HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE), v0.9.1

HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE), v0.9.1 FHIR Profiles - Local Development build (v0.9.1). See the Directory of published versions

GenomicsReport

{
  "resourceType" : "StructureDefinition",
  "id" : "onco-core-GenomicsReport",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n  <p><b>GenomicsReport Profile</b></p>\n  <p>Genetic analysis summary report. The report may include one or more tests, with two distinct test types. The first type is a targeted mutation test, where a specific mutation on a specific gene is tested for. The result is either positive or negative for that mutation. The second type is a more general test for variants. This type of test returns the identity of variants found in a certain region of the genome.\n\nThe identity of non-genomic laboratory tests is typically represented by a LOINC code. However, many genetic tests and panels do not have LOINC codes, although some might have an identifier in NCBI Genetic Testing Registry (GTR), a central location for voluntary submission of genetic test information by providers. To identify the diagnostic report, the name of the report must be in the text sub-field of the code structure. If there is a coded identifier from GTR, LOINC, or other source, then it should be included into the the code sub-field of the code structure. If there is no suitable code, the code can be omitted.\n\nConformance note: To be conformant to US Core, the code attribute must be a LOINC code, if available. If there is no suitable code in LOINC, then a code from an alternative code system (such as GTR) can be used.\n\nImplementation note: The performer of the test (organization or practitioner) should be included in the FHIR profile as the performer.actor.\n\nConformance note: The category for this profile is set to GE (Genetics), a code from http://hl7.org/fhir/ValueSet/diagnostic-service-sections. This is contrary to the [Argonaut](http://www.fhir.org/guides/argonaut/r2/) and [US Core](http://hl7.org/fhir/us/core/STU3/index.html) specifications, which require the category 'LAB' in diagnostic reports containing laboratory results. This is assumed to be an oversight in the US Core and Argonaut specifications.</p>\n  <p><b>Mapping Summary</b></p>\n  <p><pre>onco.core.GenomicsReport maps to DiagnosticReport:\n  Language maps to language\n  ImplicitRules maps to implicitRules\n  Metadata.VersionId maps to meta.versionId\n  Metadata.SourceSystem maps to meta.extension\n  Metadata.Profile maps to meta.profile\n  Metadata.LastUpdated maps to meta.lastUpdated\n  Metadata.SecurityLabel maps to meta.security\n  Metadata.Tag maps to meta.tag\n  Narrative maps to text\n  Identifier maps to identifier\n  Status maps to status\n  Code maps to code\n  Category maps to category\n  ObservationSubjectOfRecord maps to subject\n  CareContext maps to encounter\n  RelevantTime maps to effective[x]\n  StatementDateTime maps to issued\n  DiagnosticReportPerformer maps to performer\n  ResultsInterpreter maps to extension\n  Specimen maps to specimen\n  Observation maps to result (slice on = target.reference.resolve(); slice on type = profile; slice strategy = includes)\n  MediaIncluded.CommentOrDescription maps to image.comment\n  MediaIncluded.Media maps to image.link\n  ConclusionText maps to conclusion\n  ConclusionCode maps to codedDiagnosis\n  PresentedForm maps to presentedForm\n</pre></p>\n</div>"
  },
  "url" : "http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-GenomicsReport",
  "version" : "0.9.1",
  "name" : "GenomicsReport",
  "display" : "onco-core-GenomicsReport",
  "status" : "draft",
  "publisher" : "The MITRE Corporation",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "other",
          "value" : "http://standardhealthrecord.org",
          "rank" : 0
        }
      ]
    }
  ],
  "date" : "2019-10-23T00:00:00-04:00",
  "description" : "Genetic analysis summary report. The report may include one or more tests, with two distinct test types. The first type is a targeted mutation test, where a specific mutation on a specific gene is tested for. The result is either positive or negative for that mutation. The second type is a more general test for variants. This type of test returns the identity of variants found in a certain region of the genome.\n\nThe identity of non-genomic laboratory tests is typically represented by a LOINC code. However, many genetic tests and panels do not have LOINC codes, although some might have an identifier in NCBI Genetic Testing Registry (GTR), a central location for voluntary submission of genetic test information by providers. To identify the diagnostic report, the name of the report must be in the text sub-field of the code structure. If there is a coded identifier from GTR, LOINC, or other source, then it should be included into the the code sub-field of the code structure. If there is no suitable code, the code can be omitted.\n\nConformance note: To be conformant to US Core, the code attribute must be a LOINC code, if available. If there is no suitable code in LOINC, then a code from an alternative code system (such as GTR) can be used.\n\nImplementation note: The performer of the test (organization or practitioner) should be included in the FHIR profile as the performer.actor.\n\nConformance note: The category for this profile is set to GE (Genetics), a code from http://hl7.org/fhir/ValueSet/diagnostic-service-sections. This is contrary to the [Argonaut](http://www.fhir.org/guides/argonaut/r2/) and [US Core](http://hl7.org/fhir/us/core/STU3/index.html) specifications, which require the category 'LAB' in diagnostic reports containing laboratory results. This is assumed to be an oversight in the US Core and Argonaut specifications.",
  "requirements" : "To support reporting for any diagnostic report into a clinical data repository.",
  "fhirVersion" : "1.0.2",
  "mapping" : [
    {
      "identity" : "v2",
      "uri" : "http://hl7.org/v2",
      "name" : "HL7 v2"
    },
    {
      "identity" : "rim",
      "uri" : "http://hl7.org/v3",
      "name" : "RIM"
    },
    {
      "identity" : "w5",
      "uri" : "http://hl7.org/fhir/w5",
      "name" : "W5 Mapping"
    }
  ],
  "kind" : "resource",
  "constrainedType" : "DiagnosticReport",
  "abstract" : false,
  "base" : "http://hl7.org/fhir/StructureDefinition/DiagnosticReport",
  "snapshot" : {
    "element" : [
      {
        "id" : "DiagnosticReport",
        "path" : "DiagnosticReport",
        "name" : "DiagnosticReport",
        "short" : "onco-core-GenomicsReport",
