CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
2.0.0-cibuild - Release 2 ci-build United States of America flag

CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Local Development build (v2.0.0-cibuild) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: ACH Monthly Event Diagnostic Report - Report and Note

Official URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-monthly-diagnosticreport-note Version: 2.0.0-cibuild
Standards status: Trial-use Maturity Level: 1 Computable Name: AcuteCareHospitalMonthlyNoteDiagnosticReport

This profile contains Required and Must Support data elements for reporting diagnostic report- report and note information to the NHSN Acute Care Hospital (ACH) Monthly Digital Quality Measure. This profile inherits from the QI Core 6.0.0 DiagnosticReport Profile for Report and Note Exchange profile, which inherits from the US Core 6.1.0 DiagnosticReport Profile for Report and Note Exchange profile.

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 1.0.0:

  • New Content

    • Formal Views of Profile Content

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

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. DiagnosticReport C 0..* QICoreDiagnosticReportNote(6.0.0) A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
    Constraints: us-core-10
    ... id Σ 1..1 id Logical id of this artifact
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... status ?!SΣC 1..1 code (USCDI) registered | partial | preliminary | final +
    Binding: DiagnosticReportStatus (required)
    ... Slices for category SΣ 1..* CodeableConcept (QI-Core)(USCDI) Service Category
    Slice: Unordered, Open by pattern:$this
    Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
    .... category:us-core SΣ 0..* CodeableConcept (USCDI) Service category
    Binding: USCoreDiagnosticReportCategory (6.1.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
    ... code SΣ 1..1 CodeableConcept (QI-Core)(USCDI) QI-Core Report Code
    Binding: USCoreNonLaboratoryCodes (6.1.0) (extensible): LOINC codes
    ... subject SΣ 1..1 Reference(Cross-Measure Patient Profile) (QI-Core)(USCDI) The subject of the report - usually, but not always, the patient
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... encounter SΣ 0..1 Reference(QICore Encounter) (QI-Core)(USCDI) Health care event when test ordered
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... effective[x] SΣC 1..1 (QI-Core)(USCDI) Diagnostically relevant time (typically the time of the procedure)
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... issued SΣ 0..1 instant (QI-Core)(USCDI) DateTime this version was made
    ... performer SΣ 0..* Reference(QICore Practitioner | QICore Organization) (QI-Core)(USCDI) Responsible Diagnostic Service
    ... result S 0..* Reference(QICore Laboratory Result Observation | QICore Observation Clinical Result) (QI-Core)(USCDI) Observations
    ... media SΣ 0..* BackboneElement (QI-Core)(USCDI) Key images associated with this report
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... link SΣ 1..1 Reference(Media) (USCDI) Reference to the image source
    ... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
    Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
    ... presentedForm S 0..* Attachment (USCDI) Entire report as issued

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    DiagnosticReport.status Base required DiagnosticReportStatus 📦4.0.1 FHIR Std.
    DiagnosticReport.category Base example Diagnostic Service Section Codes 📦4.0.1 FHIR Std.
    DiagnosticReport.category:us-core Base required US Core Diagnostic Report Category Codes 📍6.1.0 US Core v6.1
    DiagnosticReport.code Base extensible US Core Non Laboratory Codes 📍6.1.0 US Core v6.1
    DiagnosticReport.conclusionCode Base example SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error DiagnosticReport If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error DiagnosticReport 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 DiagnosticReport 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 DiagnosticReport If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice DiagnosticReport 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()
    us-core-10 error DiagnosticReport effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

