--- type: "resource" title: "DiagnosticReport" resource: "DiagnosticReport" --- # DiagnosticReport ## Introduction ## Scope and Usage > **Note to Balloters:** To ensure this resource is ready for Normative status, we are seeking ballot comment on the substantive content. The key changes made since R5 include: > > Addition of the following elements: > > - DiagnosticReport.relatesTo > - DiagnosticReport.procedure > - DiagnosticReport.recommendation > - DiagnosticReport.communication > - DiagnosticReport.comparison > > Changes to the following elements: > > - DiagnosticReport.conclusionCode datatype A diagnostic report is the set of information that is typically provided by a diagnostic service when investigations are complete. The information includes a mix of atomic results, text reports, images, and codes. The mix varies depending on the nature of the diagnostic procedure, and sometimes on the nature of the outcomes for a particular investigation. In FHIR, the report can be conveyed in a variety of ways including a [Document](documents), [RESTful API](http), or [Messaging](messaging) framework. Included within each of these, would be the DiagnosticReport resource itself. The DiagnosticReport resource has information about the diagnostic report itself, and about the subject and, in the case of laboratory tests, the specimen of the report. It can also refer to the request details and atomic observations details or image instances. Report conclusions can be expressed as a simple text blob, structured coded data or as an attached fully formatted report such as a PDF. The DiagnosticReport resource is suitable for the following kinds of diagnostic reports: - Laboratory (Clinical Chemistry, Hematology, Microbiology, etc.) - Pathology / Histopathology / related disciplines - Imaging Investigations (x-ray, CT, MRI, etc.) - Other diagnostics such as Cardiology, Gastroenterology, etc. - Product quality tests such as pH, Assay, Microbial limits, etc. on product and substance The DiagnosticReport resource is not intended to support cumulative result presentation (tabular presentation of past and present results in the resource). The DiagnosticReport resource does not yet provide full support for detailed structured reports of sequencing; this is planned for a future release. ## Background and Context **Diagnostic Report Names** The words "tests", "results", "observations", "panels" and "batteries" are often used interchangeably when describing the various parts of a diagnostic report. This leads to much confusion. The naming confusion is worsened because of the wide variety of forms that the result of a diagnostic investigation can take, as described above. Languages other than English have their own variations on this theme. This resource uses one particular set of terms. A practitioner "requests" a set of "tests". The diagnostic service returns a "report" which may contain a "narrative" - a written summary of the outcomes, and/or "results" - the individual pieces of atomic data which each are "observations". The results are assembled in "groups" which are nested structures of Observations (traditionally referred to as "panels" or " batteries" by laboratories) that can be used to represent relationships between the individual data items. ## Boundaries and Relationships Note that many diagnostic processes are procedures that generate observations and diagnostic reports. In many cases, such an observation does not require an explicit representation of the procedure used to create the observation, but where there are details of interest about how the diagnostic procedure was performed, the [Procedure](procedure) resource is used to describe the activity. In contrast to the [Observation](observation) resource, the DiagnosticReport resource typically includes additional clinical context and some mix of atomic results, images, imaging reports, textual and coded interpretation, and formatted representations. Laboratory reports, pathology reports, and imaging reports should be represented using the DiagnosticReport resource. The Observation resource should be used to record patient-generated information (e.g., self-test results). The [Observation](observation) resource is referenced by the DiagnosticReport to provide the atomic results for a particular investigation. If you have a highly structured report, then use DiagnosticReport - it has data and workflow support. Details about the request for a diagnostic investigation are captured in the various "request" resources (e.g., the [ServiceRequest](servicerequest)) and allow the report to connect to clinical workflows. For more narrative driven reports with less work flow (histology/mortuary, etc.), the [Composition](composition) resource would be more appropriate. The performer and resultsInterpreter elements support references to Patient and RelatedPerson to accommodate self-performed and at-home testing scenarios. When the performer or resultsInterpreter references the same Patient as the subject, this indicates that the patient performed the test themselves (e.g., home glucose monitoring, self-administered COVID-19 tests). When these elements reference a RelatedPerson, this indicates that a family member, caregiver, or other related individual performed the test or interpreted the results on behalf of the patient. The performer element indicates who physically performed or was responsible for the diagnostic procedure, while resultsInterpreter indicates who was responsible for the clinical interpretation of the results. Both roles may be filled by the patient or a related person in home-based and self-care scenarios. Diagnostic studies, such as those involving radiologic images or genomic data, are referenced via the "study" element. For image studies, the details and actual image instances can be referenced in the DiagnosticReport using the "media" element or through the "study" element to reference [ImagingStudy](imagingstudy) resources which represent the content produced in a DICOM imaging study or set of DICOM Instances for a patient. When a report includes genomic testing, the complex metadata about the analysis performed can be captured referenced through the "study" element to reference [GenomicStudy](https://build.fhir.org/ig/HL7/cg-incubator/StructureDefinition-GenomicStudy.html) resources. As other complex laboratory areas develop resources to capture metadata about different types of studies, this attribute will be extended to reference those. Image and media representations of the report and supporting images and data are referenced in the "media" element. A DiagnosticReport has overlapping characteristics with DocumentReference. The DiagnosticReport is appropriate to reflect a set of discrete results (Observations) and associated contextual details for a specific report, and within those results any further structure within the Observation instances, while a DocumentReference typically reflects a non-FHIR object (e.g., an existing C-CDA document, a scan of a drivers license, or narrative note). There is some overlap potential, such as a scan of a CBC report that can either be referenced via a DocumentReference, or included in a DiagnosticReport as a presentedForm together with the structured, discrete data. In some cases, a single in-system entity may be represented as both resources if they provide relevant metadata or workflow-specific attributes. Specific implementation guides would further clarify which approach is more appropriate. ## Notes ## Notes: ### Identifiers The [identifier](datatypes#Identifier) datatype has a `type` element that may be used to distinguish the identifiers assigned by the requester and the performer of the request (known as the 'Placer' and 'Filler' in the HL7 Version 2 Messaging Standard). Use the identifier type code "PLAC" for the Placer Identifier and "FILL" for the Filler identifier as is shown in the example below: ### Clinically Relevant Time If the diagnostic procedure was performed on the patient directly, the [effective\[x\]](diagnosticreport-definitions#DiagnosticReport.effective_x_) element is a dateTime, the time it was performed. If specimens were taken, the clinically relevant time of the report can be derived from the specimen collection times, but since detailed specimen information is not always available, and nor is the clinically relevant time always exactly the specimen collection time (e.g. complex timed tests), the reports SHALL always include an effective\[x\] element. Note that [HL7 V2](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=185) messages often carry a diagnostically relevant time without carrying any specimen information. ### Associated Observations - The DiagnosticReport.code always contains the name of the report itself. The report can also contain a set of Observations in the DiagnosticReport.result element. These Observations can be simple observations (e.g. atomic results) or groups/panels of other observations. The Observation.code indicates the nature of the observation or panel (e.g. individual measure, organism isolate/sensitivity or antibody functional testing). When relevant, the observation can specify a particular specimen from which the result comes. - Examples of nesting groups/panels within an observation include reporting a "profile" consisting of several panels as is shown