FHIR R4 DocumentReference · US Core DocumentReference

This resource carries the patient’s clinical notes in the Patient Everything and Patient Summary bundles. It is not produced for Bulk Medication History.

Stable ID

The id is derived from the patient, the note date, the note type code, and the note text. Because the note text is part of the id, any edit to the note body produces a new DocumentReference rather than updating the existing one.

The encounter link described below is not part of the id. The same note therefore carries the same id in both bundles, even though only the Patient Summary bundle links it to an encounter.

Fields

Field	Cardinality	Notes
`meta.profile`	1..1	Always set to the US Core DocumentReference profile URL.
`status`	1..1	Always `current`.
`subject`	1..1	Reference to the Patient.
`type`	1..1	A single coding for the kind of note, from the source note type.
`category`	1..1	Always `clinical-note` from the US Core DocumentReference Category system.
`date`	0..1	The note date. The source carries a date with no time, so the value is published at midnight UTC (`T00:00:00Z`) — treat it as a date, not a precise timestamp.
`author`	0..1	Contained PractitionerRole for the note’s provider. Omitted when no provider is known.
`content.attachment.data`	1..1	The note body, base64-encoded.
`content.attachment.contentType`	1..1	Always `text/plain` — notes are published as plain text, never as HTML, RTF, or PDF.
`content.attachment.language`	1..1	Always `en-US`.
`context.encounter`	0..1	Patient Summary only. References the Encounter for the visit the note was written for. Never set in the Patient Everything bundle, where notes are not tied to a visit.

identifier, docStatus, authenticator, custodian, description, and context.period are not populated.

Note sourcing

Bundle	Where notes come from
Patient Everything	All notes on the patient’s record, independent of any visit. `context.encounter` is not set.
Patient Summary	Only notes attached to a visit that was selected for the summary — including notes on follow-up visits. Each is linked to its visit via `context.encounter`.

A note present in the Patient Everything bundle may be absent from the Patient Summary bundle if its visit was not selected for the summary.

Welcome

Product

FHIR

Implementation

APIs

DocumentReference

Stable ID

Fields

Note sourcing

​Stable ID

​Fields

​Note sourcing

Stable ID

Fields

Note sourcing