        "definition" : "Genetic analysis summary report. The report may include one or more tests, with two distinct test types. The first type is a targeted mutation test, where a specific mutation on a specific gene is tested for. The result is either positive or negative for that mutation. The second type is a more general test for variants. This type of test returns the identity of variants found in a certain region of the genome.\n\nThe identity of non-genomic laboratory tests is typically represented by a LOINC code. However, many genetic tests and panels do not have LOINC codes, although some might have an identifier in NCBI Genetic Testing Registry (GTR), a central location for voluntary submission of genetic test information by providers. To identify the diagnostic report, the name of the report must be in the text sub-field of the code structure. If there is a coded identifier from GTR, LOINC, or other source, then it should be included into the the code sub-field of the code structure. If there is no suitable code, the code can be omitted.\n\nConformance note: To be conformant to US Core, the code attribute must be a LOINC code, if available. If there is no suitable code in LOINC, then a code from an alternative code system (such as GTR) can be used.\n\nImplementation note: The performer of the test (organization or practitioner) should be included in the FHIR profile as the performer.actor.\n\nConformance note: The category for this profile is set to GE (Genetics), a code from http://hl7.org/fhir/ValueSet/diagnostic-service-sections. This is contrary to the [Argonaut](http://www.fhir.org/guides/argonaut/r2/) and [US Core](http://hl7.org/fhir/us/core/STU3/index.html) specifications, which require the category 'LAB' in diagnostic reports containing laboratory results. This is assumed to be an oversight in the US Core and Argonaut specifications.",
        "comments" : "This is intended to capture a single report, and is not suitable for use in displaying summary information that covers multiple reports.  For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.",
        "alias" : [
          "Report",
          "Test",
          "Result",
          "Results",
          "Labs",
          "Laboratory"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "DiagnosticReport"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "ORU -> OBR"
          },
          {
            "identity" : "rim",
            "map" : "Observation[classCode=OBS, moodCode=EVN]"
          },
          {
            "identity" : "w5",
            "map" : "clinical.diagnostics"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.id",
        "path" : "DiagnosticReport.id",
        "name" : "DiagnosticReport.id",
        "short" : "Logical id of this artifact",
        "definition" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
        "comments" : "The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "id"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true
      },
      {
        "id" : "DiagnosticReport.meta",
        "path" : "DiagnosticReport.meta",
        "name" : "DiagnosticReport.meta",
        "short" : "Metadata about the resource",
        "definition" : "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Meta"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true
      },
      {
        "id" : "DiagnosticReport.meta.id",
        "path" : "DiagnosticReport.meta.id",
        "representation" : [
          "xmlAttr"
        ],
        "name" : "DiagnosticReport.meta.id",
        "short" : "xml:id (or equivalent in JSON)",
        "definition" : "unique id for the element within a resource (for internal references).",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "id"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "n/a"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.meta.extension",
        "path" : "DiagnosticReport.meta.extension",
        "name" : "DiagnosticReport.meta.extension",
        "slicing" : {
          "id" : "2",
          "discriminator" : [
            "url"
          ],
          "ordered" : false,
          "rules" : "open"
        },
        "short" : "Additional Content defined by implementations",
        "definition" : "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
        "comments" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias" : [
          "extensions",
          "user content"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Extension"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "n/a"
          }
        ]
      },
      {
        "id" : "sourcesystem",
        "path" : "DiagnosticReport.meta.extension",
        "name" : "sourcesystem",
        "definition" : "FHIR: This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.\nFHIM: Identifies the computer system that created the medical record. This optional field may also be used to indicate that the medical record was originally created by a different organization from the one that is currently storing or utilizing the record in that the assigning authority of the Id could be set to that originating organization. This property is optional, as some systems will assume that all records that it contains originated in that system, however it is anticipated that it will become increasingly commonplace for records from multiple systems and organizations will be comingled in order to provide a complete picture of the patient's health record.",
        "min" : 0,
        "max" : "1",
        "base" : {
          "path" : "DiagnosticReport.meta.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-SourceSystem-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.meta.versionId",
        "path" : "DiagnosticReport.meta.versionId",
        "name" : "DiagnosticReport.meta.versionId",
        "short" : "Version specific identifier",
        "definition" : "The version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted.",
        "comments" : "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "id"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true
      },
      {
        "id" : "DiagnosticReport.meta.lastUpdated",
        "path" : "DiagnosticReport.meta.lastUpdated",
        "name" : "DiagnosticReport.meta.lastUpdated",
        "short" : "When the resource version last changed",
        "definition" : "When the resource last changed - e.g. when the version changed.",
        "comments" : "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "instant"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true
      },
      {
        "id" : "DiagnosticReport.meta.profile",
        "path" : "DiagnosticReport.meta.profile",
        "name" : "DiagnosticReport.meta.profile",
        "short" : "Profiles this resource claims to conform to",
        "definition" : "A list of profiles [[[StructureDefinition]]]s that this resource claims to conform to. The URL is a reference to [[[StructureDefinition.url]]].",
        "comments" : "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time.  The list of profile URLs is a set.",