    This structure is derived from QICoreDiagnosticReportNote

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. DiagnosticReport 0..* QICoreDiagnosticReportNote(6.0.0) A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
    ... id 1..1 id Logical id of this artifact
    ... meta
    .... Slices for extension Content/Rules for all slices
    ..... extension:link-received-date-extension 0..1 dateTime Received Date
    URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
    ... basedOn S 0..* Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) What was requested
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL
    ... encounter
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL
    ... effective[x] 1..1 dateTime, Period (QI-Core)(USCDI) Diagnostically relevant time (typically the time of the procedure)
    ... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results

    doco Documentation for this format
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. DiagnosticReport C 0..* QICoreDiagnosticReportNote(6.0.0) A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
    Constraints: us-core-10
    ... id Σ 1..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
    .... Slices for extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... extension:link-received-date-extension 0..1 dateTime Received Date
    URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
    .... versionId Σ 0..1 id Version specific identifier
    .... lastUpdated Σ 0..1 instant When the resource version last changed
    .... source Σ 0..1 uri Identifies where the resource comes 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
    ... 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 ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business identifier for report
    ... basedOn S 0..* Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) What was requested
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    .... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
    Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... status ?!SΣC 1..1 code (USCDI) registered | partial | preliminary | final +
    Binding: DiagnosticReportStatus (required)
    ... Slices for category SΣ 1..* CodeableConcept (QI-Core)(USCDI) Service Category
    Slice: Unordered, Open by pattern:$this
    Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
    .... category:us-core SΣ 0..* CodeableConcept (USCDI) Service category
    Binding: USCoreDiagnosticReportCategory (6.1.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
    ... code SΣ 1..1 CodeableConcept (QI-Core)(USCDI) QI-Core Report Code
    Binding: USCoreNonLaboratoryCodes (6.1.0) (extensible): LOINC codes
    ... subject SΣ 1..1 Reference(Cross-Measure Patient Profile) (QI-Core)(USCDI) The subject of the report - usually, but not always, the patient
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    .... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
    Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... encounter SΣ 0..1 Reference(QICore Encounter) (QI-Core)(USCDI) Health care event when test ordered
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    .... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
    Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... effective[x] SΣC 1..1 (QI-Core)(USCDI) Diagnostically relevant time (typically the time of the procedure)
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... issued SΣ 0..1 instant (QI-Core)(USCDI) DateTime this version was made
    ... performer SΣ 0..* Reference(QICore Practitioner | QICore Organization) (QI-Core)(USCDI) Responsible Diagnostic Service
    ... resultsInterpreter Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter
    ... specimen 0..* Reference(Specimen) Specimens this report is based on
    ... result S 0..* Reference(QICore Laboratory Result Observation | QICore Observation Clinical Result) (QI-Core)(USCDI) Observations
    ... imagingStudy 0..* Reference(QICore ImagingStudy) (QI-Core) Reference to full details of imaging associated with the diagnostic report
    ... media SΣ 0..* BackboneElement (QI-Core)(USCDI) Key images associated with this report
    .... 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
    .... comment 0..1 string Comment about the image (e.g. explanation)
    .... link SΣ 1..1 Reference(Media) (USCDI) Reference to the image source
    ... conclusion 0..1 string Clinical conclusion (interpretation) of test results
    ... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
    Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
    ... presentedForm S 0..* Attachment (USCDI) Entire report as issued

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    DiagnosticReport.meta.​security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
    DiagnosticReport.meta.​tag Base example Common Tags 📍4.0.1 FHIR Std.
    DiagnosticReport.language Base preferred Common Languages 📦4.0.1 FHIR Std.
    DiagnosticReport.basedOn.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    DiagnosticReport.status Base required DiagnosticReportStatus 📦4.0.1 FHIR Std.
    DiagnosticReport.category Base example Diagnostic Service Section Codes 📦4.0.1 FHIR Std.
    DiagnosticReport.category:us-core Base required US Core Diagnostic Report Category Codes 📍6.1.0 US Core v6.1
    DiagnosticReport.code Base extensible US Core Non Laboratory Codes 📍6.1.0 US Core v6.1
    DiagnosticReport.subject.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    DiagnosticReport.encounter.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    DiagnosticReport.conclusionCode Base example SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error DiagnosticReport If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error DiagnosticReport 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 DiagnosticReport 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 DiagnosticReport If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice DiagnosticReport 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()
    us-core-10 error DiagnosticReport effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

