	0..*	CodeableConcept	Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
content	SΣ	1..*	BackboneElement	Document attachment(s) with inline data
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	SΣ	1..1	Attachment	Inline document data (base64-encoded)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
contentType	SΣ	1..1	code	MIME type (e.g., 'application/pdf') Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed. Example General: text/plain; charset=UTF-8, image/png
language	Σ	0..1	code	Language of document content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding Example General: en-AU
data	S	0..1	base64Binary	Base64-encoded document content (optional if url is provided)
url	SΣ	0..1	url	URI pointing to document in blob storage 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	SΣ	0..1	string	Document title for display Example General: Official Corporate Logo
creation	Σ	0..1	dateTime	Date/time document was created
format	Σ	0..1	Coding	Format/content rules for the document Binding: DocumentReferenceFormatCodeSet (preferred): Document Format Codes.
context	Σ	0..1	BackboneElement	Clinical context of 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
encounter	S	0..*	Reference(Polaris Encounter Profile Core)	Related clinical encounter(s)
event		0..*	CodeableConcept	Main clinical acts documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	0..1	Period	Time period of documented service. Only 'start' expected
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
facilityType		0..1	CodeableConcept	Kind of facility where patient was seen Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
practiceSetting		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).
sourcePatientInfo		0..1	Reference(Patient)	Patient demographics from source
related		0..*	Reference(Resource)	Related identifiers or resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
DocumentReference.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
DocumentReference.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
DocumentReference.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.identifier:polarisId.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.identifier:polarisId.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
DocumentReference.identifier:rawCode.use	required	Pattern Value: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
DocumentReference.identifier:rawCode.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
DocumentReference.status	required	DocumentReferenceStatus http://hl7.org/fhir/ValueSet/document-reference-status|4.0.1 From the FHIR Standard
DocumentReference.docStatus	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 From the FHIR Standard
DocumentReference.type	extensible	DocumentTypeValueSet http://hl7.org/fhir/ValueSet/c80-doc-typecodes From the FHIR Standard
DocumentReference.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes From the FHIR Standard
DocumentReference.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
DocumentReference.securityLabel	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
DocumentReference.content.attachment.contentType	required	Mime Types(a valid code from urn:ietf:bcp:13) http://hl7.org/fhir/ValueSet/mimetypes|4.0.1 From the FHIR Standard
DocumentReference.content.attachment.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
DocumentReference.content.format	preferred	DocumentReferenceFormatCodeSet(a valid code from http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem) http://hl7.org/fhir/ValueSet/formatcodes From the FHIR Standard
DocumentReference.context.event	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
DocumentReference.context.facilityType	example	FacilityTypeCodeValueSet http://hl7.org/fhir/ValueSet/c80-facilitycodes From the FHIR Standard
DocumentReference.context.practiceSetting	example	PracticeSettingCodeValueSet http://hl7.org/fhir/ValueSet/c80-practice-codes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
attachment-has-data-or-url	error	DocumentReference	Each attachment must have either inline data (base64) or a url (blob storage URI), or both : content.all(attachment.data.exists() or attachment.url.exists())
documentreference-has-polaris-id	error	DocumentReference	Must have at least one identifier with a canonical Polaris system URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-documentreference-identifier$'))
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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(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()
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()

This structure is derived from DocumentReference

Summary

Mandatory: 7 elements(13 nested mandatory elements)
Must-Support: 24 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

• Polaris Patient Core (https://fhir.apps.health/StructureDefinition/polaris-core-patient)
• Polaris PractitionerRole Core (https://fhir.apps.health/StructureDefinition/polaris-core-practitionerrole)
• Polaris Organization Core (https://fhir.apps.health/StructureDefinition/polaris-core-organization)
• Polaris Encounter Profile Core (https://fhir.apps.health/StructureDefinition/polaris-core-encounter)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of DocumentReference.identifier
• The element 1 is sliced based on the value of DocumentReference.type.coding
• The element 1 is sliced based on the value of DocumentReference.category.coding