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "uri"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true
      },
      {
        "id" : "DiagnosticReport.meta.security",
        "path" : "DiagnosticReport.meta.security",
        "name" : "DiagnosticReport.meta.security",
        "short" : "Security Labels applied to this resource",
        "definition" : "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.",
        "comments" : "The security labels can be updated without changing the stated version of the resource  The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.",
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Coding"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true,
        "binding" : {
          "strength" : "extensible",
          "description" : "Security Labels from the Healthcare Privacy and Security Classification System.",
          "valueSetReference" : {
            "reference" : "http://hl7.org/fhir/ValueSet/security-labels"
          }
        }
      },
      {
        "id" : "DiagnosticReport.meta.tag",
        "path" : "DiagnosticReport.meta.tag",
        "name" : "DiagnosticReport.meta.tag",
        "short" : "Tags applied to this resource",
        "definition" : "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.",
        "comments" : "The tags can be updated without changing the stated version of the resource.  The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.",
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Coding"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true,
        "binding" : {
          "strength" : "example",
          "description" : "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\""
        }
      },
      {
        "id" : "DiagnosticReport.implicitRules",
        "path" : "DiagnosticReport.implicitRules",
        "name" : "DiagnosticReport.implicitRules",
        "short" : "A set of rules under which this content was created",
        "definition" : "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.",
        "comments" : "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "uri"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : true,
        "isSummary" : true
      },
      {
        "id" : "DiagnosticReport.language",
        "path" : "DiagnosticReport.language",
        "name" : "DiagnosticReport.language",
        "short" : "Language of the resource content",
        "definition" : "The base language in which the resource is written.",
        "comments" : "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource  Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "code"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "binding" : {
          "strength" : "required",
          "description" : "A human language.",
          "valueSetReference" : {
            "reference" : "http://tools.ietf.org/html/bcp47"
          }
        }
      },
      {
        "id" : "DiagnosticReport.text",
        "path" : "DiagnosticReport.text",
        "name" : "DiagnosticReport.text",
        "short" : "Text summary of the resource, for human interpretation",
        "definition" : "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
        "comments" : "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.",
        "alias" : [
          "narrative",
          "html",
          "xhtml",
          "display"
        ],
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Narrative"
          }
        ],
        "maxLength" : 0,
        "condition" : [
          "dom-1"
        ],
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "Act.text?"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.contained",
        "path" : "DiagnosticReport.contained",
        "name" : "DiagnosticReport.contained",
        "short" : "Contained, inline Resources",
        "definition" : "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
        "comments" : "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.",
        "alias" : [
          "inline resources",
          "anonymous resources",
          "contained resources"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Resource"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "N/A"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.extension",
        "path" : "DiagnosticReport.extension",
        "name" : "DiagnosticReport.extension",
        "slicing" : {
          "id" : "1",
          "discriminator" : [
            "url"
          ],
          "ordered" : false,
          "rules" : "open"
        },
        "short" : "Additional Content defined by implementations",
        "definition" : "May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
        "comments" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias" : [
          "extensions",
          "user content"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Extension"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "N/A"
          }
        ]
      },
      {
        "id" : "resultsinterpreter",
        "path" : "DiagnosticReport.extension",
        "name" : "resultsinterpreter",
        "definition" : "The practitioner or organization that is responsible for the report's conclusions and interpretations.",
        "min" : 0,
        "max" : "1",
        "base" : {
          "path" : "DiagnosticReport.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-ResultsInterpreter-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "basedon",
        "path" : "DiagnosticReport.extension",
        "name" : "basedon",
        "definition" : "The proposal, order, or plan that is partly or wholly fulfilled by this item.",
        "min" : 0,
        "max" : "*",
        "base" : {
          "path" : "DiagnosticReport.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-BasedOn-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "specimentype",
        "path" : "DiagnosticReport.extension",
        "name" : "specimentype",
        "definition" : "The type of material the specimen contains or consists of.",
        "min" : 0,
        "max" : "1",
        "base" : {
          "path" : "DiagnosticReport.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-SpecimenType-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.extension-specimentype.id",
        "path" : "DiagnosticReport.extension.id",
        "representation" : [
          "xmlAttr"
        ],
        "name" : "DiagnosticReport.extension-specimentype.id",
        "short" : "xml:id (or equivalent in JSON)",
        "definition" : "unique id for the element within a resource (for internal references).",
        "min" : 0,
        "max" : "1",
        "base" : {
          "path" : "Element.id",
          "min" : 0,
          "max" : "1"
        },
        "type" : [
          {
            "code" : "id"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "n/a"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.extension-specimentype.extension",