in [this example](diagnosticreport-example-ghp), a group of antibiotic isolate/sensitivities for a bacterial culture, or a set of perinatal measurements on a single fetus. - There is rarely a need for more than two levels of nesting in the Observation tree. One known use is for organism sensitivities - an example of a [complex Micro Isolate and Sensitivities](diagnosticreport-micro1) is provided. ### Associated Images ImagingStudy and the `media` element are somewhat overlapping - typically, the list of image references in the media element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided. ### Diagnostic Report Status - Applications consuming diagnostic reports must take careful note of updated (revised) reports and ensure that retracted reports are appropriately handled. - For applications providing diagnostic reports, a report should not be final until all the individual data items reported with it are final or appended. - If the report has been withdrawn following a previous final release, the DiagnosticReport and associated Observations should be retracted by replacing the status codes with the concept "entered-in-error" and setting the conclusion/comment (if provided) and the text narrative to some text like "This report has been withdrawn" in the appropriate language. A reason for retraction may be provided in the narrative. ### Report Content Typically, a report is either: all data, no narrative (e.g. Core lab) or a mix of data with some concluding narrative (e.g. Structured Pathology Report, Bone Density), or all narrative (for example a typical imaging report, histopathology). This resource provides for these 3 different presentations: - As atomic data items: a hierarchical set of nested references to Observation resources often including pathologist/radiologist interpretation(s) (in .result), one or more images (in .study with reference to imagingStudy or in .media), and possibly with a conclusion and/or one or more coded diagnoses (in .conclusionCode) - As narrative: an XHTML presentation in .text - As a rich text representation of the report - typically a PDF (in .presentedForm) Note that the conclusion and the coded diagnoses are part of the atomic data and SHOULD be duplicated in the narrative and in the presented form if the latter is present. The narrative and the presented form serve the same function: a representation of the report for a human. The presented form is included since diagnostic service reports often contain presentation features that are not easy to reproduce in the HTML narrative. Whether or not the presented form is included, the narrative must be a clinically safe view of the diagnostic report; at a minimum, this could be fulfilled by a note indicating that the narrative is not proper representation of the report, and that the presented form must be used, or a generated view from the atomic data. However, consumers of the report will best be served if the narrative contains clinically relevant data from the form. Commonly, the following patterns are used: - Simple Laboratory Reports: A single set of atomic observations, and a tabular presentation in narrative. This is typically encountered in high volume areas such as Biochemistry and Hematology - Histopathology Report: A document report in a presented form and the narrative. Possibly a few key images, and some coded diagnoses for registries. If the service is creating a structured report, some atomic data may be included - imaging Report: A document report in a presented form and the narrative, with an imaging study reference and possibly some key images. Some imaging reports such as a Bone Density Scan may include some atomic data Note that the nature of reports from the various disciplines that provide diagnostic reports are changing quickly, as expert systems provide improved narrative reporting in high volume reports, structured reporting brings additional data to areas that have classically been narrative based, and the nature of the imaging and laboratory procedures are merging. Therefore, these patterns described above are only examples of how a diagnostic report can be used. DiagnosticReport could also contain Observations for tests that were not performed. See [Observation](https://build.fhir.org/observation.html#cancelled) for more details on how one documents that an observation was not performed. ### Genomic Reports Genomic reporting makes heavy use of the DiagnosticReport and Observation resources to capture the genomic data in a highly structured and computable way. An implementation guide describing how to represent genetic results can be found [here](http://hl7.org/fhir/uv/genomics-reporting/index.html). Beyond the structured, computable data available in DiagnosticReport and Observation, metadata about the analysis performed is captured in the [GenomicStudy](https://build.fhir.org/ig/HL7/cg-incubator/StructureDefinition-GenomicStudy.html) resource. GenomicStudy aims at delineating relevant information of a genomic study. A genomic study might comprise one or more analyses, each serving a specific purpose. These analyses may vary in method (e.g., karyotyping, CNV, or SNV detection), performer, software, devices used, or regions targeted. ## StructureDefinition ### Elements (Simplified) - **[DiagnosticReport](/diagnosticreport-definitions#DiagnosticReport)** [0..