PATIENT ADMINISTRTAION (PA) Workgroup Development Draft

4.21 Resource DiagnosticReport - Content

This resource maintained by the Orders and Observations Work Group

The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretation, and formatted representation of diagnostic reports.

4.21.1 Scope and Usage

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 conveyed in a variety of ways including a Document, RESTful API, or Messaging framework. Included within each of these, would be the DiagnosticReport resource itself.

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 - Cardiology, Gastroenterology etc.

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.

4.21.2 Background and Context

The DiagnosticReport resource has the following aspects:

  • status, issued, identifier, performer, serviceCategory: information about the diagnostic report itself
  • subject, diagnostic[x]: information about the subject of the report
  • request details: a reference to 0 or more DiagnosticOrder resources to allow the report to connect to clinical work flows
  • results: a reference to 0 or more Observation resources which provide a hierarchical tree of groups of results
  • specimen details: a reference to 0 or more Specimen resources on which the report is based
  • conclusion, codedDiagnosis: support for structured reporting
  • images, representation: image and media representations of the report and supporting images

4.21.2.1 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.

This resource is referenced by ClinicalImpression, Condition and Procedure

4.21.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. DiagnosticReport DomainResourceA Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
... name Σ1..1CodeableConceptName/Code for this diagnostic report
LOINC Diagnostic Report Codes (Required)
... status ?! Σ1..1coderegistered | partial | final | corrected | appended | cancelled | entered-in-error
DiagnosticReportStatus (Required)
... issued Σ1..1instantDateTime this version was released
... subject Σ1..1Patient | Group | Device | LocationThe subject of the report, usually, but not always, the patient
... performer Σ1..1Practitioner | OrganizationResponsible Diagnostic Service
... encounter Σ0..1EncounterHealth care event when test ordered
... identifier Σ0..*IdentifierId for external references to this report
... requestDetail 0..*DiagnosticOrderWhat was requested
... serviceCategory Σ0..1CodeableConceptBiochemistry, Hematology etc.
Diagnostic Service Section Codes (Example)
... effective[x] ΣClinically Relevant time/time-period for report
.... effectiveDateTime1..1dateTime
.... effectivePeriod1..1Period
... specimen 0..*SpecimenSpecimens this report is based on
... result 0..*ObservationObservations - simple, or complex nested groups
... imagingStudy 0..*ImagingStudyReference to full details of imaging associated with the diagnostic report
... image Σ0..*ElementKey images associated with this report
.... comment 0..1stringComment about the image (e.g. explanation)
.... link Σ1..1MediaReference to the image source
... conclusion 0..1stringClinical Interpretation of test results
... codedDiagnosis 0..*CodeableConceptCodes for the conclusion
SNOMED CT Clinical Findings (Example)
... presentedForm 0..*AttachmentEntire Report as issued

UML Diagram

DiagnosticReport (DomainResource)A code or name that describes this diagnostic reportname : CodeableConcept 1..1 « Codes that describe Diagnostic ReportsLOINC Diagnostic Report Codes »The status of the diagnostic report as a whole (this element modifies the meaning of other elements)status : code 1..1 « The status of the diagnostic report as a wholeDiagnosticReportStatus »The date and time that this version of the report was released from the source diagnostic serviceissued : instant 1..1The 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 sourcessubject : Reference(Patient|Group|Device|Location) 1..1The diagnostic service that is responsible for issuing the reportperformer : Reference(Practitioner|Organization) 1..1The link to the health care event (encounter) when the order was madeencounter : Reference(Encounter) 0..1The local ID assigned to the report by the order filler, usually by the Information System of the diagnostic service provideridentifier : Identifier 0..*Details concerning a test requestedrequestDetail : Reference(DiagnosticOrder) 0..*The section of the diagnostic service that performs the examination e.g. biochemistry, hematology, MRIserviceCategory : CodeableConcept 0..1 « (Codes for diagnostic service sectionsDiagnostic Service Section Codes) »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 itselfeffective[x] : dateTime|Period 1..1Details about the specimens on which this diagnostic report is basedspecimen : Reference(Specimen) 0..*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")result : Reference(Observation) 0..*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 imagesimagingStudy : Reference(ImagingStudy) 0..*Concise and clinically contextualized narrative interpretation of the diagnostic reportconclusion : string 0..1Codes for the conclusioncodedDiagnosis : CodeableConcept 0..* « (Diagnoses codes provided as adjuncts to the reportSNOMED CT Clinical Findings) »Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalentpresentedForm : Attachment 0..*ImageA 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 featurescomment : string 0..1Reference to the image sourcelink : Reference(Media) 1..1A 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)image0..*