        "path" : "DiagnosticReport.extension.extension",
        "name" : "DiagnosticReport.extension-specimentype.extension",
        "short" : "Additional Content defined by implementations",
        "definition" : "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
        "comments" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias" : [
          "extensions",
          "user content"
        ],
        "min" : 0,
        "max" : "0",
        "base" : {
          "path" : "Element.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "n/a"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.extension-specimentype.url",
        "path" : "DiagnosticReport.extension.url",
        "representation" : [
          "xmlAttr"
        ],
        "name" : "DiagnosticReport.extension-specimentype.url",
        "short" : "identifies the meaning of the extension",
        "definition" : "Source of the definition for the extension code - a logical name or a URL.",
        "comments" : "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition should be version specific.  This will ideally be the URI for the Resource Profile defining the extension, with the code for the extension after a #.",
        "min" : 1,
        "max" : "1",
        "base" : {
          "path" : "Extension.url",
          "min" : 1,
          "max" : "1"
        },
        "type" : [
          {
            "code" : "uri"
          }
        ],
        "fixedUri" : "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-SpecimenType-extension",
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "N/A"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.extension-specimentype.valueCodeableConcept",
        "path" : "DiagnosticReport.extension.valueCodeableConcept",
        "name" : "DiagnosticReport.extension-specimentype.valueCodeableConcept",
        "short" : "Value of extension",
        "definition" : "Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).",
        "min" : 1,
        "max" : "1",
        "base" : {
          "path" : "Extension.value[x]",
          "min" : 0,
          "max" : "1"
        },
        "type" : [
          {
            "code" : "CodeableConcept"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "binding" : {
          "strength" : "extensible",
          "valueSetReference" : {
            "reference" : "http://mcodeinitiative.org/us/mcode/ValueSet/onco-core-GeneticSpecimenTypeVS"
          }
        },
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "N/A"
          }
        ]
      },
      {
        "id" : "regionstudied",
        "path" : "DiagnosticReport.extension",
        "name" : "regionstudied",
        "definition" : "A description of the coverage of the genome that was tested for variants.",
        "min" : 0,
        "max" : "*",
        "base" : {
          "path" : "DiagnosticReport.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-RegionStudied-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.modifierExtension",
        "path" : "DiagnosticReport.modifierExtension",
        "name" : "DiagnosticReport.modifierExtension",
        "short" : "Extensions that cannot be ignored",
        "definition" : "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
        "comments" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias" : [
          "extensions",
          "user content"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Extension"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : true,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "N/A"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.identifier",
        "path" : "DiagnosticReport.identifier",
        "name" : "DiagnosticReport.identifier",
        "short" : "Id for external references to this report",
        "definition" : "The local ID assigned to the report by the order filler, usually by the Information System of the diagnostic service provider.",
        "requirements" : "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.",
        "alias" : [
          "ReportID"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Identifier"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBR-51"
          },
          {
            "identity" : "rim",
            "map" : "id"
          },
          {
            "identity" : "w5",
            "map" : "id"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.status",
        "path" : "DiagnosticReport.status",
        "name" : "DiagnosticReport.status",
        "short" : "registered | partial | final | corrected | appended | cancelled | entered-in-error",
        "definition" : "The status of the diagnostic report as a whole.",
        "comments" : "This is labeled as \"Is Modifier\" because applications need to take appropriate action if a report is withdrawn.",
        "requirements" : "Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.",
        "min" : 1,
        "max" : "1",
        "type" : [
          {
            "code" : "code"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : true,
        "isSummary" : true,
        "binding" : {
          "strength" : "required",
          "description" : "The status of the diagnostic report as a whole.",
          "valueSetReference" : {
            "reference" : "http://hl7.org/fhir/ValueSet/diagnostic-report-status"
          }
        },
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBR-25 (not 1:1 mapping)"
          },
          {
            "identity" : "rim",
            "map" : "statusCode  Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type \"revise\""
          },
          {
            "identity" : "w5",
            "map" : "status"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.category",
        "path" : "DiagnosticReport.category",
        "name" : "DiagnosticReport.category",
        "short" : "Service category",
        "definition" : "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.",
        "comments" : "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.",
        "alias" : [
          "Department",
          "Sub-department",
          "service",
          "discipline"
        ],
        "min" : 1,
        "max" : "1",
        "base" : {
          "path" : "DiagnosticReport.category",
          "min" : 0,
          "max" : "1"
        },
        "type" : [
          {
            "code" : "CodeableConcept"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true,
        "binding" : {
          "strength" : "example",
          "description" : "Codes for diagnostic service sections.",
          "valueSetReference" : {
            "reference" : "http://hl7.org/fhir/ValueSet/diagnostic-service-sections"
          }
        },
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBR-24"
          },