*]: - A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports - **[DiagnosticReport.identifier](/diagnosticreport-definitions#DiagnosticReport.identifier)** [0..*]: [Identifier](/Identifier) Business identifier for report - **[DiagnosticReport.basedOn](/diagnosticreport-definitions#DiagnosticReport.basedOn)** [0..*]: [Reference(CarePlan](/Reference(CarePlan), [MedicationRequest](/MedicationRequest), [NutritionOrder](/NutritionOrder), [ServiceRequest)](/ServiceRequest)) What was requested - **[DiagnosticReport.status](/diagnosticreport-definitions#DiagnosticReport.status)** [1..1]: [code](/code) required:[diagnostic-report-status](/valueset-diagnostic-report-status) registered | partial | preliminary | modified | final | amended | corrected | appended | cancelled | entered-in-error | unknown - **[DiagnosticReport.category](/diagnosticreport-definitions#DiagnosticReport.category)** [0..*]: [CodeableConcept](/CodeableConcept) example:[diagnostic-service-sections](/valueset-diagnostic-service-sections) Service category - **[DiagnosticReport.code](/diagnosticreport-definitions#DiagnosticReport.code)** [1..1]: [CodeableConcept](/CodeableConcept) preferred:[report-codes](/valueset-report-codes) Name/Code for this diagnostic report - **[DiagnosticReport.subject](/diagnosticreport-definitions#DiagnosticReport.subject)** [0..1]: [Reference(Patient](/Reference(Patient), [Group](/Group), [Device](/Device), [Location](/Location), [Organization](/Organization), [Practitioner](/Practitioner), [Medication](/Medication), [Substance](/Substance), [BiologicallyDerivedProduct)](/BiologicallyDerivedProduct)) The subject of the report - usually, but not always, the patient - **[DiagnosticReport.relatesTo](/diagnosticreport-definitions#DiagnosticReport.relatesTo)** [0..*]: [RelatedArtifact](/RelatedArtifact) Related DiagnosticReports - **[DiagnosticReport.encounter](/diagnosticreport-definitions#DiagnosticReport.encounter)** [0..1]: Reference([Encounter](/Encounter)) Encounter associated with the DiagnosticReport - **[DiagnosticReport.effective[x]](/diagnosticreport-definitions#DiagnosticReport.effective%5Bx%5D)** [0..1]: [dateTime](/dateTime), [Period](/Period) Clinically relevant time/time-period for the results that are included in the report - **[DiagnosticReport.issued](/diagnosticreport-definitions#DiagnosticReport.issued)** [0..1]: [dateTime](/dateTime) DateTime this version was made - **[DiagnosticReport.procedure](/diagnosticreport-definitions#DiagnosticReport.procedure)** [0..*]: Reference([Procedure](/Procedure)) The performed procedure(s) from which the report was produced - **[DiagnosticReport.performer](/diagnosticreport-definitions#DiagnosticReport.performer)** [0..*]: [Reference(Practitioner](/Reference(Practitioner), [PractitionerRole](/PractitionerRole), [Organization](/Organization), [CareTeam](/CareTeam), [HealthcareService](/HealthcareService), [Device](/Device), [Patient](/Patient), [RelatedPerson)](/RelatedPerson)) Responsible Diagnostic Service - **[DiagnosticReport.resultsInterpreter](/diagnosticreport-definitions#DiagnosticReport.resultsInterpreter)** [0..*]: [Reference(Practitioner](/Reference(Practitioner), [PractitionerRole](/PractitionerRole), [Organization](/Organization), [CareTeam](/CareTeam), [Patient](/Patient), [RelatedPerson)](/RelatedPerson)) Who analyzed and reported the conclusions and interpretations - **[DiagnosticReport.specimen](/diagnosticreport-definitions#DiagnosticReport.specimen)** [0..*]: Reference([Specimen](/Specimen)) Specimens this report is based on - **[DiagnosticReport.result](/diagnosticreport-definitions#DiagnosticReport.result)** [0..*]: Reference([Observation](/Observation)) Observations - **[DiagnosticReport.note](/diagnosticreport-definitions#DiagnosticReport.note)** [0..*]: [Annotation](/Annotation) Comments about the diagnostic report - **[DiagnosticReport.study](/diagnosticreport-definitions#DiagnosticReport.study)** [0..