DocumentReference

Overview
Terminology Bindings
Search
Retrieve by id
Create
Operation: docref

Overview

The DocumentReference resource is used to reference a clinical document for a patient within the health system. This resource supports reading Continuity of Care Documents (CCD), returning a list of clinical documents, and a reference to retrieve a document as a PDF. Additionally, this resource supports writing an unstructured document. References to implicitRules, relatesTo, and modifierExtensions are NOT supported and will fail a create request.

For fields supported on write, see the create section.

The following fields are returned if valued for the docref operation (CCD read):

The following fields are returned if valued for clinical documents:

Terminology Bindings

DocumentReference.type

Description

Precise type of clinical document.

Details: LOINC Document Types
System: http://loinc.org

Please note that the following is not the complete list of terminology bindings mapped for our sandbox. Our sandbox has many codes, but we only document a few to provide an example. This list also does not represent what would be mapped for one of our client’s domains. This is one of the things we evaluate and implement as needed when we are making apps available at client sites.
Supported Values

18842-5 - Discharge Summary
11488-4 - Consult Note
11506-3 - Provider-unspecified Progress Note
34840-9 - Rheumatology Note
34839-1 - Rheumatology Consult Note
68608-9 - Summary Note
34133-9 - Summary of episode Note
78280-5 - Surgery Education Note

Details: Millennium Event Code
System: https://fhir.cerner.com/<EHR source id>/codeSet/72

Search

Search for DocumentReferences that meet supplied query parameters:

GET /DocumentReference?:parameters

Implementation Notes

Search results are currently limited to published clinical documents.
Contents of the document are found by following the Attachment URL. See more information on the Binary resource to determine what Authorization scopes are required, and how to set the Accept header when downloading document contents.

Authorization Types

Provider | Patient | System

Parameters

Name	Required?	Type	Description
`_id`	This, or one of `patient` or `subject`	`token`	The logical resource id associated with the resource. Example: `_id=7891`
`patient`	This, or one of `_id` or `subject`	`reference`	The patient to which the document reference belongs. Example: `patient=12345`
`subject`	This, or one of `_id` or `patient`	`reference`	The subject of the document reference. Must represent a Patient resource. May use the :Patient modifier. Example: `subject=Patient/12345 or subject:Patient=12345`
`encounter`	No	`reference`	The encounter to which the document reference belongs. Must represent an Encounter resource. May include a single or comma separated list of references. Example: `encounter=4567`
`created`	No	`date`	A date/time the referenced document was created. Must use the `ge` and `le` prefixes. Example: `created=ge2017-01-07&created=le2017-02-05`
`_count`	No	`number`	The maximum number of results to return.

Notes:

The _id parameter may not be provided at the same time as the patient, subject, encounter, created, or _count parameters.
When the created parameter is provided:
- It must be provided twice, once with the ge parameter and once with the le parameter.
- The two provided date/times may not be equal and must form a closed range.
- If one created parameter includes a time, both must include a time.

Headers

Accept: application/json+fhir
Authorization: <OAuth2 Bearer Token>

Example

Request

GET https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/DocumentReference?patient=12724066&created=ge2020-01-01&created=le2020-12-31

Response

Status: 200 OK

{
  "resourceType": "Bundle",
  "id": "0be75cc8-da20-460a-a39e-9825bdb87472",
  "type": "searchset",
  "total": 1,
  "link": [
    {
      "relation": "self",
      "url": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/DocumentReference?patient=12724066&created=ge2020-01-01&created=le2020-12-31"
    }
  ],
  "entry": [
    {
      "fullUrl": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/DocumentReference/197286315",
      "resource": {
        "resourceType": "DocumentReference",
        "id": "197286315",
        "meta": {
          "versionId": "197286314",
          "lastUpdated": "2020-04-05T04:00:46.000Z"
        },
        "text": {
          "status": "generated",
          "div": "<div><p><b>Document Reference</b></p><p><b>Patient Name</b>: SMART, NANCY</p><p><b>Document Type</b>: Pregnancy Summary Document</p><p><b>Document Title</b>: Pregnancy Summary Document</p><p><b>Date</b>: Apr  5, 2020  4:00 A.M. UTC</p><p><b>Document Status</b>: Auth (Verified)</p></div>"
        },
        "subject": {
          "reference": "Patient/12724066",
          "display": "SMART, NANCY"
        },
        "type": {
          "coding": [
            {
              "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/72",
              "code": "22520442",
              "display": "Pregnancy Summary Document",
              "userSelected": true
            },
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
              "code": "UNK",
              "display": "unknown"
            }
          ],
          "text": "Pregnancy Summary Document"
        },
        "created": "2020-04-05T04:00:45.000Z",
        "indexed": "2020-04-05T04:00:45.000Z",
        "status": "current",
        "docStatus": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/composition-status",
              "code": "final",
              "display": "Final"
            }
          ],
          "text": "Auth (Verified)"
        },
        "description": "Pregnancy Summary Document",
        "content": [
          {
            "attachment": {
              "contentType": "application/pdf",
              "url": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/Binary/XR-197286315",
              "title": "Pregnancy Summary Document"
            }
          }
        ]
      }
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Retrieve by id