          {
            "identity" : "rim",
            "map" : "inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code"
          },
          {
            "identity" : "w5",
            "map" : "class"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.code",
        "path" : "DiagnosticReport.code",
        "name" : "DiagnosticReport.code",
        "short" : "Name/Code for this diagnostic report",
        "definition" : "A code or name that describes this diagnostic report.",
        "min" : 1,
        "max" : "1",
        "type" : [
          {
            "code" : "CodeableConcept"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : true,
        "binding" : {
          "strength" : "extensible",
          "valueSetReference" : {
            "reference" : "http://mcodeinitiative.org/us/mcode/ValueSet/onco-core-GeneticTestVS"
          }
        },
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)"
          },
          {
            "identity" : "rim",
            "map" : "code"
          },
          {
            "identity" : "w5",
            "map" : "what"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.subject",
        "path" : "DiagnosticReport.subject",
        "name" : "DiagnosticReport.subject",
        "short" : "The subject of an observation",
        "definition" : "The subject of an observation.",
        "requirements" : "SHALL know the subject context.",
        "alias" : [
          "Patient"
        ],
        "min" : 1,
        "max" : "1",
        "base" : {
          "path" : "DiagnosticReport.subject",
          "min" : 1,
          "max" : "1"
        },
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Patient"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "PID-3 (no HL7 v2 mapping for Group or Device)"
          },
          {
            "identity" : "rim",
            "map" : "participation[typeCode=SBJ]"
          },
          {
            "identity" : "w5",
            "map" : "who.focus"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.encounter",
        "path" : "DiagnosticReport.encounter",
        "name" : "DiagnosticReport.encounter",
        "short" : "Health care event when test ordered",
        "definition" : "The link to the health care event (encounter) when the order was made.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://hl7.org/fhir/StructureDefinition/Encounter"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "PV1-19"
          },
          {
            "identity" : "rim",
            "map" : "inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"
          },
          {
            "identity" : "w5",
            "map" : "context"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.effectivex",
        "path" : "DiagnosticReport.effective[x]",
        "name" : "DiagnosticReport.effectivex",
        "short" : "Clinically Relevant time/time-period for report",
        "definition" : "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.",
        "comments" : "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.",
        "requirements" : "Need to know where in the patient history to file/present this report.",
        "alias" : [
          "Observation time",
          "Effective Time"
        ],
        "min" : 1,
        "max" : "1",
        "type" : [
          {
            "code" : "dateTime"
          },
          {
            "code" : "Period"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : true,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBR-7"
          },
          {
            "identity" : "rim",
            "map" : "effectiveTime"
          },
          {
            "identity" : "w5",
            "map" : "when.done"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.issued",
        "path" : "DiagnosticReport.issued",
        "name" : "DiagnosticReport.issued",
        "short" : "DateTime this version was released",
        "definition" : "The date and time that this version of the report was released from the source diagnostic service.",
        "comments" : "May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.",
        "requirements" : "Clinicians need to be able to check the date that the report was released.",
        "alias" : [
          "Date Created",
          "Date published",
          "Date Issued"
        ],
        "min" : 1,
        "max" : "1",
        "type" : [
          {
            "code" : "instant"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBR-22"
          },
          {
            "identity" : "rim",
            "map" : "participation[typeCode=VRF or AUT].time"
          },
          {
            "identity" : "w5",
            "map" : "when.recorded"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.performer",
        "path" : "DiagnosticReport.performer",
        "name" : "DiagnosticReport.performer",
        "short" : "Responsible Diagnostic Service",
        "definition" : "The diagnostic service that is responsible for issuing the report.",
        "comments" : "This is not necessarily the source of the atomic data items. It is the entity that takes responsibility for the clinical report.",
        "requirements" : "Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.",
        "alias" : [
          "Laboratory",
          "Service",
          "Practitioner",
          "Department",
          "Company"
        ],
        "min" : 1,
        "max" : "1",
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://hl7.org/fhir/StructureDefinition/Practitioner",
              "http://hl7.org/fhir/StructureDefinition/Organization"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : true,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "PRT-8 (where this PRT-4-Participation = \"PO\")"
          },
          {
            "identity" : "rim",
            "map" : "participation[typeCode=AUT].role[classCode=ASSIGN].scoper"
          },
          {
            "identity" : "w5",
            "map" : "who.witness"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.request",
        "path" : "DiagnosticReport.request",
        "name" : "DiagnosticReport.request",
        "short" : "What was requested",
        "definition" : "Details concerning a test or procedure requested.",
        "comments" : "Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.",
        "requirements" : "Need to be able to track completion of requests based on reports issued and also to report what diagnostic tests were requested (not always the same as what is delivered).",
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://hl7.org/fhir/StructureDefinition/DiagnosticOrder",
              "http://hl7.org/fhir/StructureDefinition/ProcedureRequest",
              "http://hl7.org/fhir/StructureDefinition/ReferralRequest"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "ORC? OBR-2/3?"