*]: Reference([ImagingStudy](/ImagingStudy)) Reference to full details of an analysis associated with the diagnostic report - **[DiagnosticReport.supportingInfo](/diagnosticreport-definitions#DiagnosticReport.supportingInfo)** [0..*]: [BackboneElement](/BackboneElement) Additional information supporting the diagnostic report - **[DiagnosticReport.supportingInfo.type](/diagnosticreport-definitions#DiagnosticReport.supportingInfo.type)** [1..1]: [CodeableConcept](/CodeableConcept) example:[diagnosticreport-relevant-information-types](/valueset-diagnosticreport-relevant-information-types) Supporting information role code - **[DiagnosticReport.supportingInfo.reference](/diagnosticreport-definitions#DiagnosticReport.supportingInfo.reference)** [1..1]: [Reference(ImagingStudy](/Reference(ImagingStudy), [Procedure](/Procedure), [Observation](/Observation), [DiagnosticReport](/DiagnosticReport), [FamilyMemberHistory](/FamilyMemberHistory), [AllergyIntolerance](/AllergyIntolerance), [Condition](/Condition), [DocumentReference)](/DocumentReference)) Supporting information reference - **[DiagnosticReport.media](/diagnosticreport-definitions#DiagnosticReport.media)** [0..*]: [BackboneElement](/BackboneElement) Key images or data associated with this report - **[DiagnosticReport.media.comment](/diagnosticreport-definitions#DiagnosticReport.media.comment)** [0..1]: [string](/string) Comment about the image or data (e.g. explanation) - **[DiagnosticReport.media.link](/diagnosticreport-definitions#DiagnosticReport.media.link)** [1..1]: Reference([DocumentReference](/DocumentReference)) Reference to the image or data source - **[DiagnosticReport.composition](/diagnosticreport-definitions#DiagnosticReport.composition)** [0..1]: Reference([Composition](/Composition)) Reference to a Composition resource for the DiagnosticReport structure - **[DiagnosticReport.conclusion](/diagnosticreport-definitions#DiagnosticReport.conclusion)** [0..1]: [markdown](/markdown) Clinical conclusion (interpretation) of test results - **[DiagnosticReport.conclusionCode](/diagnosticreport-definitions#DiagnosticReport.conclusionCode)** [0..*]: [CodeableReference](/CodeableReference) example:[clinical-findings](/valueset-clinical-findings) Codes and/or references for the clinical conclusion of test results - **[DiagnosticReport.recomendation](/diagnosticreport-definitions#DiagnosticReport.recomendation)** [0..*]: [CodeableReference](/CodeableReference) Recommendations based on findings and interpretations - **[DiagnosticReport.presentedForm](/diagnosticreport-definitions#DiagnosticReport.presentedForm)** [0..*]: [Attachment](/Attachment) Entire report as issued - **[DiagnosticReport.communication](/diagnosticreport-definitions#DiagnosticReport.communication)** [0..*]: Reference([Communication](/Communication)) Communication initiated during the reporting process - **[DiagnosticReport.comparison](/diagnosticreport-definitions#DiagnosticReport.comparison)** [0..1]: Reference([List](/List)) Prior data and findings for comparison ## Mappings - [DiagnosticReport Mappings](/diagnosticreport-mappings) — 63 mapping entries ## Resource Packs ### list-DiagnosticReport-packs.xml ```xml ``` ## Search Parameters - [based-on](/diagnosticreport-search#based-on) — **reference** — Reference to the service request. — `DiagnosticReport.basedOn` - [category](/diagnosticreport-search#category) — **token** — Which diagnostic discipline/department created the report — `DiagnosticReport.category` - [code](/diagnosticreport-search#code) — **token** — The code for the report, as opposed to codes for the atomic results, which are the names on the observation resource referred to from the result — `DiagnosticReport.code` - [conclusioncode-code](/diagnosticreport-search#conclusioncode-code) — **token** — A coded conclusion (interpretation/impression) on the report — `DiagnosticReport.conclusionCode.concept` - [conclusioncode-reference](/diagnosticreport-search#conclusioncode-reference) — **reference** — A reference for the conclusion (interpretation/impression) on the report — `DiagnosticReport.conclusionCode.reference` - [date](/diagnosticreport-search#date) — **date** — The clinically relevant time of the report — `DiagnosticReport.effective.ofType(dateTime) | DiagnosticReport.effective.ofType(Period)` - [encounter](/diagnosticreport-search#encounter) — **reference** — The Encounter when the order was made — `DiagnosticReport.encounter` - [identifier](/diagnosticreport-search#identifier) — **token** — An identifier for the report — `DiagnosticReport.identifier` - [issued](/diagnosticreport-search#issued) — **date** — When the report was issued — `DiagnosticReport.issued` - [media](/diagnosticreport-search#media) — **reference** — A reference to