This page is part of the FUT Infrastructure (v11.0.1: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
| Official URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-transformation-documentreference | Version: 11.0.1 | |||
| Active as of 2026-10-23 | Computable Name: ehealth-transformation-documentreference | |||
A DocumentReference resource is used to describe a document that is made available to a healthcare system. A document is some sequence of bytes that is identifiable, establishes its own context (e.g., what subject, author, etc. can be displayed to the user), and has defined update management. The DocumentReference resource can be used with any document format that has a recognized mime type and that conforms to this definition.
The eHealth Infrastructure has multiple profiles for DocumentReference, each with their own purpose. Generally, DocumentReference resources are used in document indexing systems, such as IHE XDS , and are used to refer to:
The eHealth Transformation DocumentReference is used to store CDA documents in the FHIR system or refer to those stored in an XDS modelled repository (i.e. registry/repository following the XDS model).
The eHealth Transformation DocumentReference resource is stored solely in the Document-Transformation service. However, the Document-Query service, which is used to query and retrieve CDA documents from national document sharing infrastructure, will return the found document metadata and documents in the form of an eHealth Transformation DocumentReference resource.
The resources stored in the Document-Transformation service are CDA document representations of FHIR resources in the eHealth infrastructure, such as Observation, QuestionnaireResponses, Appointments and Questionnaires. Upon approval a resource can be transformed to a CDA format and shared to an XDS repository. The DocumentReference resource will then contain a reference to the document in the XDS repository.
To support the expression of the document lifecycle in the external system as well as the lifecycle of the internal sharing process, the eHealth Transformation profile of DocumentReference has the following extensions:
ehealth-manuallydeprecated-type - to indicate whether the document is manually deprecated.ehelth-document-sharing-state - to indicate the state of the document in relation to sharing it to an XDS repository.For the purpose of sharing documents to the XDS repository, the DocumentReference has a collection of states to express where in the document-sharing process the document is and why it is there.
There are 4 overall states expressing where in the sharing process the document is, and a further 11 sub-states to express th reason why the document is in the given state.
The states defined in the system http://ehealth.sundhed.dk/cs/document-sharing-state and are stored in the DocumentReference using the ehelth-document-sharing-state extension.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots, and their representations.
| Name | Flags | Card. | Type | Description & Constraints Filter:  |
|---|---|---|---|---|
  DocumentReference |
0..* | DocumentReference | A reference to a document | |
  implicitRules |
0..1 | uri | A set of rules under which this content was created | |
  Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
   extension:manuallyDeprecated |
0..1 | boolean | Ehealth Document manually deprecated URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-manuallydeprecated-type | |
 extension:documentSharingState |
0..* | Coding | Where in the sharing process the document is, and the reason why URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-document-sharing-state Binding: Document Sharing State (required) | |
 modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |
| status |
1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. | |
 type |
0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Type (required) | |
| category |
0..1 | CodeableConcept | Categorization of document Binding: Document Class (required) | |
 subject |
0..1 | Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r} | Who/what is the subject of the document | |
| author |
0..* | Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r} | Who and/or what authored the document | |
| authenticator |
0..1 | Reference(ehealth-practitioner | ehealth-organization) {r} | Who/what authenticated the document | |
| custodian |
0..1 | Reference(ehealth-organization) {r} | Organization which maintains the document | |
 content |
1..* | BackboneElement | Document referenced | |
 modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| attachment |
1..1 | Attachment | Where to access the document | |
 format |
0..1 | Coding | Format/content rules for the document Binding: FormatCodes (required) | |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.type | Base | required | Document Type | 📦11.0.1 | This IG |
| DocumentReference.category | Base | required | Document Class | 📦11.0.1 | This IG |
| DocumentReference.content.format | Base | required | FormatCodes | 📦11.0.1 | This IG |
| Id | Grade | Path(s) | Description | Expression |
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.type | Base | required | Document Type | 📦11.0.1 | This IG |
| DocumentReference.category | Base | required | Document Class | 📦11.0.1 | This IG |
| DocumentReference.content.format | Base | required | FormatCodes | 📦11.0.1 | This IG |
| DocumentReference.context.event | Base | required | Event Type Codes | 📦11.0.1 | This IG |
| DocumentReference.context.facilityType | Base | required | Facility Type Codes | 📦11.0.1 | This IG |
| DocumentReference.context.practiceSetting | Base | required | Practice Setting Codes | 📦11.0.1 | This IG |
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| DocumentReference |
0..* | DocumentReference | A reference to a document | |||||
| id |
0..1 | id | Logical id of this artifact | |||||
| meta |
0..1 | Meta | Metadata about the resource | |||||
| implicitRules |
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.