XML Template

<DiagnosticReport xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <name><!-- 1..1 CodeableConcept Name/Code for this diagnostic report --></name>
 <status value="[code]"/><!-- 1..1 registered | partial | final | corrected | appended | cancelled | entered-in-error -->
 <issued value="[instant]"/><!-- 1..1 DateTime this version was released -->
 <subject><!-- 1..1 Reference(Patient|Group|Device|Location) The subject of the report, usually, but not always, the patient --></subject>
 <performer><!-- 1..1 Reference(Practitioner|Organization) Responsible Diagnostic Service --></performer>
 <encounter><!-- 0..1 Reference(Encounter) Health care event when test ordered --></encounter>
 <identifier><!-- 0..* Identifier Id for external references to this report --></identifier>
 <requestDetail><!-- 0..* Reference(DiagnosticOrder) What was requested --></requestDetail>
 <serviceCategory><!-- 0..1 CodeableConcept Biochemistry, Hematology etc. --></serviceCategory>
 <effective[x]><!-- 1..1 dateTime|Period Clinically Relevant time/time-period for report --></effective[x]>
 <specimen><!-- 0..* Reference(Specimen) Specimens this report is based on --></specimen>
 <result><!-- 0..* Reference(Observation) Observations - simple, or complex nested groups --></result>
 <imagingStudy><!-- 0..* Reference(ImagingStudy) Reference to full details of imaging associated with the diagnostic report --></imagingStudy>
 <image>  <!-- 0..* Key images associated with this report -->
  <comment value="[string]"/><!-- 0..1 Comment about the image (e.g. explanation) -->
  <link><!-- 1..1 Reference(Media) Reference to the image source --></link>
 </image>
 <conclusion value="[string]"/><!-- 0..1 Clinical Interpretation of test results -->
 <codedDiagnosis><!-- 0..* CodeableConcept Codes for the conclusion --></codedDiagnosis>
 <presentedForm><!-- 0..* Attachment Entire Report as issued --></presentedForm>
</DiagnosticReport>

JSON Template

{doco
  "resourceType" : "DiagnosticReport",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "name" : { CodeableConcept }, // R!  Name/Code for this diagnostic report
  "status" : "<code>", // R!  registered | partial | final | corrected | appended | cancelled | entered-in-error
  "issued" : "<instant>", // R!  DateTime this version was released
  "subject" : { Reference(Patient|Group|Device|Location) }, // R!  The subject of the report, usually, but not always, the patient
  "performer" : { Reference(Practitioner|Organization) }, // R!  Responsible Diagnostic Service
  "encounter" : { Reference(Encounter) }, // Health care event when test ordered
  "identifier" : [{ Identifier }], // Id for external references to this report
  "requestDetail" : [{ Reference(DiagnosticOrder) }], // What was requested
  "serviceCategory" : { CodeableConcept }, // Biochemistry, Hematology etc.
  // effective[x]: Clinically Relevant time/time-period for report. One of these 2:
  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "specimen" : [{ Reference(Specimen) }], // Specimens this report is based on
  "result" : [{ Reference(Observation) }], // Observations - simple, or complex nested groups
  "imagingStudy" : [{ Reference(ImagingStudy) }], // Reference to full details of imaging associated with the diagnostic report
  "image" : [{ // Key images associated with this report
    "comment" : "<string>", // Comment about the image (e.g. explanation)
    "link" : { Reference(Media) } // R!  Reference to the image source
  }],
  "conclusion" : "<string>", // Clinical Interpretation of test results
  "codedDiagnosis" : [{ CodeableConcept }], // Codes for the conclusion
  "presentedForm" : [{ Attachment }] // Entire Report as issued
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. DiagnosticReport DomainResourceA Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
... name Σ1..1CodeableConceptName/Code for this diagnostic report
LOINC Diagnostic Report Codes (Required)
... status ?! Σ1..1coderegistered | partial | final | corrected | appended | cancelled | entered-in-error
DiagnosticReportStatus (Required)
... issued Σ1..1instantDateTime this version was released
... subject Σ1..1Patient | Group | Device | LocationThe subject of the report, usually, but not always, the patient
... performer Σ1..1Practitioner | OrganizationResponsible Diagnostic Service
... encounter Σ0..1EncounterHealth care event when test ordered
... identifier Σ0..*IdentifierId for external references to this report
... requestDetail 0..*DiagnosticOrderWhat was requested
... serviceCategory Σ0..1CodeableConceptBiochemistry, Hematology etc.
Diagnostic Service Section Codes (Example)
... effective[x] ΣClinically Relevant time/time-period for report
.... effectiveDateTime1..1dateTime
.... effectivePeriod1..1Period
... specimen 0..*SpecimenSpecimens this report is based on
... result 0..*ObservationObservations - simple, or complex nested groups
... imagingStudy 0..*ImagingStudyReference to full details of imaging associated with the diagnostic report
... image Σ0..*ElementKey images associated with this report
.... comment 0..1stringComment about the image (e.g. explanation)
.... link Σ1..1MediaReference to the image source
... conclusion 0..1stringClinical Interpretation of test results
... codedDiagnosis 0..*CodeableConceptCodes for the conclusion
SNOMED CT Clinical Findings (Example)
... presentedForm 0..*AttachmentEntire Report as issued