List an individual DocumentReference by its id:

GET /DocumentReference/:id

Implementation Notes

Contents of the document are found by following the Attachment URL. See more information on the Binary resource to determine what Authorization scopes are required, and how to set the Accept header when downloading document contents.
If no mappings are available for LOINC codes when returning DocumentReference.type codings, an unknown data absent reason will be returned in place of the LOINC codes. This is to follow the Argonaut profile’s required binding for type. When available, Proprietary codings will be returned in addition to the data absent reason.

Authorization Types

Provider | Patient | System

Headers

Accept: application/json+fhir
Authorization: <OAuth2 Bearer Token>

Example

Request

GET https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/DocumentReference/197286315

Response

Status: 200 OK

{
  "resourceType": "DocumentReference",
  "id": "197286315",
  "meta": {
    "versionId": "197286314",
    "lastUpdated": "2020-04-05T04:00:46.000Z"
  },
  "text": {
    "status": "generated",
    "div": "<div><p><b>Document Reference</b></p><p><b>Patient Name</b>: SMART, NANCY</p><p><b>Document Type</b>: Pregnancy Summary Document</p><p><b>Document Title</b>: Pregnancy Summary Document</p><p><b>Date</b>: Apr  5, 2020  4:00 A.M. UTC</p><p><b>Document Status</b>: Auth (Verified)</p></div>"
  },
  "subject": {
    "reference": "Patient/12724066",
    "display": "SMART, NANCY"
  },
  "type": {
    "coding": [
      {
        "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/72",
        "code": "22520442",
        "display": "Pregnancy Summary Document",
        "userSelected": true
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
        "code": "UNK",
        "display": "unknown"
      }
    ],
    "text": "Pregnancy Summary Document"
  },
  "created": "2020-04-05T04:00:45.000Z",
  "indexed": "2020-04-05T04:00:45.000Z",
  "status": "current",
  "docStatus": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/composition-status",
        "code": "final",
        "display": "Final"
      }
    ],
    "text": "Auth (Verified)"
  },
  "description": "Pregnancy Summary Document",
  "content": [
    {
      "attachment": {
        "contentType": "application/pdf",
        "url": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/Binary/XR-197286315",
        "title": "Pregnancy Summary Document"
      }
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Create

Create new documents. Currently limited to unstructured clinical notes or documentation. For example, a document with display formatting or styling can be written, but a CCD cannot.

POST /DocumentReference

Implementation Notes

The modifier elements implicitRules, modifierExtension and relatesTo are not supported and will be rejected if present.
Currently only XHTML formatted documents are supported. You can validate your document using any available strict XHTML 1.0 validator (eg: w3 validator or this html5 validator).