the image source. — `DiagnosticReport.media.link` - [patient](/diagnosticreport-search#patient) — **reference** — The subject of the report if a patient — `DiagnosticReport.subject.where(resolve() is Patient)` - [performer](/diagnosticreport-search#performer) — **reference** — Who is responsible for the report — `DiagnosticReport.performer` - [result](/diagnosticreport-search#result) — **reference** — Link to an atomic result (observation resource) — `DiagnosticReport.result` - [results-interpreter](/diagnosticreport-search#results-interpreter) — **reference** — Who was the source of the report — `DiagnosticReport.resultsInterpreter` - [specimen](/diagnosticreport-search#specimen) — **reference** — The specimen details — `DiagnosticReport.specimen` - [status](/diagnosticreport-search#status) — **token** — The status of the report — `DiagnosticReport.status` - [study](/diagnosticreport-search#study) — **reference** — Studies associated with the diagnostic report — `DiagnosticReport.study` - [subject](/diagnosticreport-search#subject) — **reference** — The subject of the report — `DiagnosticReport.subject` - [procedure](/diagnosticreport-search#procedure) — **reference** — The procedure(s) from which the report was produced. — `DiagnosticReport.procedure` [Full Search Parameters](/diagnosticreport-search) ## Examples - [101](/diagnosticreport-example-101) — diagnosticreport-example — General Laboratory Report Example - [102](/diagnosticreport-example-102) — diagnosticreport-example-dxa — Imaging Example (Bone Density DXA) - [72ac8493-52ac-41bd-8d5d-7258c289b5ea](/diagnosticreport-example-72ac8493-52ac-41bd-8d5d-7258c289b5ea) — diagnosticreport-examples-general — Various reports gathered from v2 messages - [diagnosticreport-example](/diagnosticreport-example-diagnosticreport-example) — diagnosticreport-example - [diagnosticreport-example-cultures](/diagnosticreport-example-diagnosticreport-example-cultures) — diagnosticreport-example-cultures - [diagnosticreport-example-dxa](/diagnosticreport-example-diagnosticreport-example-dxa) — diagnosticreport-example-dxa - [diagnosticreport-example-f001-bloodexam](/diagnosticreport-example-diagnosticreport-example-f001-bloodexam) — diagnosticreport-example-f001-bloodexam - [diagnosticreport-example-f201-brainct](/diagnosticreport-example-diagnosticreport-example-f201-brainct) — diagnosticreport-example-f201-brainct - [diagnosticreport-example-f202-bloodculture](/diagnosticreport-example-diagnosticreport-example-f202-bloodculture) — diagnosticreport-example-f202-bloodculture - [diagnosticreport-example-ghp](/diagnosticreport-example-diagnosticreport-example-ghp) — diagnosticreport-example-ghp - [diagnosticreport-example-gingival-biopsy](/diagnosticreport-example-diagnosticreport-example-gingival-biopsy) — diagnosticreport-example-gingival-biopsy - [diagnosticreport-example-gingival-mass](/diagnosticreport-example-diagnosticreport-example-gingival-mass) — diagnosticreport-example-gingival-mass - [diagnosticreport-example-lipid-panel](/diagnosticreport-example-diagnosticreport-example-lipid-panel) — diagnosticreport-example-lipid-panel - [diagnosticreport-example-lipid-profile](/diagnosticreport-example-diagnosticreport-example-lipid-profile) — diagnosticreport-example-lipid-profile - [diagnosticreport-example-papsmear](/diagnosticreport-example-diagnosticreport-example-papsmear) — diagnosticreport-example-papsmear - [diagnosticreport-example-ultrasound](/diagnosticreport-example-diagnosticreport-example-ultrasound) — diagnosticreport-example-ultrasound - [diagnosticreport-examples-general](/diagnosticreport-example-diagnosticreport-examples-general) — diagnosticreport-examples-general - [diagnosticreport-examples-header](/diagnosticreport-example-diagnosticreport-examples-header) — diagnosticreport-examples-header - [diagnosticreport-examples-lab-text](/diagnosticreport-example-diagnosticreport-examples-lab-text) — diagnosticreport-examples-lab-text - [f001](/diagnosticreport-example-f001) — diagnosticreport-example-f001-bloodexam — Real-world patient example - [f201](/diagnosticreport-example-f201) — diagnosticreport-example-f201-brainct — Real-world patient example - [f202](/diagnosticreport-example-f202) — diagnosticreport-example-f202-bloodculture — Real-world patient example - [ghp](/diagnosticreport-example-ghp) — diagnosticreport-example-ghp — An Example of a report with multiple specimen and panels - [gingival-biopsy](/diagnosticreport-example-gingival-biopsy) — diagnosticreport-example-gingival-biopsy — An example showing use of supportingInfo - [gingival-mass](/diagnosticreport-example-gingival-mass) — diagnosticreport-example-gingival-mass — An example of a