UML Diagram

DiagnosticReport (DomainResource)A code or name that describes this diagnostic reportname : CodeableConcept 1..1 « Codes that describe Diagnostic ReportsLOINC Diagnostic Report Codes »The status of the diagnostic report as a whole (this element modifies the meaning of other elements)status : code 1..1 « The status of the diagnostic report as a wholeDiagnosticReportStatus »The date and time that this version of the report was released from the source diagnostic serviceissued : instant 1..1The 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 sourcessubject : Reference(Patient|Group|Device|Location) 1..1The diagnostic service that is responsible for issuing the reportperformer : Reference(Practitioner|Organization) 1..1The link to the health care event (encounter) when the order was madeencounter : Reference(Encounter) 0..1The local ID assigned to the report by the order filler, usually by the Information System of the diagnostic service provideridentifier : Identifier 0..*Details concerning a test requestedrequestDetail : Reference(DiagnosticOrder) 0..*The section of the diagnostic service that performs the examination e.g. biochemistry, hematology, MRIserviceCategory : CodeableConcept 0..1 « (Codes for diagnostic service sectionsDiagnostic Service Section Codes) »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 itselfeffective[x] : dateTime|Period 1..1Details about the specimens on which this diagnostic report is basedspecimen : Reference(Specimen) 0..*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")result : Reference(Observation) 0..*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 imagesimagingStudy : Reference(ImagingStudy) 0..*Concise and clinically contextualized narrative interpretation of the diagnostic reportconclusion : string 0..1Codes for the conclusioncodedDiagnosis : CodeableConcept 0..* « (Diagnoses codes provided as adjuncts to the reportSNOMED CT Clinical Findings) »Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalentpresentedForm : Attachment 0..*ImageA 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 featurescomment : string 0..1Reference to the image sourcelink : Reference(Media) 1..1A 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)image0..*

XML Template

<DiagnosticReport xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <name><!-- 1..1 CodeableConcept Name/Code for this diagnostic report --></name>
 <status value="[code]"/><!-- 1..1 registered | partial | final | corrected | appended | cancelled | entered-in-error -->
 <issued value="[instant]"/><!-- 1..1 DateTime this version was released -->
 <subject><!-- 1..1 Reference(Patient|Group|Device|Location) The subject of the report, usually, but not always, the patient --></subject>
 <performer><!-- 1..1 Reference(Practitioner|Organization) Responsible Diagnostic Service --></performer>
 <encounter><!-- 0..1 Reference(Encounter) Health care event when test ordered --></encounter>
 <identifier><!-- 0..* Identifier Id for external references to this report --></identifier>
 <requestDetail><!-- 0..* Reference(DiagnosticOrder) What was requested --></requestDetail>
 <serviceCategory><!-- 0..1 CodeableConcept Biochemistry, Hematology etc. --></serviceCategory>
 <effective[x]><!-- 1..1 dateTime|Period Clinically Relevant time/time-period for report --></effective[x]>
 <specimen><!-- 0..* Reference(Specimen) Specimens this report is based on --></specimen>
 <result><!-- 0..* Reference(Observation) Observations - simple, or complex nested groups --></result>
 <imagingStudy><!-- 0..* Reference(ImagingStudy) Reference to full details of imaging associated with the diagnostic report --></imagingStudy>
 <image>  <!-- 0..* Key images associated with this report -->
  <comment value="[string]"/><!-- 0..1 Comment about the image (e.g. explanation) -->
  <link><!-- 1..1 Reference(Media) Reference to the image source --></link>
 </image>
 <conclusion value="[string]"/><!-- 0..1 Clinical Interpretation of test results -->
 <codedDiagnosis><!-- 0..* CodeableConcept Codes for the conclusion --></codedDiagnosis>
 <presentedForm><!-- 0..* Attachment Entire Report as issued --></presentedForm>
</DiagnosticReport>