    This structure is derived from QICoreDiagnosticReportNote

    Summary

    Mandatory: 3 elements(2 nested mandatory elements)
    Must-Support: 5 elements

    Structures

    This structure refers to these other structures:

    Extensions

    This structure refers to these extensions:

    Maturity: 1

    Key Elements View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. DiagnosticReport C 0..* QICoreDiagnosticReportNote(6.0.0) A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
    Constraints: us-core-10
    ... id Σ 1..1 id Logical id of this artifact
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... status ?!SΣC 1..1 code (USCDI) registered | partial | preliminary | final +
    Binding: DiagnosticReportStatus (required)
    ... Slices for category SΣ 1..* CodeableConcept (QI-Core)(USCDI) Service Category
    Slice: Unordered, Open by pattern:$this
    Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
    .... category:us-core SΣ 0..* CodeableConcept (USCDI) Service category
    Binding: USCoreDiagnosticReportCategory (6.1.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
    ... code SΣ 1..1 CodeableConcept (QI-Core)(USCDI) QI-Core Report Code
    Binding: USCoreNonLaboratoryCodes (6.1.0) (extensible): LOINC codes
    ... subject SΣ 1..1 Reference(Cross-Measure Patient Profile) (QI-Core)(USCDI) The subject of the report - usually, but not always, the patient
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... encounter SΣ 0..1 Reference(QICore Encounter) (QI-Core)(USCDI) Health care event when test ordered
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... effective[x] SΣC 1..1 (QI-Core)(USCDI) Diagnostically relevant time (typically the time of the procedure)
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... issued SΣ 0..1 instant (QI-Core)(USCDI) DateTime this version was made
    ... performer SΣ 0..* Reference(QICore Practitioner | QICore Organization) (QI-Core)(USCDI) Responsible Diagnostic Service
    ... result S 0..* Reference(QICore Laboratory Result Observation | QICore Observation Clinical Result) (QI-Core)(USCDI) Observations
    ... media SΣ 0..* BackboneElement (QI-Core)(USCDI) Key images associated with this report
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... link SΣ 1..1 Reference(Media) (USCDI) Reference to the image source
    ... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
    Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
    ... presentedForm S 0..* Attachment (USCDI) Entire report as issued

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    DiagnosticReport.status Base required DiagnosticReportStatus 📦4.0.1 FHIR Std.
    DiagnosticReport.category Base example Diagnostic Service Section Codes 📦4.0.1 FHIR Std.
    DiagnosticReport.category:us-core Base required US Core Diagnostic Report Category Codes 📍6.1.0 US Core v6.1
    DiagnosticReport.code Base extensible US Core Non Laboratory Codes 📍6.1.0 US Core v6.1
    DiagnosticReport.conclusionCode Base example SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error DiagnosticReport If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error DiagnosticReport 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 DiagnosticReport 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 DiagnosticReport If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice DiagnosticReport 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()
    us-core-10 error DiagnosticReport effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

    Differential View

    This structure is derived from QICoreDiagnosticReportNote

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. DiagnosticReport 0..* QICoreDiagnosticReportNote(6.0.0) A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
    ... id 1..1 id Logical id of this artifact
    ... meta
    .... Slices for extension Content/Rules for all slices
    ..... extension:link-received-date-extension 0..1 dateTime Received Date
    URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
    ... basedOn S 0..* Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) What was requested
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL
    ... encounter
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL
    ... effective[x] 1..1 dateTime, Period (QI-Core)(USCDI) Diagnostically relevant time (typically the time of the procedure)
    ... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results