          },
          {
            "identity" : "rim",
            "map" : "outboundRelationship[typeCode=FLFS].target"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.specimen",
        "path" : "DiagnosticReport.specimen",
        "name" : "DiagnosticReport.specimen",
        "short" : "Specimens this report is based on",
        "definition" : "Details about the specimens on which this diagnostic report is based.",
        "comments" : "If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per Observation or group.",
        "requirements" : "Need to be able to report information about the collected specimens on which the report is based.",
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://hl7.org/fhir/StructureDefinition/Specimen"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "SPM"
          },
          {
            "identity" : "rim",
            "map" : "participation[typeCode=SBJ]"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.result",
        "path" : "DiagnosticReport.result",
        "name" : "DiagnosticReport.result",
        "slicing" : {
          "id" : "3",
          "discriminator" : [
            "target.reference/@profile"
          ],
          "ordered" : false,
          "rules" : "open"
        },
        "short" : "Observations - simple, or complex nested groups",
        "definition" : "Observations that are part of this diagnostic report. Observations can be simple name/value pairs (e.g. \"atomic\" results), or they can be grouping observations that include references to other members of the group (e.g. \"panels\").",
        "requirements" : "Need to support individual results, or report groups of results, where the result grouping is arbitrary, but meaningful. This structure is recursive - observations can contain observations.",
        "alias" : [
          "Data",
          "Atomic Value",
          "Result",
          "Atomic result",
          "Data",
          "Test",
          "Analyte",
          "Battery",
          "Organizer"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Observation"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBXs"
          },
          {
            "identity" : "rim",
            "map" : "outboundRelationship[typeCode=COMP].target"
          }
        ]
      },
      {
        "id" : "onco-core-GeneticVariantFound",
        "path" : "DiagnosticReport.result",
        "name" : "onco-core-GeneticVariantFound",
        "short" : "GeneticVariantFound: Records an alteration in the most common DNA nucleotide sequence",
        "definition" : "Records an alteration in the most common DNA nucleotide sequence. The term variant can be used to describe an alteration that may be benign, pathogenic, or of unknown significance. The term variant is increasingly being used in place of the term mutation. When reporting 'Genetic Variant Found', at least one element out of the following must be reported: 'Variant Found Identifier', 'Variant Found HGVS Name', and 'Variant Found Description'.",
        "alias" : [
          "Data",
          "Atomic Value",
          "Result",
          "Atomic result",
          "Data",
          "Test",
          "Analyte",
          "Battery",
          "Organizer"
        ],
        "min" : 0,
        "max" : "*",
        "base" : {
          "path" : "DiagnosticReport.result",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-GeneticVariantFound"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBXs"
          },
          {
            "identity" : "rim",
            "map" : "outboundRelationship[typeCode=COMP].target"
          }
        ]
      },
      {
        "id" : "onco-core-GeneticVariantTested",
        "path" : "DiagnosticReport.result",
        "name" : "onco-core-GeneticVariantTested",
        "short" : "GeneticVariantTested: A test for a specific mutation on a particular gene",
        "definition" : "A test for a specific mutation on a particular gene. This profile is used to record whether a single discrete variant tested is present or absent (denoted as positive or negative respectively).",
        "alias" : [
          "Data",
          "Atomic Value",
          "Result",
          "Atomic result",
          "Data",
          "Test",
          "Analyte",
          "Battery",
          "Organizer"
        ],
        "min" : 0,
        "max" : "*",
        "base" : {
          "path" : "DiagnosticReport.result",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-GeneticVariantTested"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBXs"
          },
          {
            "identity" : "rim",
            "map" : "outboundRelationship[typeCode=COMP].target"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.imagingStudy",
        "path" : "DiagnosticReport.imagingStudy",
        "name" : "DiagnosticReport.imagingStudy",
        "short" : "Reference to full details of imaging associated with the diagnostic report",
        "definition" : "One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.",
        "comments" : "ImagingStudy and ImageObjectStudy and the image element are somewhat overlapping - typically, the list of image references in the image 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.",
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://hl7.org/fhir/StructureDefinition/ImagingStudy",
              "http://hl7.org/fhir/StructureDefinition/ImagingObjectSelection"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.image",
        "path" : "DiagnosticReport.image",
        "name" : "DiagnosticReport.image",
        "short" : "Key images associated with this report",
        "definition" : "A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).",
        "requirements" : "Many diagnostic services include images in the report as part of their service.",
        "alias" : [
          "DICOM",
          "Slides",
          "Scans"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "BackboneElement"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBX?"