JSON Template

{doco
  "resourceType" : "DiagnosticReport",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "name" : { CodeableConcept }, // R!  Name/Code for this diagnostic report
  "status" : "<code>", // R!  registered | partial | final | corrected | appended | cancelled | entered-in-error
  "issued" : "<instant>", // R!  DateTime this version was released
  "subject" : { Reference(Patient|Group|Device|Location) }, // R!  The subject of the report, usually, but not always, the patient
  "performer" : { Reference(Practitioner|Organization) }, // R!  Responsible Diagnostic Service
  "encounter" : { Reference(Encounter) }, // Health care event when test ordered
  "identifier" : [{ Identifier }], // Id for external references to this report
  "requestDetail" : [{ Reference(DiagnosticOrder) }], // What was requested
  "serviceCategory" : { CodeableConcept }, // Biochemistry, Hematology etc.
  // effective[x]: Clinically Relevant time/time-period for report. One of these 2:
  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "specimen" : [{ Reference(Specimen) }], // Specimens this report is based on
  "result" : [{ Reference(Observation) }], // Observations - simple, or complex nested groups
  "imagingStudy" : [{ Reference(ImagingStudy) }], // Reference to full details of imaging associated with the diagnostic report
  "image" : [{ // Key images associated with this report
    "comment" : "<string>", // Comment about the image (e.g. explanation)
    "link" : { Reference(Media) } // R!  Reference to the image source
  }],
  "conclusion" : "<string>", // Clinical Interpretation of test results
  "codedDiagnosis" : [{ CodeableConcept }], // Codes for the conclusion
  "presentedForm" : [{ Attachment }] // Entire Report as issued
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON)

4.21.3.1 Terminology Bindings

PathDefinitionTypeReference
DiagnosticReport.name Codes that describe Diagnostic ReportsRequiredhttp://hl7.org/fhir/vs/report-names
DiagnosticReport.status The status of the diagnostic report as a wholeRequiredhttp://hl7.org/fhir/diagnostic-report-status
DiagnosticReport.serviceCategory Codes for diagnostic service sectionsExamplehttp://hl7.org/fhir/vs/diagnostic-service-sections
DiagnosticReport.codedDiagnosis Diagnoses codes provided as adjuncts to the reportExamplehttp://hl7.org/fhir/vs/clinical-findings

Examples of nested report groups: the antibody hepatitis order panel code for a group of hepatitis antibody related tests, or the organism code for a group of antibiotic isolate/sensitivities, or a set of perinatal measurements on a single fetus.

4.21.4 Notes:

  • If the diagnostic procedure was performed on the patient directly, diagnostic[x] is a dateTime, the time it was performed. If specimens were taken, the diagnostically relevant time can be derived from the specimen collection times, but since detailed specimen information is not always available, and nor is the diagnostically relevant time always exactly the specimen collection time (e.g. complex timed tests), the reports SHALL always include a diagnostic[x] element. Note that v2 messages often carry a diagnostically relevant time without carrying any specimen information.
  • A report always contains the name of the report itself. The report can also contain a set of observations, which can themselves be simple observations (e.g. atomic results) or can themselves be groups/panels of other observations. The Observation.name is a code that 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.
  • There is rarely a need for more than two levels of nesting in the Observation tree. One known use is for organism sensitivities - see this example.
  • 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 amended. If a report is retracted, all the results should be retracted by replacing every result value with the Concept "withdrawn" in the internal terminology "Special values" (url = "http://hl7.org/fhir/special-values"), and setting the conclusion (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.

4.21.4.1 Report Content

This resource provides for 3 different ways of presenting the Diagnostic Report:

  • As atomic data items: a hierarchical set of nested references to Observation resources, one or more images, and possibly with a conclusion and/or one or more coded diagnoses
  • As narrative: an XHTML presentation in the standard resource narrative
  • As a "presented form": A rich text representation of the report - typically a PDF

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. Typically this is 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. As a consequence the patterns described above are only examples of how a diagnostic report can be used.

4.21.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
datedateThe clinically relevant time of the reportDiagnosticReport.effective[x]
diagnosistokenA coded diagnosis on the reportDiagnosticReport.codedDiagnosis
encounterreferenceThe Encounter when the order was madeDiagnosticReport.encounter
(Encounter)
identifiertokenAn identifier for the reportDiagnosticReport.identifier
imagereferenceReference to the image sourceDiagnosticReport.image.link
(Media)
issueddateWhen the report was issuedDiagnosticReport.issued
nametokenThe name of the report (e.g. the code for the report as a whole, as opposed to codes for the atomic results, which are the names on the observation resource referred to from the result)DiagnosticReport.name
patientreferenceThe subject of the report if a patientDiagnosticReport.subject
(Patient)
performerreferenceWho was the source of the report (organization)DiagnosticReport.performer
(Practitioner, Organization)
requestreferenceWhat was requestedDiagnosticReport.requestDetail
(DiagnosticOrder)
resultreferenceLink to an atomic result (observation resource)DiagnosticReport.result
(Observation)
servicetokenWhich diagnostic discipline/department created the reportDiagnosticReport.serviceCategory
specimenreferenceThe specimen detailsDiagnosticReport.specimen
(Specimen)
statustokenThe status of the reportDiagnosticReport.status
subjectreferenceThe subject of the reportDiagnosticReport.subject
(Group, Device, Patient, Location)