    doco Documentation for this format

    Snapshot View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. DiagnosticReport C 0..* QICoreDiagnosticReportNote(6.0.0) A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
    Constraints: us-core-10
    ... id Σ 1..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
    .... Slices for extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... extension:link-received-date-extension 0..1 dateTime Received Date
    URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
    .... versionId Σ 0..1 id Version specific identifier
    .... lastUpdated Σ 0..1 instant When the resource version last changed
    .... source Σ 0..1 uri Identifies where the resource comes 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
    ... 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 ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business identifier for report
    ... basedOn S 0..* Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) What was requested
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    .... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
    Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... status ?!SΣC 1..1 code (USCDI) registered | partial | preliminary | final +
    Binding: DiagnosticReportStatus (required)
    ... Slices for category SΣ 1..* CodeableConcept (QI-Core)(USCDI) Service Category
    Slice: Unordered, Open by pattern:$this
    Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections.
    .... category:us-core SΣ 0..* CodeableConcept (USCDI) Service category
    Binding: USCoreDiagnosticReportCategory (6.1.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
    ... code SΣ 1..1 CodeableConcept (QI-Core)(USCDI) QI-Core Report Code
    Binding: USCoreNonLaboratoryCodes (6.1.0) (extensible): LOINC codes
    ... subject SΣ 1..1 Reference(Cross-Measure Patient Profile) (QI-Core)(USCDI) The subject of the report - usually, but not always, the patient
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    .... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
    Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... encounter SΣ 0..1 Reference(QICore Encounter) (QI-Core)(USCDI) Health care event when test ordered
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    .... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
    Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... effective[x] SΣC 1..1 (QI-Core)(USCDI) Diagnostically relevant time (typically the time of the procedure)
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... issued SΣ 0..1 instant (QI-Core)(USCDI) DateTime this version was made
    ... performer SΣ 0..* Reference(QICore Practitioner | QICore Organization) (QI-Core)(USCDI) Responsible Diagnostic Service
    ... resultsInterpreter Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter
    ... specimen 0..* Reference(Specimen) Specimens this report is based on
    ... result S 0..* Reference(QICore Laboratory Result Observation | QICore Observation Clinical Result) (QI-Core)(USCDI) Observations
    ... imagingStudy 0..* Reference(QICore ImagingStudy) (QI-Core) Reference to full details of imaging associated with the diagnostic report
    ... media SΣ 0..* BackboneElement (QI-Core)(USCDI) Key images associated with this report
    .... 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
    .... comment 0..1 string Comment about the image (e.g. explanation)
    .... link SΣ 1..1 Reference(Media) (USCDI) Reference to the image source
    ... conclusion 0..1 string Clinical conclusion (interpretation) of test results
    ... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
    Binding: SNOMEDCTClinicalFindings (example): Diagnosis codes provided as adjuncts to the report.
    ... presentedForm S 0..* Attachment (USCDI) Entire report as issued

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    DiagnosticReport.meta.​security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
    DiagnosticReport.meta.​tag Base example Common Tags 📍4.0.1 FHIR Std.
    DiagnosticReport.language Base preferred Common Languages 📦4.0.1 FHIR Std.
    DiagnosticReport.basedOn.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    DiagnosticReport.status Base required DiagnosticReportStatus 📦4.0.1 FHIR Std.
    DiagnosticReport.category Base example Diagnostic Service Section Codes 📦4.0.1 FHIR Std.
    DiagnosticReport.category:us-core Base required US Core Diagnostic Report Category Codes 📍6.1.0 US Core v6.1
    DiagnosticReport.code Base extensible US Core Non Laboratory Codes 📍6.1.0 US Core v6.1
    DiagnosticReport.subject.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    DiagnosticReport.encounter.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    DiagnosticReport.conclusionCode Base example SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error DiagnosticReport If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error DiagnosticReport 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 DiagnosticReport 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 DiagnosticReport If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice DiagnosticReport 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()
    us-core-10 error DiagnosticReport effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended' (status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()

    This structure is derived from QICoreDiagnosticReportNote

    Summary

    Mandatory: 3 elements(2 nested mandatory elements)
    Must-Support: 5 elements

    Structures

    This structure refers to these other structures:

    Extensions

    This structure refers to these extensions:

    Maturity: 1

     

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