Tiro.health Implementation Guide
0.1.0 - ci-build

Tiro.health Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Extension: NarrativeAlternativeFormat - Detailed Descriptions

Draft as of 2026-04-30

Definitions for the narrative-alternative-format extension.

Guidance on how to interpret the contents of this table can be foundhere

0. Extension
Definition

Provides the narrative content in an alternative format such as RTF or plain text.


Optional Extension Element - found in all resources.

ShortNarrative Alternative FormatOptional Extensions Element
Control0..*
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
2. Extension.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
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.

Control0..0*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Extension.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    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 SHALL be a URI for the Structure Definition defining the extension.

    Control1..1
    Typeuri
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    Fixed Valuehttp://fhir.tiro.health/StructureDefinition/narrative-alternative-format
    6. Extension.value[x]
    Definition

    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

    ShortValue of extension
    Control10..1
    This element is affected by the following invariants: ext-1
    TypeAttachment, date, Meta, Address, integer, Count, DataRequirement, Dosage, uuid, Identifier, RatioRange, Coding, SampledData, id, positiveInt, Distance, Availability, integer64, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ExtendedContactDetail, CodeableConcept, ParameterDefinition, dateTime, code, string, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, CodeableReference, Signature, unsignedInt, time
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. Extension.value[x].contentType
    Definition

    Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

    ShortMime type of the content, with charset etc.
    Control10..1
    This element is affected by the following invariants: att-1
    BindingThe codes SHALL be taken from Narrative Alternative Format MIME Typeshttp://hl7.org/fhir/ValueSet/mimetypes|5.0.0
    (required to http://fhir.tiro.health/ValueSet/narrative-alternative-format-mime-types)
    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Processors of the data need to be able to know how to interpret the data.

    ExampleGeneral: text/plain; charset=UTF-8, image/png
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. Extension.value[x].data
    Definition

    The actual data of the attachment - a sequence of bytes, base64 encoded.

    ShortData inline, base64ed
    Comments

    The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

    Control10..1
    This element is affected by the following invariants: att-1
    Typebase64Binary
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Requirements

    The data needs to able to be transmitted inline.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

    Guidance on how to interpret the contents of this table can be foundhere

    0. Extension
    Definition

    Provides the narrative content in an alternative format such as RTF or plain text.

    ShortNarrative Alternative Format
    2. Extension.extension
    Control0..0
    4. Extension.url
    Fixed Valuehttp://fhir.tiro.health/StructureDefinition/narrative-alternative-format
    6. Extension.value[x]
    Control1..?
    TypeAttachment, date, Meta, Address, integer, Count, DataRequirement, Dosage, uuid, Identifier, RatioRange, Coding, SampledData, id, positiveInt, Distance, Availability, integer64, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ExtendedContactDetail, CodeableConcept, ParameterDefinition, dateTime, code, string, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, CodeableReference, Signature, unsignedInt, time
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    8. Extension.value[x].contentType
    Control1..?
    BindingThe codes SHALL be taken from Narrative Alternative Format MIME Types
    (required to http://fhir.tiro.health/ValueSet/narrative-alternative-format-mime-types)
    10. Extension.value[x].data
    Control1..?

    Guidance on how to interpret the contents of this table can be foundhere

    0. Extension
    Definition

    Provides the narrative content in an alternative format such as RTF or plain text.

    ShortNarrative Alternative Format
    Control0..*
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    2. Extension.id
    Definition

    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

    ShortUnique id for inter-element referencing
    Control0..1
    This element is affected by the following invariants: ele-1
    Typeid
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    4. Extension.extension
    Definition

    An Extension

    ShortExtension
    Control0..0
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on Extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 6. Extension.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      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 SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://fhir.tiro.health/StructureDefinition/narrative-alternative-format
      8. Extension.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control1..1
      This element is affected by the following invariants: ext-1
      TypeAttachment
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. Extension.value[x].id
      Definition

      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      ShortUnique id for inter-element referencing
      Control0..1
      This element is affected by the following invariants: ele-1
      Typeid
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      12. Extension.value[x].extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional content defined by implementations
      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.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 14. Extension.value[x].contentType
        Definition

        Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

        ShortMime type of the content, with charset etc.
        Control1..1
        This element is affected by the following invariants: att-1
        BindingThe codes SHALL be taken from Narrative Alternative Format MIME Types
        (required to http://fhir.tiro.health/ValueSet/narrative-alternative-format-mime-types)
        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Processors of the data need to be able to know how to interpret the data.

        ExampleGeneral: text/plain; charset=UTF-8, image/png
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Extension.value[x].language
        Definition

        The human language of the content. The value can be any valid value according to BCP 47.

        ShortHuman language of the content (BCP-47)
        Control0..1
        BindingThe codes SHALL be taken from AllLanguages
        (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0)

        IETF language tag for a human language.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Users need to be able to choose between the languages in a set of attachments.

        ExampleGeneral: en-AU
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. Extension.value[x].data
        Definition

        The actual data of the attachment - a sequence of bytes, base64 encoded.

        ShortData inline, base64ed
        Comments

        The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

        Control1..1
        This element is affected by the following invariants: att-1
        Typebase64Binary
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        The data needs to able to be transmitted inline.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. Extension.value[x].url
        Definition

        A location where the data can be accessed.

        ShortUri where the data can be found
        Comments

        If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.

        Control0..1
        Typeurl
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        The data needs to be transmitted by reference.

        ExampleGeneral: http://www.acme.com/logo-small.png
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Extension.value[x].size
        Definition

        The number of bytes of data that make up this attachment (before base64 encoding, if that is done).

        ShortNumber of bytes of content (if url provided)
        Comments

        The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.

        Control0..1
        Typeinteger64
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. Extension.value[x].hash
        Definition

        The calculated hash of the data using SHA-1. Represented using base64.

        ShortHash of the data (sha-1, base64ed)
        Comments

        The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see Provenance.signature for mechanism to protect a resource with a digital signature.

        Control0..1
        Typebase64Binary
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. Extension.value[x].title
        Definition

        A label or set of text to display in place of the data.

        ShortLabel to display in place of the data
        Comments

        May sometimes be derived from the source filename.

        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

        ExampleGeneral: Official Corporate Logo
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. Extension.value[x].creation
        Definition

        The date that the attachment was first created.

        ShortDate attachment was first created
        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        This is often tracked as an integrity issue for use of the attachment.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Extension.value[x].height
        Definition

        Height of the image in pixels (photo/video).

        ShortHeight of the image in pixels (photo/video)
        Control0..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. Extension.value[x].width
        Definition

        Width of the image in pixels (photo/video).

        ShortWidth of the image in pixels (photo/video)
        Control0..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. Extension.value[x].frames
        Definition

        The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gif. If there is more than one frame, this SHALL have a value in order to alert interface software that a multi-frame capable rendering widget is required.

        ShortNumber of frames if > 1 (photo)
        Comments

        if the number of frames is not supplied, the value may be unknown. Applications should not assume that there is only one frame unless it is explicitly stated.

        Control0..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Extension.value[x].duration
        Definition

        The duration of the recording in seconds - for audio and video.

        ShortLength in seconds (audio / video)
        Comments

        The duration might differ from occurrencePeriod if recording was paused.

        Control0..1
        Typedecimal
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Extension.value[x].pages
        Definition

        The number of pages when printed.

        ShortNumber of printed pages
        Control0..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))