          },
          {
            "identity" : "rim",
            "map" : "outboundRelationship[typeCode=COMP].target"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.image.id",
        "path" : "DiagnosticReport.image.id",
        "representation" : [
          "xmlAttr"
        ],
        "name" : "DiagnosticReport.image.id",
        "short" : "xml:id (or equivalent in JSON)",
        "definition" : "unique id for the element within a resource (for internal references).",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "id"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "n/a"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.image.extension",
        "path" : "DiagnosticReport.image.extension",
        "name" : "DiagnosticReport.image.extension",
        "short" : "Additional Content defined by implementations",
        "definition" : "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
        "comments" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias" : [
          "extensions",
          "user content"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Extension"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "n/a"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.image.modifierExtension",
        "path" : "DiagnosticReport.image.modifierExtension",
        "name" : "DiagnosticReport.image.modifierExtension",
        "short" : "Extensions that cannot be ignored",
        "definition" : "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
        "comments" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias" : [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Extension"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : true,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : "N/A"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.image.comment",
        "path" : "DiagnosticReport.image.comment",
        "name" : "DiagnosticReport.image.comment",
        "short" : "Comment about the image (e.g. explanation)",
        "definition" : "A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.",
        "comments" : "The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.",
        "requirements" : "The provider of the report should make a comment about each image included in the report.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "string"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : ".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code=\"annotation\"].value"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.image.link",
        "path" : "DiagnosticReport.image.link",
        "name" : "DiagnosticReport.image.link",
        "short" : "Reference to the image source",
        "definition" : "Reference to the image source.",
        "min" : 1,
        "max" : "1",
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://hl7.org/fhir/StructureDefinition/Media"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : true,
        "mapping" : [
          {
            "identity" : "rim",
            "map" : ".value.reference"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.conclusion",
        "path" : "DiagnosticReport.conclusion",
        "name" : "DiagnosticReport.conclusion",
        "short" : "Clinical Interpretation of test results",
        "definition" : "Concise and clinically contextualized narrative interpretation of the diagnostic report.",
        "comments" : "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 (e.g. typical imaging report, histopathology)]. In all of these cases, the narrative goes in \"text\".",
        "requirements" : "Need to be able to provide a conclusion that is not lost among the basic result data.",
        "alias" : [
          "Report"
        ],
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "string"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBX"
          },
          {
            "identity" : "rim",
            "map" : "inboundRelationship[typeCode=\"SPRT\"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.codedDiagnosis",
        "path" : "DiagnosticReport.codedDiagnosis",
        "name" : "DiagnosticReport.codedDiagnosis",
        "short" : "Codes for the conclusion",
        "definition" : "Codes for the conclusion.",
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "CodeableConcept"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "binding" : {
          "strength" : "example",
          "description" : "Diagnoses codes provided as adjuncts to the report.",
          "valueSetReference" : {
            "reference" : "http://hl7.org/fhir/ValueSet/clinical-findings"
          }
        },
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBX"
          },
          {
            "identity" : "rim",
            "map" : "inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)"
          }
        ]
      },
      {
        "id" : "DiagnosticReport.presentedForm",
        "path" : "DiagnosticReport.presentedForm",
        "name" : "DiagnosticReport.presentedForm",
        "short" : "Entire report as issued",
        "definition" : "Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.",
        "comments" : "\"application/pdf\" is recommended as the most reliable and interoperable in this context.",
        "requirements" : "Gives Laboratory the ability to provide its own fully formatted report for clinical fidelity.",
        "min" : 0,
        "max" : "*",
        "type" : [
          {
            "code" : "Attachment"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "mapping" : [
          {
            "identity" : "v2",
            "map" : "OBX"
          },
          {
            "identity" : "rim",
            "map" : "text (type=ED)"
          }
        ]
      }
    ]
  },
  "differential" : {
    "element" : [
      {
        "id" : "DiagnosticReport",
        "path" : "DiagnosticReport",
        "name" : "DiagnosticReport",
        "short" : "onco-core-GenomicsReport",
        "definition" : "Genetic analysis summary report. The report may include one or more tests, with two distinct test types. The first type is a targeted mutation test, where a specific mutation on a specific gene is tested for. The result is either positive or negative for that mutation. The second type is a more general test for variants. This type of test returns the identity of variants found in a certain region of the genome.\n\nThe identity of non-genomic laboratory tests is typically represented by a LOINC code. However, many genetic tests and panels do not have LOINC codes, although some might have an identifier in NCBI Genetic Testing Registry (GTR), a central location for voluntary submission of genetic test information by providers. To identify the diagnostic report, the name of the report must be in the text sub-field of the code structure. If there is a coded identifier from GTR, LOINC, or other source, then it should be included into the the code sub-field of the code structure. If there is no suitable code, the code can be omitted.\n\nConformance note: To be conformant to US Core, the code attribute must be a LOINC code, if available. If there is no suitable code in LOINC, then a code from an alternative code system (such as GTR) can be used.\n\nImplementation note: The performer of the test (organization or practitioner) should be included in the FHIR profile as the performer.actor.\n\nConformance note: The category for this profile is set to GE (Genetics), a code from http://hl7.org/fhir/ValueSet/diagnostic-service-sections. This is contrary to the [Argonaut](http://www.fhir.org/guides/argonaut/r2/) and [US Core](http://hl7.org/fhir/us/core/STU3/index.html) specifications, which require the category 'LAB' in diagnostic reports containing laboratory results. This is assumed to be an oversight in the US Core and Argonaut specifications.",
        "min" : 0,
        "type" : [
          {
            "code" : "DiagnosticReport"
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.meta",
        "path" : "DiagnosticReport.meta",
        "name" : "DiagnosticReport.meta",
        "min" : 0,