| |||||
| 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 | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| extension:manuallyDeprecated |
0..1 | boolean | Ehealth Document manually deprecated URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-manuallydeprecated-type | |||||
| extension:documentSharingState |
0..* | Coding | Where in the sharing process the document is, and the reason why URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-document-sharing-state Binding: Document Sharing State (required) | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |||||
| masterIdentifier |
0..1 | Identifier | Master Version Specific Identifier | |||||
| identifier |
0..* | Identifier | Other identifiers for the document | |||||
| status |
1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. | |||||
| docStatus |
0..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document. | |||||
| type |
0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Type (required) | |||||
| category |
0..1 | CodeableConcept | Categorization of document Binding: Document Class (required) | |||||
| subject |
0..1 | Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r} | Who/what is the subject of the document | |||||
| date |
0..1 | instant | When this document reference was created | |||||
| author |
0..* | Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r} | Who and/or what authored the document | |||||
| authenticator |
0..1 | Reference(ehealth-practitioner | ehealth-organization) {r} | Who/what authenticated the document | |||||
| custodian |
0..1 | Reference(ehealth-organization) {r} | Organization which maintains the document | |||||
| relatesTo |
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 |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| code |
1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. | |||||
| target |
1..1 | Reference(ehealth-documentreference) | Target of the relationship | |||||
| description |
0..1 | string | Human-readable description | |||||
| securityLabel |
0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | |||||
| content |
1..* | BackboneElement | Document referenced | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| attachment |
1..1 | Attachment | Where to access the document | |||||
| format |
0..1 | Coding | Format/content rules for the document Binding: FormatCodes (required) | |||||
| context |
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 |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| encounter |
0..* | Reference(Encounter | EpisodeOfCare) | Context of the document content | |||||
| event |
0..* | CodeableConcept | Main clinical acts documented Binding: Event Type Codes (required) | |||||
| period |
0..1 | Period | Time of service that is being documented | |||||
| facilityType |
0..1 | CodeableConcept | Kind of facility where patient was seen Binding: Facility Type Codes (required) | |||||
| practiceSetting |
0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Codes (required) | |||||
| sourcePatientInfo |
0..1 | Reference(ehealth-patient) | Patient demographics from source | |||||
| related |
0..* | Reference(Resource) | Related identifiers or resources | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.docStatus | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.type | Base | required | Document Type | 📦11.0.1 | This IG |
| DocumentReference.category | Base | required | Document Class | 📦11.0.1 | This IG |
| DocumentReference.relatesTo.code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std. |
| DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| DocumentReference.content.format | Base | required | FormatCodes | 📦11.0.1 | This IG |
| DocumentReference.context.event | Base | required | Event Type Codes | 📦11.0.1 | This IG |
| DocumentReference.context.facilityType | Base | required | Facility Type Codes | 📦11.0.1 | This IG |
| DocumentReference.context.practiceSetting | Base | required | Practice Setting Codes | 📦11.0.1 | This IG |
| Id | Grade | Path(s) | Description | Expression |
Summary
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| DocumentReference |
0..* | DocumentReference | A reference to a document | |
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:manuallyDeprecated |
0..1 | boolean | Ehealth Document manually deprecated URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-manuallydeprecated-type | |
| extension:documentSharingState |
0..* | Coding | Where in the sharing process the document is, and the reason why URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-document-sharing-state Binding: Document Sharing State (required) | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |
| status |
1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. | |
| type |
0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Type (required) | |
| category |
0..1 | CodeableConcept | Categorization of document Binding: Document Class (required) | |
| subject |
0..1 | Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r} | Who/what is the subject of the document | |
| author |
0..* | Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r} | Who and/or what authored the document | |
| authenticator |
0..1 | Reference(ehealth-practitioner | ehealth-organization) {r} | Who/what authenticated the document | |
| custodian |
0..1 | Reference(ehealth-organization) {r} | Organization which maintains the document | |
| content |
1..* | BackboneElement | Document referenced | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| attachment |
1..1 | Attachment | Where to access the document | |
| format |
0..1 | Coding | Format/content rules for the document Binding: FormatCodes (required) | |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.type | Base | required | Document Type | 📦11.0.1 | This IG |
| DocumentReference.category | Base | required | Document Class | 📦11.0.1 | This IG |
| DocumentReference.content.format | Base | required | FormatCodes | 📦11.0.1 | This IG |
| Id | Grade | Path(s) | Description | Expression |
Differential View
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.type | Base | required | Document Type | 📦11.0.1 | This IG |
| DocumentReference.category | Base | required | Document Class | 📦11.0.1 | This IG |
| DocumentReference.content.format | Base | required | FormatCodes | 📦11.0.1 | This IG |
| DocumentReference.context.event | Base | required | Event Type Codes | 📦11.0.1 | This IG |
| DocumentReference.context.facilityType | Base | required | Facility Type Codes | 📦11.0.1 | This IG |
| DocumentReference.context.practiceSetting | Base | required | Practice Setting Codes | 📦11.0.1 | This IG |
Snapshot ViewView
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| DocumentReference |
0..* | DocumentReference | A reference to a document | |||||
| id |
0..1 | id | Logical id of this artifact | |||||
| meta |
0..1 | Meta | Metadata about the resource | |||||
| implicitRules |
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.