Authorization Types

Provider | System

Headers

Authorization: <OAuth2 Bearer Token>
Accept: application/json+fhir
Content-Type: application/json+fhir

Body fields

Name	Required	Type
`resourceType`	Yes	`string`
Description The type of the FHIR resource Example DocumentReference Notes resourceType must be DocumentReference top of section
`subject`	Yes	`Reference` (`Patient`)
Description Who or what is the subject of the document. Example { "reference": "Patient/1234" } top of section
`type`	Yes	`CodeableConcept`
Description Kind of document. Example { "coding": [ { "system": "http://loinc.org", "code": "34840-9" } ] } Example { "coding": [ { "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/72", "code": "2820583" } ] } Notes The type must include a LOINC or a proprietary coding. Multiple LOINC codings or a single proprietary coding can be provided. When providing proprietary code system, it should be of format 'https://fhir.cerner.com/<your EHR source id>/codeSet/<code set>' (where code set is a Millennium code set). Example: 'https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/72'. Please note that the list in the terminology bindings section is not the complete list mapped for our sandbox. Our sandbox has many codes, but we only document a few to provide examples. The list does not represent what would be mapped for one of our client’s domains. This is one of the things we evaluate and implement as needed when we are making apps available at client sites. top of section
`author`	No	`List` `of` `Reference` (`Practitioner`)
Description Who and/or what authored the document Example { "author": [ { "reference": "Practitioner/2150097" } ] } Notes At most one practitioner can be populated. If author is not provided, the author will be determined based on the access token. top of section
`indexed`	Yes	`instant`
Description When this document reference was created Example { "indexed": "2015-05-16T091014Z" } top of section
`status`	Yes	`code`
Description The status of this document reference Example { "status": "current" } Notes Currently support `current` only top of section
`docStatus`	No	`CodeableConcept`
Description The status of underlying document Example { "docStatus": { "coding": [ { "system": "http://hl7.org/fhir/composition-status", "code": "final" } ] } } Notes Currently support `final` only top of section
`description`	No	`string`
Description Human-readable description (title) Example { "description": "Rheumatology Note" } top of section
`content`	Yes	`List` `of` `BackboneElement`
Description The referenced document top of section
`content.attachment`	Yes	`Attachment`
Description An array of document contents. Must contain exactly 1 attachment. Example { "content": [ { "attachment": { "contentType": "application/xhtml+xml;charset=utf-8", "data": "PCFET0NUWVBFIGh0bWwNCiAgU1lTVEVNI...<snipped for brevity>" } } ] } top of section
`content.attachment.contentType`	Yes	`string`
Description Mime type of the content, with charset etc. Example { "content": [ { "attachment": { "contentType": "application/xhtml+xml;charset=utf-8" } } ] } Notes contentType must be 'application/xhtml+xml;charset=utf-8' top of section
`content.attachment.data`	Yes	`string`
Description Data inline, base64 encoded XHTML. Example { "content": [ { "attachment": { "data": "PCFET0NUWVBFIGh0bWwNCiAgU1lTVEVNI...<snipped for brevity>" } } ] } Notes Please refer common issues section for more info. top of section
`context`	Yes	`BackboneElement`
Description The clinical context in which the document was prepared top of section
`context.encounter`	Yes	`Reference` (`Encounter`)
Description Context of the document content Example { "context": { "encounter": { "reference": "Encounter/4208053" } } } top of section
`context.period`	No	`Period`
Description When the documented service was performed. Example { "context": { "period" : { "end": "2015-08-20T09:10:14Z" } } } Notes If provided, the service time must be set to `context.period.end`. If not provided, the document will be stored with the indexed dateTime. top of section

Example

Request

POST https://fhir-ehr-code.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/DocumentReference

Body

{
  "resourceType": "DocumentReference",
  "subject": {
    "reference": "Patient/53663272"
  },
  "type": {
    "coding": [
      {
        "system": "http://loinc.org",
        "code": "34840-9"
      }
    ]
  },
  "author": [
    {
      "reference": "Practitioner/21500981"
    }
  ],
  "indexed": "2015-11-18T18:00:00Z",
  "status": "current",
  "docStatus": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/composition-status",
        "code": "final"
      }
    ]
  },
  "description": "Rheumatology Note",
  "content": [
    {
      "attachment": {
        "contentType": "application/xhtml+xml;charset=utf-8",
        "data": "<snipped for brevity>"
      }
    }
  ],
  "context": {
    "encounter": {
      "reference": "Encounter/4208059"
    },
    "period": {
      "end": "2015-08-20T09:10:14Z"
    }
  }
}