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.meta.extension",
        "path" : "DiagnosticReport.meta.extension",
        "name" : "DiagnosticReport.meta.extension",
        "slicing" : {
          "id" : "2",
          "discriminator" : [
            "url"
          ],
          "ordered" : false,
          "rules" : "open"
        },
        "min" : 0,
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "sourcesystem",
        "path" : "DiagnosticReport.meta.extension",
        "name" : "sourcesystem",
        "definition" : "FHIR: This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.\nFHIM: Identifies the computer system that created the medical record. This optional field may also be used to indicate that the medical record was originally created by a different organization from the one that is currently storing or utilizing the record in that the assigning authority of the Id could be set to that originating organization. This property is optional, as some systems will assume that all records that it contains originated in that system, however it is anticipated that it will become increasingly commonplace for records from multiple systems and organizations will be comingled in order to provide a complete picture of the patient's health record.",
        "min" : 0,
        "max" : "1",
        "base" : {
          "path" : "DiagnosticReport.meta.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-SourceSystem-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.extension",
        "path" : "DiagnosticReport.extension",
        "name" : "DiagnosticReport.extension",
        "slicing" : {
          "id" : "1",
          "discriminator" : [
            "url"
          ],
          "ordered" : false,
          "rules" : "open"
        },
        "min" : 0,
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "resultsinterpreter",
        "path" : "DiagnosticReport.extension",
        "name" : "resultsinterpreter",
        "definition" : "The practitioner or organization that is responsible for the report's conclusions and interpretations.",
        "min" : 0,
        "max" : "1",
        "base" : {
          "path" : "DiagnosticReport.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-ResultsInterpreter-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "basedon",
        "path" : "DiagnosticReport.extension",
        "name" : "basedon",
        "definition" : "The proposal, order, or plan that is partly or wholly fulfilled by this item.",
        "min" : 0,
        "max" : "*",
        "base" : {
          "path" : "DiagnosticReport.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-BasedOn-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "specimentype",
        "path" : "DiagnosticReport.extension",
        "name" : "specimentype",
        "definition" : "The type of material the specimen contains or consists of.",
        "min" : 0,
        "max" : "1",
        "base" : {
          "path" : "DiagnosticReport.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-SpecimenType-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.extension-specimentype.valueCodeableConcept",
        "path" : "DiagnosticReport.extension.valueCodeableConcept",
        "name" : "DiagnosticReport.extension-specimentype.valueCodeableConcept",
        "min" : 0,
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false,
        "binding" : {
          "strength" : "extensible",
          "valueSetReference" : {
            "reference" : "http://mcodeinitiative.org/us/mcode/ValueSet/onco-core-GeneticSpecimenTypeVS"
          }
        }
      },
      {
        "id" : "regionstudied",
        "path" : "DiagnosticReport.extension",
        "name" : "regionstudied",
        "definition" : "A description of the coverage of the genome that was tested for variants.",
        "min" : 0,
        "max" : "*",
        "base" : {
          "path" : "DiagnosticReport.extension",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-RegionStudied-extension"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.category",
        "path" : "DiagnosticReport.category",
        "name" : "DiagnosticReport.category",
        "min" : 1,
        "max" : "1",
        "base" : {
          "path" : "DiagnosticReport.category",
          "min" : 0,
          "max" : "1"
        },
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.code",
        "path" : "DiagnosticReport.code",
        "name" : "DiagnosticReport.code",
        "min" : 0,
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false,
        "binding" : {
          "strength" : "extensible",
          "valueSetReference" : {
            "reference" : "http://mcodeinitiative.org/us/mcode/ValueSet/onco-core-GeneticTestVS"
          }
        }
      },
      {
        "id" : "DiagnosticReport.subject",
        "path" : "DiagnosticReport.subject",
        "name" : "DiagnosticReport.subject",
        "short" : "The subject of an observation",
        "definition" : "The subject of an observation.",
        "min" : 0,
        "base" : {
          "path" : "DiagnosticReport.subject",
          "min" : 1,
          "max" : "1"
        },
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Patient"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : false,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.effectivex",
        "path" : "DiagnosticReport.effective[x]",
        "name" : "DiagnosticReport.effectivex",
        "min" : 0,
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.performer",
        "path" : "DiagnosticReport.performer",
        "name" : "DiagnosticReport.performer",
        "min" : 0,
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "DiagnosticReport.result",
        "path" : "DiagnosticReport.result",
        "name" : "DiagnosticReport.result",
        "slicing" : {
          "id" : "3",
          "discriminator" : [
            "target.reference/@profile"
          ],
          "ordered" : false,
          "rules" : "open"
        },
        "min" : 0,
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Observation"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "onco-core-GeneticVariantFound",
        "path" : "DiagnosticReport.result",
        "name" : "onco-core-GeneticVariantFound",
        "short" : "GeneticVariantFound: Records an alteration in the most common DNA nucleotide sequence",
        "definition" : "Records an alteration in the most common DNA nucleotide sequence. The term variant can be used to describe an alteration that may be benign, pathogenic, or of unknown significance. The term variant is increasingly being used in place of the term mutation. When reporting 'Genetic Variant Found', at least one element out of the following must be reported: 'Variant Found Identifier', 'Variant Found HGVS Name', and 'Variant Found Description'.",
        "min" : 0,
        "max" : "*",
        "base" : {
          "path" : "DiagnosticReport.result",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-GeneticVariantFound"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false
      },
      {
        "id" : "onco-core-GeneticVariantTested",
        "path" : "DiagnosticReport.result",
        "name" : "onco-core-GeneticVariantTested",
        "short" : "GeneticVariantTested: A test for a specific mutation on a particular gene",
        "definition" : "A test for a specific mutation on a particular gene. This profile is used to record whether a single discrete variant tested is present or absent (denoted as positive or negative respectively).",
        "min" : 0,
        "max" : "*",
        "base" : {
          "path" : "DiagnosticReport.result",
          "min" : 0,
          "max" : "*"
        },
        "type" : [
          {
            "code" : "Reference",
            "profile" : [
              "http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-GeneticVariantTested"
            ]
          }
        ],
        "maxLength" : 0,
        "mustSupport" : true,
        "isModifier" : false,
        "isSummary" : false
      }
    ]
  }
}