DiagnosticReport — Examination report

The FHIR container that bundles results, conclusion and technical metadata of a diagnostic examination: laboratory, pathology, genomics, imaging.

Purpose of the resource

DiagnosticReport aggregates the results of a diagnostic examination, their interpretation and the metadata of the act. It is the "report" entity from the reader's perspective — referring physician or patient — as opposed to the individual Observations that carry each unit measurement.

Concretely: a complete blood count (CBC) generates one DiagnosticReport that references five to twenty Observations (WBC, RBC, hemoglobin, hematocrit, platelets, differential). An abdominal CT generates a DiagnosticReport that points to the DICOM images (via ImagingStudy) and carries the radiology report as structured text (presentedForm or conclusion).

Key fields

Event pattern (status)

DiagnosticReport follows the Event pattern of the FHIR workflow. State machine around status:

• registered — case opened, examination not started.
• partial — some results available, others pending.
• preliminary — preliminary results (urgent, not validated).
• final — validated, signed.
• amended — corrected after final with clinical information added.
• corrected — erroneous result in the final version, now fixed.
• cancelled — examination cancelled.
• entered-in-error — entered by mistake.

JSON example

Final CBC report for Patient "example", in response to ServiceRequest/lab-cbc:

{
  "resourceType": "DiagnosticReport",
  "id": "cbc-result",
  "basedOn": [{ "reference": "ServiceRequest/lab-cbc" }],
  "status": "final",
  "category": [{
    "coding": [{
      "system": "http://terminology.hl7.org/CodeSystem/v2-0074",
      "code": "HM",
      "display": "Hematology"
    }]
  }],
  "code": {
    "coding": [{
      "system": "http://loinc.org",
      "code": "58410-2",
      "display": "Complete blood count panel"
    }]
  },
  "subject": { "reference": "Patient/example" },
  "encounter": { "reference": "Encounter/example" },
  "effectiveDateTime": "2026-05-14T08:30:00+01:00",
  "issued": "2026-05-14T10:45:00+01:00",
  "performer": [{ "reference": "Organization/lab-acme" }],
  "specimen": [{ "reference": "Specimen/blood-001" }],
  "result": [
    { "reference": "Observation/wbc" },
    { "reference": "Observation/rbc" },
    { "reference": "Observation/hgb" },
    { "reference": "Observation/hct" },
    { "reference": "Observation/plt" }
  ],
  "conclusion": "Counts within normal range. No significant abnormality."
}

• basedOn points to the originating ServiceRequest — the placer order.
• status=final indicates a validated report, ready to be billed and archived.
• category Hematology (HM) per v2-0074.
• effectiveDateTime = sampling date; issued = report sign-off date — the gap documents lab latency.
• result lists the 5 atomic Observations (WBC, RBC, HGB, HCT, PLT).
• conclusion carries the synthetic interpretation in plain text.

REST API

• GET /DiagnosticReport?subject=Patient/example&status=final — finalised reports for a patient.
• GET /DiagnosticReport?based-on=ServiceRequest/lab-cbc — report matching a specific request.
• POST /DiagnosticReport — create a new report (typically by the LIS).
• GET /DiagnosticReport?_include=DiagnosticReport:result&_include=DiagnosticReport:specimen — include Observations and Specimen.
• GET /DiagnosticReport?code=58410-2&date=ge2026-01-01 — search by LOINC code + date.
• GET /DiagnosticReport/cbc-result/$document — composite operation returning a document Bundle containing the report + its Observations.

National profiles

Common pitfalls

• Confusing effective[x] with issued — effective is the clinical event date (sampling, MRI); issued is the administrative signature/release date. Mixing them distorts diagnostic delay metrics.
• No link to specimen — without a referenced Specimen, the source sample cannot be traced, complicating retrospective investigation (wrong tube, degraded sample).
• Orphan Observation — each result must point to an existing Observation. Referencing a deleted or non-existent Observation invalidates the report on strict servers.
• Status regression — moving from final back to preliminary is forbidden. To fix a finalised report, use amended or corrected.
• Imaging without study — a CT report must point to an ImagingStudy carrying the DICOM reference (Study UID, Series, Instances); without it, the PACS viewer cannot wire it up.

Related resources

• ServiceRequest — request that triggered the report.
• Observation — atomic results making up the report.
• Specimen — analysed sample.
• ImagingStudy — associated DICOM study.
• GenomicStudy — genomic study (R5).
• Media — image attachments (ultrasounds, photos).
• HL7 v2 ORU^R01 — legacy equivalent.