presented form anatomic pathology report - [lipid-panel-example](/diagnosticreport-example-lipid-panel-example) — diagnosticreport-example-lipid-panel — An example showing use of a panel - [lri-example](/diagnosticreport-example-lri-example) — bundle-lri-example — An collection Bundle showing an example of a complex Micro Isolate and Sensitivities - [micro](/diagnosticreport-example-micro) — diagnosticreport-micro1 — An example of a complex Micro Isolate and Sensitivities. - [pap](/diagnosticreport-example-pap) — diagnosticreport-example-papsmear — An example of a principally narrative anatomic pathology report - [ultrasound](/diagnosticreport-example-ultrasound) — diagnosticreport-example-ultrasound — Abdominal Ultrasound example [Full Examples](/diagnosticreport-examples) ## Mapping Exceptions ### diagnosticreport-event-mapping-exceptions.xml ### Divergent Elements - **Event.identifier** → **DiagnosticReport.identifier** - shortUnmatched | reason=Unknown | pattern=Business identifier for diagnostic report | resource=Business identifier for report - definitionUnmatched | reason=Unknown | pattern=Business identifiers assigned to this diagnostic report by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server. | resource=Identifiers assigned to this report by the performer or other systems. - commentsUnmatched | reason=Unknown | pattern=Note: This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. | resource=Usually assigned by the Information System of the diagnostic service provider (filler id). - requirementsUnmatched | reason=Unknown | pattern=Allows identification of the diagnostic report as it is known by various participating systems and in a way that remains consistent across servers. | resource=Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context. - **Event.basedOn** → **DiagnosticReport.basedOn** - missingTypes | reason=Unknown | pattern=Reference(Request) - extraTypes | reason=Unknown - summary | reason=Unknown | pattern=true - shortUnmatched | reason=Unknown | pattern=Fulfills plan, proposal or order | resource=What was requested - definitionUnmatched | reason=Unknown | pattern=A plan, proposal or order that is fulfilled in whole or in part by this diagnostic report. | resource=Details concerning a service requested. - requirementsUnmatched | reason=Unknown | pattern=Allows tracing of authorization for the diagnostic report and tracking whether proposals/recommendations were acted upon. | resource=This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon. - **Event.status** → **DiagnosticReport.status** - shortUnmatched | reason=Unknown | pattern=preparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown | resource=registered | partial | preliminary | modified | final | amended | corrected | appended | cancelled | entered-in-error | unknown - definitionUnmatched | reason=Unknown | pattern=The current state of the diagnostic report. | resource=The status of the diagnostic report. - commentsUnmatched | reason=Unknown | pattern=A nominal state-transition diagram can be found in the (Event pattern documentation Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is. - **Event.category** → **DiagnosticReport.category** - shortUnmatched | reason=Unknown | pattern=High level categorization of diagnostic report | resource=Service category - definitionUnmatched | reason=Unknown | pattern=Partitions the diagnostic report into one or more categories that can be used to filter searching, to govern access control and/or to guide system behavior. | resource=A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes. - commentsUnmatched | reason=Unknown | pattern=Categorization might be done automatically (inferred by code) or manually by user assertion. The absence of a category may limit the ability to determine when the element should be handled, so strong consideration should be given to how systems will be able to determine category values for legacy data and how data that cannot be categorized will be handled. As well, some categories might not be mutually exclusive, so systems should prepare for multiple declared categories - even within a single category 'axis'. In general, there should not be a 'strong' binding ('required' or 'extensible') on the category element overall. Instead, the element can be sliced and bindings can be asserted that apply to particular repetitions. | resource=Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code. - **Event.code** → **DiagnosticReport.code** - shortUnmatched | reason=Unknown | pattern=What service was done | resource=Name/Code for this diagnostic report - definitionUnmatched | reason=Unknown | pattern=A code that identifies the specific