| |||||
| 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 | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| extension:manuallyDeprecated |
0..1 | boolean | Ehealth Document manually deprecated URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-manuallydeprecated-type | |||||
| extension:documentSharingState |
0..* | Coding | Where in the sharing process the document is, and the reason why URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-document-sharing-state Binding: Document Sharing State (required) | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |||||
| masterIdentifier |
0..1 | Identifier | Master Version Specific Identifier | |||||
| identifier |
0..* | Identifier | Other identifiers for the document | |||||
| status |
1..1 | code | current | superseded | entered-in-error Binding: DocumentReferenceStatus (required): The status of the document reference. | |||||
| docStatus |
0..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): Status of the underlying document. | |||||
| type |
0..1 | CodeableConcept | Kind of document (LOINC if possible) Binding: Document Type (required) | |||||
| category |
0..1 | CodeableConcept | Categorization of document Binding: Document Class (required) | |||||
| subject |
0..1 | Reference(ehealth-patient | ehealth-practitioner | Group | ehealth-device) {r} | Who/what is the subject of the document | |||||
| date |
0..1 | instant | When this document reference was created | |||||
| author |
0..* | Reference(ehealth-practitioner | ehealth-organization | ehealth-device | ehealth-patient | ehealth-relatedperson) {r} | Who and/or what authored the document | |||||
| authenticator |
0..1 | Reference(ehealth-practitioner | ehealth-organization) {r} | Who/what authenticated the document | |||||
| custodian |
0..1 | Reference(ehealth-organization) {r} | Organization which maintains the document | |||||
| relatesTo |
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 |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| code |
1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. | |||||
| target |
1..1 | Reference(ehealth-documentreference) | Target of the relationship | |||||
| description |
0..1 | string | Human-readable description | |||||
| securityLabel |
0..* | CodeableConcept | Document security-tags Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | |||||
| content |
1..* | BackboneElement | Document referenced | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| attachment |
1..1 | Attachment | Where to access the document | |||||
| format |
0..1 | Coding | Format/content rules for the document Binding: FormatCodes (required) | |||||
| context |
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 |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| encounter |
0..* | Reference(Encounter | EpisodeOfCare) | Context of the document content | |||||
| event |
0..* | CodeableConcept | Main clinical acts documented Binding: Event Type Codes (required) | |||||
| period |
0..1 | Period | Time of service that is being documented | |||||
| facilityType |
0..1 | CodeableConcept | Kind of facility where patient was seen Binding: Facility Type Codes (required) | |||||
| practiceSetting |
0..1 | CodeableConcept | Additional details about where the content was created (e.g. clinical specialty) Binding: Practice Setting Codes (required) | |||||
| sourcePatientInfo |
0..1 | Reference(ehealth-patient) | Patient demographics from source | |||||
| related |
0..* | Reference(Resource) | Related identifiers or resources | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| DocumentReference.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| DocumentReference.status | Base | required | DocumentReferenceStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.docStatus | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std. |
| DocumentReference.type | Base | required | Document Type | 📦11.0.1 | This IG |
| DocumentReference.category | Base | required | Document Class | 📦11.0.1 | This IG |
| DocumentReference.relatesTo.code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std. |
| DocumentReference.securityLabel | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| DocumentReference.content.format | Base | required | FormatCodes | 📦11.0.1 | This IG |
| DocumentReference.context.event | Base | required | Event Type Codes | 📦11.0.1 | This IG |
| DocumentReference.context.facilityType | Base | required | Facility Type Codes | 📦11.0.1 | This IG |
| DocumentReference.context.practiceSetting | Base | required | Practice Setting Codes | 📦11.0.1 | This IG |
| Id | Grade | Path(s) | Description | Expression |
Summary
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Other representations of profile: CSV, Excel, Schematron