Response

Status: 201 Created

Connection: Keep-Alive
Content-Encoding: gzip
Content-Length: 20
Content-Type: text/html; charset=UTF-8
Date: Wed, 06 Jan 2016 18:09:18 GMT
Keep-Alive: timeout=15, max=100
access-control-allow-methods: DELETE, GET, POST, PUT, OPTIONS, HEAD
access-control-allow-origin: *
access-control-expose-headers: ETag, Content-Location, Location, X-Request-Id, WWW-Authenticate, Date
access-control-max-age: 0
cache-control: no-cache
location: https://fhir-ehr-code.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/DocumentReference/5789254
strict-transport-security: max-age=631152000
vary: Origin,User-Agent,Accept-Encoding
x-content-type-options: nosniff
x-frame-options: SAMEORIGIN
x-request-id: 9c7510c0-0bb5-4148-b37e-51a774c4091b
x-xss-protection: 1; mode=block

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned. Additional OperationOutcomes may be returned in the following scenarios:

HTTP Status	Cause	Severity	Code
422	Body contained relatesTo	error	not-supported

Operation: docref

Argonaut operation for querying DocumentReferences for the supplied parameters:

GET /DocumentReference/$docref?:parameters

Implementation Notes

The DocumentReference.relatesTo modifier element is not supported and will not be returned.

Authorization Types

Provider | Patient | System

Terminology Bindings

DocumentReference.type

Description

Precise type of clinical document.

Details: LOINC
System: http://loinc.org

Supported Values

34133-9 - Summary of episode note

DocumentReference.content.format

Description

Document format codes.

Details: DocumentReference Format Code Set
System: urn:oid:1.3.6.1.4.1.19376.1.2.3

Parameters

Name	Required?	Type	Description
`patient`	Y	`reference`	A reference to the patient whose document references are required. Example: `12345`
`type`	Y	`token`	The document reference type, can be a list of comma separated values. Example: `http://loinc.org\|34133-9`
`start`	N	`date`	The start of the date range from which document reference records should be included. If not provided, then all records from the beginning of time are included. Example: `2014-09-24T12:00:00.000Z`
`end`	N	`date`	The end of the date range till which document reference records should be included. If not provided, then all records up to the current date are included. Example: `2016-09-24T12:00:00.000Z`

Notes:

The type parameter must include both a system and a code. (e.g. &type=http://loinc.org|34133-9)
The start and end parameters must be valid dateTimes with a time component. They must have prefixes of eq or nothing.

Headers

Accept: application/json+fhir
Authorization: <OAuth2 Bearer Token>

Example

Request

GET https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/DocumentReference/$docref?patient=12724066&type=http%3A%2F%2Floinc.org%7C34133-9

Response

Status: 200 OK

{
  "resourceType": "Bundle",
  "id": "33c6587c-ab3c-4846-a2c6-05724fe4013e",
  "type": "searchset",
  "total": 1,
  "link": [
    {
      "relation": "self",
      "url": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/DocumentReference/$docref?patient=12724066&type=http%3A%2F%2Floinc.org%7C34133-9"
    }
  ],
  "entry": [
    {
      "fullUrl": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/DocumentReference/c7d249c7-1742-47a8-9fca-1fc361728aa8",
      "resource": {
        "resourceType": "DocumentReference",
        "id": "c7d249c7-1742-47a8-9fca-1fc361728aa8",
        "subject": {
          "reference": "Patient/12724066"
        },
        "type": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "34133-9"
            }
          ],
          "text": "Summary of episode note"
        },
        "indexed": "2020-07-08T17:05:01Z",
        "status": "current",
        "content": [
          {
            "attachment": {
              "contentType": "application/xml",
              "url": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/Binary/$autogen-ccd-if?patient=12724066"
            },
            "format": [
              {
                "system": "urn:oid:1.3.6.1.4.1.19376.1.2.3",
                "code": "urn:hl7-org:sdwg:ccda-structuredBody:2.1",
                "display": "For documents following C-CDA constraints using a structured body."
              }
            ]
          }
        ]
      }
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Millennium

DocumentReference

Overview

Terminology Bindings

Search

Authorization Types

Parameters

Headers

Example

Request

Response

Errors

Retrieve by id

Authorization Types

Headers

Example

Request

Response

Errors

Create

Authorization Types

Headers

Body fields

Example

Request

Body

Response

Errors

Operation: docref

Authorization Types

Terminology Bindings

Parameters

Headers

Example

Request

Response

Errors