service or action that was or is being performed. | resource=A code or name that describes this diagnostic report. - **Event.subject** → **DiagnosticReport.subject** - extraTypes | reason=Unknown - shortUnmatched | reason=Unknown | pattern=Individual service was done for/to | resource=The subject of the report - usually, but not always, the patient - definitionUnmatched | reason=Unknown | pattern=The individual or set of individuals the action is being or was performed on. | resource=The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources. - requirementsUnmatched | reason=Unknown | pattern=Links the diagnostic report to the Patient context. May also affect access control. | resource=SHALL know the subject context. - **Event.encounter** → **DiagnosticReport.encounter** - shortUnmatched | reason=Unknown | pattern=Encounter the diagnostic report is part of | resource=Encounter associated with the DiagnosticReport - definitionUnmatched | reason=Unknown | pattern=The Encounter during which this diagnostic report was created or to which the creation of this record is tightly associated. | resource=The encounter (e.g. a patient and healthcare provider interaction) that is associated with the DiagnosticReport. - commentsUnmatched | reason=Unknown | pattern=This will typically be the encounter the diagnostic report was created during, but some diagnostic reports may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests). | resource=This will typically be the encounter, when it exists, during which the data or specimens (e.g. imaging, blood draw, or assessment procedure) that are being reported by the DiagnosticReport were obtained/acquired. When a DiagnosticReport is based on a ServiceRequest (order), the ServiceRequest.encounter referenced in DiagnosticReport.basedOn may be used to associate the two. - requirementsUnmatched | reason=Unknown | pattern=Links the diagnostic report to the Encounter context. May also affect access control. | resource=Links the report to the Encounter context. - **Event.occurrence[x]** → **DiagnosticReport.effective[x]** - missingTypes | reason=Unknown | pattern=Timing - shortUnmatched | reason=Unknown | pattern=When diagnostic report occurred/is occurring | resource=Clinically relevant time/time-period for the results that are included in the report - definitionUnmatched | reason=Unknown | pattern=The date, period or timing when the diagnostic report did occur or is occurring. | resource=The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself. - commentsUnmatched | reason=Unknown | pattern=This indicates when the activity actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this {{event}} is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. . | resource=If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic. - **Event.performer.actor** → **DiagnosticReport.performer** - extraTypes | reason=Unknown - shortUnmatched | reason=Unknown | pattern=Who performed diagnostic report | resource=Responsible Diagnostic Service - definitionUnmatched | reason=Unknown | pattern=Indicates who or what performed the diagnostic report. | resource=The diagnostic service that is responsible for issuing the report. - **Event.performer.actor** → **DiagnosticReport.resultsInterpreter** - missingTypes | reason=Unknown | pattern=Reference(Device) - shortUnmatched | reason=Unknown | pattern=Who performed diagnostic report | resource=Who analyzed and reported the conclusions and interpretations - definitionUnmatched | reason=Unknown | pattern=Indicates who or what performed the diagnostic report. | resource=The practitioner or organization that is responsible for the report's conclusions and interpretations. - **Event.note** → **DiagnosticReport.note** - shortUnmatched | reason=Unknown | pattern=Comments made about the event | resource=Comments about the diagnostic report - definitionUnmatched | reason=Unknown | pattern=Comments made about the diagnostic report by the performer, subject or other participants. | resource=Comments about the diagnostic report. ### Unmapped Elements - **Event.reported** — Unknown - **Event.reason** — Unknown - **Event.relevantHistory** — Unknown - **Event.performer.function** — Unknown - **Event.recorded** — Unknown - **Event.product** — Unknown - **Event.performer** — Unknown ### diagnosticreport-fivews-mapping-exceptions.xml ### Unmapped Elements - **FiveWs.author** — Unknown - **FiveWs.cause** — Unknown - **FiveWs.version** — Unknown - **FiveWs.witness** — Unknown - **FiveWs.where** — Unknown - **FiveWs.init** — Unknown - **FiveWs.why** — Unknown - **FiveWs.source** — Unknown - **FiveWs.who** — Unknown - **FiveWs.grade** — Unknown - **FiveWs.planned** — Unknown